FURP.ORG / PUBLIC DATA EXPLORER

ASCENSION WISCONSIN INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ASCENSION WISCONSIN INC (EIN 39-1834639)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201311359349307896
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-15T18:25:47-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1555 E WELLS ST SUITE 1400AddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391834639EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA ST MARY'S INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone4143262230Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14425 NORTH PORT WASHINGTON ROAD NOAddressLine1
Address Line2301AddressLine2
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARK R TAYLORName
TitlePRESIDENT / CEOTitle
Phone4143262230Phone
Date Signed2013-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
PTINP00966076PTIN
Phone4142713000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARK R TAYLORNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14425 NORTH PORT WASHINGTON ROAD NOAddressLine1
Address Line2301AddressLine2
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Gross Receipts195834084GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteCOLUMBIA-STMARYS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2001YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionHEALTH CARE SYSTEM DEDICATED TO MAKING A POSITIVE DIFFERENCE IN INDIVIDUALS AND OUR COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees507TotalNbrEmployees
Total Nbr Volunteers15TotalNbrVolunteers
Total Gross UBI29000TotalGrossUBI
Net Unrelated Business Txbl Income1417NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year376371ContributionsGrantsPriorYear
Contributions Grants Current Year439143ContributionsGrantsCurrentYear
Program Service Revenue Prior Year119610361ProgramServiceRevenuePriorYear
Program Service Revenue CY112151825ProgramServiceRevenueCY
Investment Income Prior Year3320818InvestmentIncomePriorYear
Investment Income Current Year3500195InvestmentIncomeCurrentYear
Other Revenue Prior Year40555376OtherRevenuePriorYear
Other Revenue Current Year79742921OtherRevenueCurrentYear
Total Revenue Prior Year163862926TotalRevenuePriorYear
Total Revenue Current Year195834084TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year206484GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY436410GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year42683203SalariesEtcPriorYear
Salaries Etc Current Year34658787SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year104498673OtherExpensePriorYear
Other Expenses Current Year121762418OtherExpensesCurrentYear
Total Expenses Prior Year147388360TotalExpensesPriorYear
Total Expenses Current Year156857615TotalExpensesCurrentYear
Revenues Less Expenses Prior Year16474566RevenuesLessExpensesPriorYear
Revenues Less Expenses CY38976469RevenuesLessExpensesCY
Total Assets BOY276339021TotalAssetsBOY
Total Assets EOY285378938TotalAssetsEOY
Total Liabilities BOY217760006TotalLiabilitiesBOY
Total Liabilities EOY220962152TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY58579015NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY64416786NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCOLUMBIA ST. MARY'S, INC. ("CSM") IS A HEALTH CARE PROVIDER FOUNDED IN RESPONSE TO IDENTIFIED COMMUNITY NEEDS, WHICH IS SPONSORED BY ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM, AND COLUMBIA HEALTH SYSTEM, A NON-SECTARIAN COMMUNITY HEALTH SYSTEM. CSM EXISTS TO MAKE A POSITIVE DIFFERENCE IN THE HEALTH STATUS AND LIVES OF INDIVIDUALS AND OUR COMMUNITY, WITH SPECIAL CONCERN FOR THOSE WHO ARE VULNERABLE. CSM AND ITS AFFILIATES ARE COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE, VALUES-DRIVEN PROGRAMS AND SERVICES WITH EQUAL ATTENTION TO THE PHYSICIAL, SPIRITUAL, AND EMOTIONAL DIMENSIONS OF HEALTH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense130128940Expense
Grants436310Grants
Revenue191865750Revenue
DescriptionCSM, INC EXISTS AS THE PARENT CORPORATION IN THE CSM SYSTEM, WHICH IS COMPRISED OF THREE HOSPITALS, (COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE INC, COLUMBIA ST. MARY'S HOSPITAL OZAUKEE INC, AND SACRED HEART REHABILITATION INSTITUTE INC.), 61 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, SETON CHILDREN'S SCHOOL (CLOSED IN JUNE 2012), A PARTNERSHIP WITH THE ORTHOPAEDIC HOSPITAL OF WISCONSIN, A PARTNERSHIP WITH THE SLEEP WELLNESS INSTITUTE, AND FOUR URGENT CARE CENTERS. DURING FISCAL 2012, CSM'S HEALTH SYSTEM PROVIDED CARE TO 389,817 PATIENTS. THE ESTIMATED UNREIMBURSED COST OF SERVICES PROVIDED TO THE ELDERLY, UNINSURED AND UNDERINSURED TOTALED $144,086,307. REFER TO THE COMMUNITY BENEFIT INFORMATION IN SCHEDULE H FOR DISCUSSION OF HOW CSM MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE.Description
Total Program Service Expense130128940TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096206NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees507NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RHONDA ANDERSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4143262230TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14425 N PORT WASHINGTON ROADAddressLine1
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (33 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
GEORGE H HOFF
VICE CHAIR1.00X000
KEVIN GONIU MD
BOARD MEMBER AND CSM PHYSI5.00X0591105121065
MARK R TAYLOR
PRESIDENT/CEO START 02/111.00X813840043715X
MASON G ROSS
BOARD MEMBER1.00X000
MICHAEL GREBE
BOARD MEMBER1.00X000
R BRUCE MCDONALD
CHAIR1.00X000
RANDALL PERRY
SECRETARY/TREASURER1.00X000
ROBERT LYON MD
BOARD MEMBER1.00X000
ROBERT J VENABLE
BOARD MEMBER1.00X000
SISTER THERESA SULLIVAN DC
BOARD MEMBER1.00X000
TINA CHANG
BOARD MEMBER1.00X000
CHRISTINE NUERNBERG
BOARD MEMBER1.00X000
PATRICIA J DOLHUN MD
BOARD MEMBER1.00X000
MICHELLE S NETTLES
BOARD MEMBER1.00X000
LEO P BRIDEAU
PRESIDENT/CEO END 02/111.001009984037627X
RHONDA ANDERSON
PRESIDENT / CFO5.00411076061167X
AMY MARQUARDT
VP LEGAL SERVICES END 05/115.0038796504622X
CHERYL HILL
VP/CHRO5.00286781082120X
DAVID H SHAPIRO MD
CHIEF MEDICAL OFFICER5.00330924069464X
GERRI LIETZ-STAFFILENO
VP HOSP OPERATIONS5.000312700103919X
KAROL MARCIANO
EXEC VP BUS DEV END 05/115.0036848308876X
MARY PAUL
VP/CIO5.00067611044176X
SUE SANICOLA
VP PHYSICIAN SERVICES5.00223728055026X
WILLIAM HART
VP / COO5.00035202439629X
DEBORAH FRIBERG
PRESIDENT HOSP DIV END 06/125.00048999040004X
BRUCE MCCARTHY MD
