2013-05-15T18:25:47-05:00 2012-06-30 861065772 DELOITTE TAX LLP 555 E WELLS ST SUITE 1400 MILWAUKEE WI 53202 990 2011-07-01 391834639 COLUMBIA ST MARY'S INC COLU 4143262230 4425 NORTH PORT WASHINGTON ROAD NO 301 GLENDALE WI 53212 MARK R TAYLOR 4143262230 2013-05-15 1 P00966076 4142713000 2011 2016-02-24 21:20:13Z MARK R TAYLOR 4425 NORTH PORT WASHINGTON ROAD NO 301 GLENDALE WI 53212 195834084 0 0928 X COLUMBIA-STMARYS.ORG X 2001 WI HEALTH CARE SYSTEM DEDICATED TO MAKING A POSITIVE DIFFERENCE IN INDIVIDUALS AND OUR COMMUNITY. 14 12 507 15 29000 1417 376371 439143 119610361 112151825 3320818 3500195 40555376 79742921 163862926 195834084 206484 436410 0 0 42683203 34658787 0 0 0 104498673 121762418 147388360 156857615 16474566 38976469 276339021 285378938 217760006 220962152 58579015 64416786 X COLUMBIA 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. 0 0 130128940 436310 191865750 CSM, 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. 130128940 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 206 0 1 507 1 1 1 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X RHONDA ANDERSON 4143262230 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 X GEORGE H HOFF 1.00 X 0 0 0 KEVIN GONIU MD 5.00 X 0 591105 121065 MARK R TAYLOR 1.00 X X 813840 0 43715 MASON G ROSS 1.00 X 0 0 0 MICHAEL GREBE 1.00 X 