EVP / PRESIDENT PHYSICIAN DIV5.00534936040420X
CONSTANCE J BRADLEY
VP HOSP OPERATIONS5.00021874240191X
DAVID OLSON
EXEC VP/PRES CSM HOSP END 06/125.00032116618694X
PAUL WESTRICK
VP MISSION INTEGRATION5.00231194071573X
MITCH QUADE
DIRECTOR REVENUE CYCLE5.00153817035851X
CHRISTOPHER MEYER
MANAGED CARE OFFICER5.00169786015566X
LYNN STREETER
EXEC DIR FINANCIAL PLANNIN5.00154934062624X
GREGORY J HARTZOG
DIRECTOR OF SALES & MARKETING5.00137900055913X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5215348TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2961837TotalReportableCompFrmRltdOrgs
Total Other Compensation1052242TotalOtherCompensation
Number Individuals GT100 K41NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ACCRETIVE
401 NORTH MICHIGAN AVECHICAGOIL60611MANAGEMENT SERVICES48335934
TRIMEDX LLC
6325 DIGITAL WAYINDIANAPOLISIN46278HEALTHCARE EQUIPMENT SERVICES7261817
ACCENTURE LLP
100 E WISCONSIN AVEMILWAUKEEWI53202EHR PROJECT MANAGEMENT2970272
CERNER CORPORATION
2800 ROCKCREEK PARKWAYKANSAS CITYMO64117EHR PROJECT MANAGEMENT1639810
CG SCHMIDT BARTON MALOW
26500 AMERICAN DRIVESOUTHFIELDMI48034PROJECT MANAGEMENT1604276
FieldValueIRS element (for citing)
Number Of Contractors GT100 K32NumberOfContractorsGT100K
Related Organizations220032RelatedOrganizations
All Other Contributions219111AllOtherContributions
Total Contributions439143TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OVERHEAD ALLOCATION561000111731566111731566
RENTAL INCOME-PHYSICIA532000420259420259
FieldValueIRS element (for citing)
Total Program Service Revenue112151825TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3500191TotalRevenueColumn
Exclusion$3,500,191ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4TotalRevenueColumn
Related Or Exempt Function Income4RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PENSION ADJUSTMENTS5242923943833639438336
EXPENSE TRANSFERS5610001931187119311871
JOINT VENTURE INCOME6221101071000010710000

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column10282714TotalRevenueColumn
Related Or Exempt Function Income10253714RelatedOrExemptFunctionIncome
Unrelated Business Revenue29000UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue79742921TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column195834084TotalRevenueColumn
Related Or Exempt Function Income191865750RelatedOrExemptFunctionIncome
Unrelated Business Revenue29000UnrelatedBusinessRevenue
Exclusion$3,500,191ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total436410Total
Program Services436410ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4605571Total
Management And General4605571ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total24286281Total
Program Services22648464ProgramServices
Management And General1637817ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1680821Total
Program Services1413234ProgramServices
Management And General267587ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2202063Total
Program Services1851495ProgramServices
Management And General350568ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1884051Total
Program Services1584110ProgramServices
Management And General299941ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total21867342Total
Program Services20373802ProgramServices
Management And General1493540ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total905360Total
Management And General905360ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total1001943Total
Management And General1001943ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total11714914Total
Program Services11714914ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1673900Total
Program Services1673900ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total756205Total
Program Services756205ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total33478133Total
Program Services33478133ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6658204Total
Program Services6658204ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total210479Total
Program Services210479ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total118367Total
Program Services88775ProgramServices
Management And General29592ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total16136756Total
Management And General16136756ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total12776240Total
Program Services12776240ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total186578Total
Program Services186578ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
ASCENSION FEES/DUES47216684721668
IMPAIRMENT WRITE-DOWNS41190054119005
COMMUNITY AFFILIATION E11411831141183
PATIENT CARE SUPPLIES601810601810

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3694331Total
Program Services3694331ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total156857615Total
Program Services130128940ProgramServices
Management And General26728675ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY681105BOY
EOY1190415EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY24138075BOY
EOY58145560EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4126738BOY
EOY20490305EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY35483443BOY
EOY26366123EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY899742BOY
EOY81822EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6329014BOY
EOY5075855EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis53333097LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec26179415LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY33003676BOY
EOY27153682EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY41165054BOY
EOY39472562EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY19651548BOY
EOY38691170EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY110860626BOY
EOY68711444EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY276339021BOY
EOY285378938EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY21978695BOY
EOY28946366EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY195781311BOY
EOY192015786EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY217760006BOY
EOY220962152EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY37574016BOY
EOY46601279EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY15201690BOY
EOY12687910EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5803309BOY
EOY5127597EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY58579015BOY
EOY64416786EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY276339021BOY
EOY285378938EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses38976469ReconcilationRevenueExpenses
Reconcilation Other Changes-33138698ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Written IRS DeterminationXWrittenIRSDetermination
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (5 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
CSM HOSPITAL MILWAUKEE
3908063153111$72,236,976
CSM HOSPITAL OZAUKEE
3908070633111$32,501,712
SACRED HEART REHABILITATION INSTITUTE
3909021993111$2,924,256
SETON CHILDREN'S SCHOOL
3913912459111$0
COLUMBIA COLLEGE OF NURSING INC
3915969862111$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs5TotalNumberOfSupportedOrgs
Sum Of Amounts107662944SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$27,696DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$700OtherActivitiesAmount
Total Lobbying Expenditures IIB28396TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationA KEY EMPLOYEE SPENDS 10% OF TIME (AMOUNT REPORTED ON LINE G) RESEARCHING ISSUES AND PREPARING FOR MEETINGS AND PRESENTATIONS FOR: COUNTY OFFICIALS - FUNDING AND OPERATIONAL ISSUES RELATED TO THE GENERAL ASSISTANCE MEDICAL PROGRAM STATE LEGISLATORS, OTHER ELECTED OFFICIALS AND STAFF - LOBBYING ON MEDICAL ASSISTANCE FUNDING, PUBLIC HEALTH INITIATIVES, AND PROVIDER REGULATIONS; FEDERAL ELECTED OFFICIALS AND STAFF - LOBBYING AND MEDICARE AND MEDICAID FUNDING AND PROVIDER REGULATIONS. OTHER ACTIVITIES: AMOUNT PAID TO GOVERNMENT AFFAIRS CONSULTING FIRM PROVIDING LEGISLATIVE, REGULATORY, AND COMMUNICATIONS SERVICES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1672816OtherCostOrOtherBasis
Book Value1672816BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis24813112OtherCostOrOtherBasis
Depreciation4707332Depreciation
Book Value20105780BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2053759OtherCostOrOtherBasis
Depreciation1357728Depreciation
Book Value696031BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis24309240OtherCostOrOtherBasis
Depreciation19652069Depreciation
Book Value4657171BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis484170OtherCostOrOtherBasis
Depreciation462286Depreciation
Book Value21884BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings27153682TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (8 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
ORTHOPAEDIC HOSPITAL OF WISC LLC17271000C
HOME CARE MEDICAL967055C
CSM STRATEGIC ALLIANCE40000C
HORIZON HOMECARE2368000C
WI MEDICAL CYCLOTRON LLC40000C
CSM FOUNDATION (RESTRICTED FUNDS)17815507C
SLEEP SERVICES871000C
ACCOUNTABLE CARE SOLUTIONS100000C
FieldValueIRS element (for citing)
Total Of Book Value Program Related39472562TotalOfBookValueProgramRelated

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
DEFERRED COMPENSATION416329
ASSETS HELD FOR SALE1200000
PENSION PREFUNDING29846774
DUE FROM AFFILIATES37248341
FieldValueIRS element (for citing)
Total Book Value Other Assets68711444TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
INTERCOMPANY DEBT TO ASCENSION HEALTH ALLIANCE$163,319,615
ACCRUED PENSION$17,588,647
DEFERRED COMPENSATION$416,088
MISC NONCURRENT LIABILITIES$2,930,939
MISC CURRENT LIABILITIES$3,775,508
DEFERRED INCOME$3,984,989
FieldValueIRS element (for citing)
Total Of Amounts192015786TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationPART X: ASC 740 FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS IN AUDITED FINANCIALS: NOT APPLICABLE.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense352869TotalCommunityBenefitExpense
Net Community Benefit Expense352869NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4383400TotalCommunityBenefitExpense
Direct Offsetting Revenue772271DirectOffsettingRevenue
Net Community Benefit Expense3611129NetCommunityBenefitExpense
Percent Of Total Expense0.02310PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense4736269TotalCommunityBenefitExpense
Direct Offsetting Revenue772271DirectOffsettingRevenue
Net Community Benefit Expense3963998NetCommunityBenefitExpense
Percent Of Total Expense0.02540PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4736269TotalCommunityBenefitExpense
Direct Offsetting Revenue772271DirectOffsettingRevenue
Net Community Benefit Expense3963998NetCommunityBenefitExpense
Percent Of Total Expense0.02540PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$108,269BadDebtExpenseAmount
Amount Reimbursed By Medicare3864818AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare13743218CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-9878400MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 ORTHOPAEDIC HOSPITAL OF WISCONSIN LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityORTHOPEDIC SURGERIESDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.50000OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.50000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ORTHOPAEDIC HOSPITAL OF WISCONSIN LLCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1475 WEST RIVER WOODS PARKWAYAddressLine1
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ORTHOPAEDIC HOSPITAL OF WISCONSINBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
Notified All PatientsXNotifiedAllPatients
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

ExplanationExplanationIdentifierIdentifier
PART I, LINE 3C: THE HOSPITALS OF CSM PROVIDE MEDICALLY NECESSARY CARE TO ALL PATIENTS, REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN, GENDER, DISABILITY OR ECONOMIC STATUS. OHOW'S SPECIFIC POLICY USES A PERCENTAGE OF FEDERAL POVERTY LEVEL (FPL) TO DETERMINE FREE AND DISCOUNTED CARE. AT A MINIMUM, PATIENTS WITH INCOME LESS THAN OR EQUAL TO 200% OF THE FPL, WHICH MAY BE ADJUSTED FOR COST OF LIVING UTILIZING THE LOCAL WAGE INDEX COMPARED TO NATIONAL WAGE INDEX, WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED TO THEM.
PART I, LINE 6A: OHOW FILES AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE WISCONSIN HOSPITAL ASSOCIATION ("WHA"). CSM DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE WHA SINCE CSM DOES NOT HAVE ANY PATIENT CARE REVENUE. HOWEVER, CSM IS THE PARENT ENTITY OF 3 HOSPITALS, COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC., COLUMBIA ST. MARY'S HOSPITAL OZAUKEE, SACRED HEART REHABILITATION, INC., EACH OF WHICH FILE COMMUNITY BENEFIT REPORTS WITH WHA. CSM DOES, HOWEVER, DESCRIBE THE BENEFITS THAT THE CSM ORGANIZATION PROVIDES TO THE COMMUNITY ON ITS WEBSITE.
PART I, LINE 7: THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR CERTAIN CATEGORIES IN THE TABLE, THIS WAS A COST ACCOUNTING SYSTEM; IN OTHER CATEGORIES, A SPECIFIC COST-TO-CHARGE RATIO WAS APPLIED.PART I, LINE 7G: THE ORGANIZATION HAS NOT INCLUDED COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES.
PART I, L7 COL(F): CSM'S SHARE OF THE AMOUNT OF BAD DEBT EXPENSE REPORTED BY OHOW IN 2012 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN (F) IS $367,740.
PART II: NO COMMUNITY BUILDING ACTIVITIES HAVE BEEN REPORTED BASED ON THE OHOW JOINT VENTURE; HOWEVER, IN ORDER TO ACCOMPLISH THE COLLABORATIVE WORK IN THE COMMUNITY AND TO OVERSEE ACCESS CLINICS AND OUTREACH PROGRAMS, CSM HAS A COMMUNITY SERVICES DEPARTMENT WHICH OVERSEES THE CSM COMMUNITY BENEFIT PROCESS. CSM, INC. PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES THROUGH PROGRAMS SUCH AS INROADS, WHICH IS AN OPPORTUNITY FOR CULTURALLY DIVERSE COLLEGE STUDENTS TO SERVE AN INTERNSHIP OVER SUMMER BREAK TO FAMILIARIZE THEMSELVES WITH THE CHALLENGES AND OPPORTUNITIES IN HEALTH CARE AND GAIN REAL WORLD EXPERIENCE. INROADS IS REFLECTED IN THE COMMUNITY BUILDING SECTION OF THE REPORT. CSM IS A FOUNDING MEMBER OF THE MILWAUKEE HEALTH CARE PARTNERSHIP (MHCP), WHICH IS A COLLABORATION BETWEEN THE FIVE MILWAUKEE HEALTH SYSTEMS AND FEDERALLY QUALIFIED HEALTH CENTERS TO IMPROVE ACCESS TO HEALTH CARE IN THE COMMUNITY. THE PARTNERSHIP HAS WORKED WITH COUNTY HEALTH OFFICIALS TO IMPROVE BEHAVIORAL ACCESS AND PARTNERSHIP FUNDING SUPPORTS MENTAL HEALTH RESPITE BEDS IN THE COMMUNITY. CSM'S CEO AND MISSION ACCESS VICE PRESIDENT EACH SPEND SIGNIFICANT TIME IN MHCP COLLABORATIVE WORK. ACCESS TO HEALTH EDUCATION AND SCREENING IN MANY AREAS OF THE CITY IS BEST ACCOMPLISHED THROUGH CHURCH COLLABORATION. CSM EMPLOYS NURSES TO WORK IN COLLABORATION WITH CHURCHES AND COMMUNITY ORGANIZATIONS TO OFFER HEALTH EDUCATION, HEALTH SCREENING, AND CARE MANAGEMENT SUPPORT TO PARISHIONERS AND COMMUNITY MEMBERS IN A VARIETY OF OUTREACH PROGRAMS AFFILIATED WITH CHURCHES. CSM DEVELOPED THE BEGINNING STAGES OF A COLLABORATION WITH 44 CHURCH OF GOD IN CHRIST CHURCHES IN MILWAUKEE TO ACCOMPLISH BETTER HEALTH AWARENESS AND IMPROVE SCREENING RATES.
PART III, LINE 4: OHOW, WHICH FILES FINANCIAL STATEMENTS SEPARATE FROM CSM, INCLUDES THE FOLLOWING FOOTNOTE RELATED TO ACCOUNTS RECEIVABLES: "THE MAJORITY OF THE HOSPITAL'S ACCOUNTS RECEIVABLES ARE DUE FROM THIRD-PARTY PAYORS UNDER REIMBURSEMENT AGREEMENTS AND FROM PATIENTS FOR SERVICES PROVIDED. ACCOUNTS RECEIVABLE ARE DUE UPON RECEIPT OF INVOICE. RECEIVABLES ARE STATED NET OF ANY ALLOWANCE FOR CONTRACTUAL DISCOUNTS AND UNCOLLECTIBLE ACCOUNTS BY CONSIDERING THE NUMBER OF DAYS PAST DUE, COLLECTION HISTORY, AND THE GENERAL ECONOMY AND INDUSTRY AS A WHOLE. CONTRACTUAL ADJUSTMENTS ARE BASED ON EXPECTED PAYMENT RATES IN ACCORDANCE WITH THIRD-PARTY PAYOR AGREEMENTS. THE HOSPITAL WRITES OFF ACCOUNTS RECEIVABLE WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PAYMENTS SUBSEQUENTLY RECEIVED ARE CREDITED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS."
PART III, LINE 8: OHOW FOLLOWS THE CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT.
PART III, LINE 9B: OHOW HAS A WRITTEN DEBT COLLECTION POLICY THAT ALSO INCLUDES A PROVISION ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE CERTAIN COLLECTION PRACTICES DO NOT APPLY.
PART V, SECTION B, LINE 9: ALL PATIENTS WITH INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE-OFF OF THE CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED. ELIGIBILITY MAY BE DETERMINED AT ANY POINT IN THE REVENUE CYCLE. FINANCIAL COUNSELORS PROVIDE ASSISTANCE TO THE PATIENTS TO DETERMINE IF THEY ARE ELIGIBLE FOR MEDICAID OR OTHER PUBLIC ASSISTANCE IN ORDER TO QUALIFY FOR CHARITY CARE. CREDIT REPORTS OR OTHER SIMILAR REPORTS MAY BE RUN TO VERIFY INFORMATION PROVIDED.ORTHOPAEDIC HOSPITAL OF WISCONSIN
PART V, SECTION B, LINE 10: PATIENTS WITH INCOMES ABOVE 300% OF THE POVERTY LEVEL MAY BE ELIGIBLE FOR SOME LEVEL OF DISCOUNT BASED ON A SUBSTANTIVE ASSESSMENT OF THEIR ABILITY TO PAY. THE ASSESSMENT CONSIDERS TOTAL INCOME AND DOLLAR AMOUNT OF PATIENT RESPONSIBILITY ON A SLIDING SCALE. A MEANS TEST IS PERFORMED THAT CONSIDERS INCOME, TOTAL MEDICAL BILL OBLIGATIONS, MORTGAGE PAYMENTS, UTILITY PAYMENTS, NUMBER OF FAMILY MEMBERS, AND ANY DISABILITY CONSIDERATIONS. PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, BUT ARE IN NEED OF FINANCIAL ASSISTANCE, WILL BE OFFERED APPROPRIATE EXTENDED PAYMENT TERMS OR OTHER PAYMENT OPTIONS THAT TAKE INTO ACCOUNT THE PATIENT'S FINANCIAL STATUS.ORTHOPAEDIC HOSPITAL OF WISCONSIN
PART V, SECTION B, LINE 19D: ALL PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE A MINIMUM DISCOUNT OF 40% OFF GROSS CHARGES FOR SERVICES PROVIDED TO THEM.ORTHOPAEDIC HOSPITAL OF WISCONSIN
PART VI, LINE 2: COLUMBIA ST. MARY'S, INC. SERVES THE MILWAUKEE AND OZAUKEE COMMUNITIES THROUGH A COMMUNITY BENEFIT PROCESS OVERSEEN BY THE MILWAUKEE COMMUNITY BENEFIT COMMITTEE AND THE OZAUKEE COMMUNITY BENEFIT COMMITTEE. THE PROCESS OF UNDERSTANDING COMMUNITY NEEDS THROUGH A COMMUNITY HEALTH NEEDS ASSESSMENT AND INTERPRETED THROUGH THE WORK OF COMMUNITY BENEFIT COMMITTEES TO LEAD TO A COMMUNITY BENEFIT PLAN FOR MILWAUKEE AND OZAUKEE COMMUNITIES IS CONSISTENT ACROSS THE ORGANIZATION. ALTHOUGH THE COMMUNITY BENEFIT PLAN OCCURS PRIMARILY IN THE MILWAUKEE, OZAUKEE AND SACRED HEART REHABILITATION INSTITUTE SETTINGS, THE WORK IS ALSO SUPPORTED BY DEPARTMENTS BEHIND THE SCENES ACROSS CSM, INCLUDING ACCOUNTING, HUMAN RESOURCES, PURCHASING, LEGAL COUNSEL AND OTHER ADMINISTRATIVE FUNCTIONS. PROGRAMS SUCH AS THE ORTHOPAEDIC HOSPITAL OF WISCONSIN HAVE ALSO CONTRIBUTED TO SUPPORT OF COMMUNITY BENEFIT PROGRAMMING. COMMUNITY BENEFIT COMMITTEES AT CSM HAVE CONSISTENT ROLES TO SUPPORT THE COMMUNITY BENEFIT FUNCTIONS. THE ROLES INCLUDE THE FOLLOWING: - DEVELOP COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO DETERMINE COMMUNITY NEEDS- REVIEW CHNA AND CREATE COMMUNITY BENEFIT PLAN TO ADDRESS NEEDS- INCORPORATE COMMUNITY BENEFIT PLAN GOALS IN THE CSM INTEGRATED STRATEGIC, OPERATIONAL AND FINANCIAL PLAN (ISOFP) FOR BOARD LEVEL APPROVAL AND SUBMISSION TO ASCENSION HEALTH SYSTEM - DEVELOP A STRATEGY TO MEASURE AND INCREASE THE IMPACT OF COMMUNITY BENEFIT PLAN ELEMENTSTHE COMMUNITY HEALTH NEEDS ASSESSMENTS ARE SPECIFIC TO THE DEMOGRAPHICS AND HEALTH ISSUES TO THE COMMUNITY. THE NEEDS ASSESSMENTS IN FY12 INVOLVED THE GATHERING OF SECONDARY INFORMATION ABOUT THE COMMUNITIES FROM VARIED PUBLIC SOURCES INCLUDING STATE DATA, AND COUNTY DATA. THE MOST REMARKABLE NEEDS FOR THE SERVICE WERE ADDRESSED THROUGH COMMUNITY BENEFIT PLANS FOR EACH COMMUNITY.
PART VI, LINE 3: CSM ATTEMPTS TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY OR DISCOUNTED CARE AS OUTLINED IN THE CHARITY CARE POLICY DURING THE PRE-REGISTRATION, REGISTRATION, ADMISSIONS AND DISCHARGE PROCESSES. A COPY OF THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM, AND A SUMMARY OF THE POLICY IS PROVIDED TO PATIENTS WITH ADMISSION AND DISCHARGE PAPERWORK. CSM HAS TRAINED FINANCIAL COUNSELORS AVAILABLE TO DISCUSS PAYMENT OPTIONS TO THE PATIENTS. UPON MAKING AN APPOINTMENT, THE FINANCIAL COUNSELORS WILL MEET WITH THE PATIENT TO DETERMINE WHAT OTHER FINANCIAL ASSISTANCE PROGRAMS THE PATIENT MAY QUALIFY FOR.
PART VI, LINE 4: CSM PRIMARILY SERVES THE MILWAUKEE AND OZAUKEE COUNTIES IN SOUTHEASTERN WISCONSIN. OHOW IS LOCATED IN AN URBAN COMMUNITY WITHIN MILWAUKEE COUNTY. THE POPULATION OF MILWAUKEE COUNTY IS APPROXIMATELY 953,000, WITH OVER 20% OF THE HOUSEHOLDS LIVING AT OR BELOW FEDERAL POVERTY GUIDELINES. THE MEDIAN INCOME IS APPROXIMATELY $43,000, OVER 46% OF THE POPULATION IS A MINORITY, AND APPROXIMATELY 16% OF THE POPULATION SPEAK A LANGUAGE OTHER THAN ENGLISH. DISCOUNTS FOR THE UNINSURED AND UNDERINSURED ARE NOT INCLUDED IN PARTS I OR II OF SCHEDULE H.
PART VI, LINE 5: A HALLMARK OF CSM, INC. IS THE ABILITY TO PROACTIVELY MEET HEALTH NEEDS THROUGH PREVENTIVE PROGRAMS AND PROGRAMS TO ALLOW ACCESS TO PRIMARY AND SPECIALTY CARE. THE PROGRAMS ARE MOST OFTEN DELIVERED THROUGH PARTNERSHIP WITH OTHER NON-PROFIT ORGANIZATIONS IN HEALTH AND SOCIAL SERVICES. EACH HOSPITAL HAS ACCESS IMPROVEMENT PROGRAMS INCLUDING: ST. BENS CLINIC FOR THE HOMELESS, SETON DENTAL CLINIC, COMMUNITY CHRONIC DISEASE MANAGEMENT CLINIC, HUIRAS FAMILY COMMUNITY HEALTH CENTER, EL CENTRO DE SALUDE CLINIC SPONSORED BY THE COLUMBIA COLLEGE OF NURSING, THE CSM OB/CLINIC AND THE CSM FAMILY HEALTH CENTER. A PARTICULARLY STRONG PARTNER IN THESE ACTIVITIES HAS BEEN THE MEDICAL COLLEGE OF WISCONSIN IN SPONSORSHIP OF PROGRAMS: - THE FAMILY HEALTH CENTER, A RESIDENCY-BASED FAMILY MEDICINE CLINIC THAT PROVIDES PRIMARY CARE TO MORE THAN 9,000 INDIVIDUALS IN THE COMMUNITY.- THE OB/GYN CLINIC, A RESIDENCY-BASED PROGRAM THAT SERVES OVER 150 PATIENTS, 250 OB APPOINTMENTS PER MONTH, AND 325 DELIVERIES PER YEAR.- THE CHRONIC DISEASE MANAGEMENT CLINIC, WHICH SCREENS AND MANAGES HYPERTENSION, DIABETES, OBESITY, AND SMOKING FOR LOW INCOME ADULTS THROUGH A CLINIC BASED IN A FOOD PANTRY. - THE SATURDAY CLINIC FOR THE UNINSURED, WHICH USES MEDICAL STUDENTS AND VOLUNTEER PHYSICIANS TO SERVE HUNDREDS OF UNINSURED PATIENTS EACH YEAR.IN TURN, CSM ACROSS THE HOSPITAL SETTINGS HOSTS RESIDENTS FOR THEIR TRAINING GROWTH AND DEVELOPMENT. ALL OF THESE SERVICES ARE REPORTED AS PART OF THE COMMUNITY BENEFIT EXPENSES IN SECTION H OF THE APPROPRIATE HOSPITAL REPORT.
PART VI, LINE 6: THE CSM HEALTH SYSTEM FOCUSES ON CONTRIBUTING TO THE POSITIVE HEALTH STATUS OF THE COMMUNITIES IT SERVES. CSM IS AN ORGANIZATION COMPRISED OF THREE HOSPITALS, 61 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, SETON CHILDREN'S SCHOOL (CLOSED IN JUNE 2012), A PARTNERSHIP WITH THE ORTHOPAEDIC HOSPITAL OF WISCONSIN, A PARTNERSHIP WITH SLEEP SERVICES OF WISCONSIN, AND FOUR URGENT CARE CENTERS. CSM PROVIDES CARE FOR INDIVIDUALS AND FAMILIES THROUGHOUT MILWAUKEE, OZAUKEE, WASHINGTON, AND SHEBOYGAN COUNTIES - WITH MORE THAN 160 YEARS OF SERVICE TO INDIVIDUALS AND FAMILIES IN THESE COMMUNITIES.OHOW ITSELF IS A SPECIALTY HOSPITAL WHICH PERFORMS MORE THAN 5,000 SURGICAL PROCEDURES EACH YEAR AND OFFERS THE COMPLETE RANGE OF ORTHOPAEDIC SERVICES, INCLUDING JOINT REPLACEMENTS AND SPINE PROCEDURES, REHABILITATION, DIAGNOSTIC TESTING AND PAIN MANAGEMENT SERVICES. AS A MEMBER OF ASCENSION HEALTH, THE NATION'S LARGEST CATHOLIC HEALTHCARE SYSTEM, CSM CONTINUES TO BUILD AND STRENGTHEN SUSTAINABLE COLLABORATIVE EFFORTS THAT BENEFIT THE HEALTH OF INDIVIDUALS, FAMILIES, AND SOCIETY AS A WHOLE. THE GOAL OF CSM IS TO PERPETUATE THE HEALTH MISSION OF THE CHURCH. CSM FURTHERS THIS GOAL THROUGH DELIVERY OF PATIENT SERVICES, CARE TO THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY, AND MEDICAL RESEARCH. OUR CONCERN FOR ALL HUMAN LIFE AND DIGNITY OF EACH PERSON LEADS THE ORGANIZATION TO PROVIDE MEDICAL SERVICES TO ALL PEOPLE IN THE COMMUNITY WITHOUT REGARD TO THE PATIENT'S RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY.CSM EMPLOYS A COMMUNITY BENEFIT PHILOSOPHY IN PROGRAM PLANNING AND IMPLEMENTATION. CSM PROVIDES FOR THE HEALTH OF THE COMMUNITY THROUGH FINANCIAL SUPPORT PROVIDED TO PATIENTS BY FINANCIAL DISCOUNTS AND CONTRACTS, BY DEVELOPING CLINICS AND SERVICES FOR SPECIFIC VULNERABLE GROUPS, BY SPONSORING COMMUNITY EDUCATION AND TRAINING AND BY COLLABORATING WITH GOVERNMENT PROGRAMS.DURING FISCAL 2012, THE CSM SYSTEM PROVIDED $57,420,320 IN UNREIMBURSED SERVICES, INCLUDING $10,566,988 IN TRADITIONAL CHARITY CARE, $9,616,833 IN DISCOUNTS TO THE UNINSURED, $16,119,663 IN COMMUNITY BENEFIT PROGRAMS, AND $21,116,886 IN OTHER UNPAID PUBLIC PROGRAMS, INCLUDING SUBSIDIZED HEALTH CARE, PROFESSIONAL EDUCATION, FINANCIAL CONTRIBUTIONS AND COMMUNITY BUILDING ACTIVITIES.IN ADDITION, THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF LOCAL COMMUNITY LEADERS AND PHYSICIANS, THE MAJORITY OF WHOM RESIDE WITHIN THE COMMUNITIES CSM SERVES AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY; HOWEVER, THE CLINICS WITHIN THE ORGANIZATION ARE SERVED BY PHYSICIANS AFFILIATED WITH CSM.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
WISCONSIN PRIMARY HEALTH CARE ASSOCIATION
4600 AMERICAN PARKWAY SUITE 204MADISONWI53718391407034501(C)(3)200000CONTRIBUTION TO MILWAUKEE HEALTH CENTERS
UNITED WAY OF GREATER MILWAUKEE
225 W VINE STREETMILWAUKEEWI53212390806190501(C)(3)2100002011 UNITED WAY CAMPAIGN CONTRIBUTIONS
CAP CORPS MIDWEST
1927 N 4TH STMILWAUKEEWI53212391813186501(C)(3)15000DONATION TO CAPUCHIN FRANCISCAN VOLUNTEER CORPS MIDWEST
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: CONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 4425 NORTH PORT WASHINGTON RD, GLENDALE, WI 53212.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (21 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
KEVIN GONIU MD
0530364041000019741066148054917071217000
MARK R TAYLOR
482149021734301143480184460252690857555000
LEO P BRIDEAU
3883670436894018472301347502415201047611000
RHONDA ANDERSON
3778570116980215210482500129170472243000
AMY MARQUARDT
99244088808019991302079025430392587000
CHERYL HILL
242867086130353010638650182550368901000
DAVID H SHAPIRO MD
279606018413032905064682047820400388000
GERRI LIETZ-STAFFILENO
0220696028354063650083685020234041661900
KAROL MARCIANO
94745057192021654602095067810377359000
MARY PAUL
03743340207246094530033791010385072028600
SUE SANICOLA
175160000485680311320238940278754000
WILLIAM HART
0291124010122050778024066015563039165300
DEBORAH FRIBERG
045990807706022376012250027754052999400
BRUCE MCCARTHY MD
5272840328204370098460305740575356000
CONSTANCE J BRADLEY
020029900018443029139011052025893300
DAVID OLSON
02987700484801754802825015869033986000
PAUL WESTRICK
1780050126760405130457670258060302767000
MITCH QUADE
1457530008064077340281170189668000
CHRISTOPHER MEYER
12536800044418029690125970185352000
LYNN STREETER
114943000399910418010208230217558000
GREGORY J HARTZOG
114392000235080284490274640193813000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1APAYMENTS WERE MADE TO NEW CEO FOR TEMPORARY HOUSING IN CALENDAR YEAR 2012.
PART I, LINES 4A-BPART I, LINE 4B: ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B, IN THE YEAR PAID. THE FILING ORGANIZATION, CSM INC, DID NOT CONTRIBUTE TO THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FOR ANY OF THE EXECUTIVES IN THIS YEAR. SEVERANCE AMOUNTS PAID IN FY12 INCLUDE: AMY MARQUARDT $172,749 KAROL MARCIANO $167,578
PART I, LINE 7BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO ARE EMPLOYED BY THE CSM ORGANIZATIONS AND ARE MEDICAL DOCTORS ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THE REVENUE GENERATED FROM PATIENTS THEY SERVE, BASED ON ESTABLISHED GUIDELINES. OFFICERS AND KEY EMPLOYEES PARTICIPATE IN A MANAGEMENT INCENTIVE PLAN, WHEREBY CERTAIN FINANCIAL TRIGGERS OF THE CSM SYSTEM AS APPROVED BY THE BOARD MUST BE MET BEFORE ANY ELIGIBLE EMPLOYEE MAY RECEIVE PAYMENT OF THE INCENTIVE. ONCE THE TRIGGER IS MET, THE INCENTIVE IS MEASURED BASED ON VARIOUS ESTABLISHED GOALS, INCLUDING OPERATING MARGIN, PATIENT SATISFACTION, QUALITY, AND PRODUCTIVITY.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonR BRUCE MCDONALDNamePerson
FieldValueIRS element (for citing)
RelationshipCHAIRRelationship
Amount Of Transaction103444AmountOfTransaction
Description Of TransactionCFO OF JOHNSON CONTROLS, INC., A PUBLIC COMPANY WHICH PROVIDES SERVICES TO CSM AND ITS AFFILIATES. ALL TRANSACTIONS ARE CONDUCTED AT ARMS' LENGTH.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6CSM HAS TWO CORPORATE MEMBERS: ASCENSION HEALTH AND COLUMBIA HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 7AONE OF CSM'S CORPORATE MEMBERS, ASCENSION HEALTH, HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF CSM.
FORM 990, PART VI, SECTION A, LINE 7BASCENSION HEALTH HAS DESIGNED A SYSTEM AUTHORITY MATRIX WHICH ASSIGNS AUTHORITY FOR KEY DECISIONS THAT ARE NECESSARY IN THE OPERATION OF THE SYSTEM. SPECIFIC AREAS THAT ARE IDENTIFIED IN THE AUTHORITY MATRIX ARE: NEW ORGANIZATIONS & MAJOR TRANSACTIONS; GOVERNING DOCUMENTS; APPOINTMENTS/REMOVALS; EVALUATION; DEBT LIMITS; STRATEGIC & FINANCIAL PLANS; ASSETS; SYSTEM POLICIES & PROCEDURES. THESE AREAS ARE SUBJECT TO CERTAIN LEVELS OF APPROVAL BY ASCENSION PER THE SYSTEM AUTHORITY MATRIX. COLUMBIA HEALTH SYSTEM HAS THE AUTHORITY TO APPROVE ANY CHANGES TO THE GOVERNING DOCUMENTS WHICH WOULD AFFECT ITS INTEREST OR RIGHTS IN CSM, THE MISSION AND VISION STATEMENTS OF CSM, AND ANY MAJOR CORPORATE STRUCTURAL TRANSACTIONS OF CSM.
FORM 990, PART VI, SECTION B, LINE 11MANAGEMENT, INCLUDING CERTAIN OFFICERS, WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. MANAGEMENT PRESENTS THE FORM TO THE BOARD, OR A DESIGNATED COMMITTEE, TO REVIEW AND ANSWER ANY QUESTIONS. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS.
FORM 990, PART VI, SECTION B, LINE 12CCSM HAS A WRITTEN CONFLICT OF INTEREST POLICY. THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX EXEMPT PURPOSE.
FORM 990, PART VI, SECTION B, LINE 15IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO OTHER HOSPITALS IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. THE CEO WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATIONS, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART VII, COLUMN BEMPLOYEE HOURS THE KEY EMPLOYEES AND OFFICERS LISTED ON FORM 990, PART VII, PROVIDE SERVICES TO THIS ORGANIZATION AS WELL AS OTHER RELATED CSM ORGANIZATIONS. THE HOURS REPORTED IN COLUMN (B) REPRESENT THE ESTIMATED PERCENTAGE OF TIME THESE INDIVIDUALS DEVOTE TO THE REPORTING ORGANIZATION BASED ON AN AVERAGE WEEK. THE TOTAL AVERAGE HOURS PER WEEK THESE INDIVIDUALS SPEND ON ALL CSM ORGANIZATIONS, INCLUDING THIS ORGANIZATION, EXCEED 40 HOURS.
FORM 990, PART VII, COLUMN ABOARD MEMBERS WHO ARE ALSO CSM PHYSICIANS ARE COMPENSATED BY CSM FOR SERVICES PERFORMED AS CSM PHYSICIANS AND EMPLOYEES, NOT FOR THEIR SERVICES AS BOARD MEMBERS.
FORM 990, PART XI, LINE 5:DEFERRED PENSION COSTS -19,483,870. INVESTMENT IN FOUNDATION -3,189,492. CONVERTED EQUITY - SCS -1,608,073. EQUITY TRANSFER - ASCENSION -8,779,729. EQUITY TRANSFER - CHS -320,016. EQUITY TRANSFER - CSM (MHCP) 242,482. TOTAL TO FORM 990, PART XI, LINE 5: -33,138,698.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CNO CHANGES SINCE PRIOR YEAR

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212390806315HOSPITALWI501(C)(3)3COLUMBIA ST MARY'S INC1
COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212390807063HOSPITALWI501(C)(3)3COLUMBIA ST MARY'S INC1
SACRED HEART REHABILITATION INSTITUTE INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212390902199REHAB FACILITYWI501(C)(3)3COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC1
COLUMBIA COLLEGE OF NURSING INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391596986COLLEGEWI501(C)(3)2COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC1
SETON CHILDREN'S SCHOOL INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391391245SCHOOLWI501(C)(3)9COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC1
ASCENSION HEALTH
4600 EDMUNDSON ROADST LOUISMO63136311662309HEALTH SYSTEMMO501(C)(3)110N/A
HORIZON HOME CARE & HOSPICE INC
8949 N DEERBROOK TRLMILWAUKEEWI53223391171298HOME CARE/HOSPICEWI501(C)(3)30N/A
COLUMBIA HEALTH SYSTEM
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391494977HEALTH SYSTEMWI501(C)(3)110N/A
COLUMBIA ST MARY'S FOUNDATION INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391494981FOUNDATIONWI501(C)(3)70N/A

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC
575 RIVERWOODS PKWYGLENDALEWI53212392015655HEALTH CAREWICOLUMBIA ST MARY'S INCRELATED1060500017271000010.50000
SLEEP SERVICES OF WISCONSIN LLC
111 E KILBOURN AVE STE 1300MILWAUKEEWI53202273148310SLEEP SERVICESWICOLUMBIA ST MARY'S INCRELATED529000871000010.50000

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
CSM STRATEGIC ALLIANCE
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391871856HEALTHCAREWICOLUMBIA ST MARY'S INCC-2000420000.50000
MADISON MEDICAL AFFILIATES INC
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391855720HEALTHCAREWICOLUMBIA ST MARY'S HOSPITAL MILWAUKEE INCC-8285877-103592731.00000
PROSPECT MEDICAL COMMONS CONDO ASSOCIATION
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212208042108CONDO ASSOCWICOLUMBIA ST MARY'S INCC0.70000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (16 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
ORTHOPAEDIC HOSPITAL OF WISCONSIN
O653924
ASCENSION HEALTH
E163319615
COLUMBIA ST MARY'S HOSPITAL MILWAUKEE
K72236976
COLUMBIA ST MARY'S HOSPITAL OZAUKEE
K32501712
SACRED HEART REHABILITATION INSTITUTE
K2924256
ORTHOPAEDIC HOSPITAL OF WISCONSIN
P26553000
COLUMBIA COLLEGE OF NURSING
P3487000
SETON CHILDREN'S SCHOOL
P1680000
COLUMBIA ST MARY'S HOSPITAL MILWAUKEE
P131702000
COLUMBIA ST MARY'S HOSPITAL OZAUKEE
P23677000
ASCENSION HEALTH
Q8779729
ASCENSION HEALTH
Q4721668
SLEEP SERVICES OF WISCONSIN
B75000
COLUMBIA HEALTH SYSTEM
Q320016
COLUMBIA ST MARY'S FOUNDATION INC
C220032
COLUMBIA ST MARY'S HOSPITAL MILWAUKEE
O37248341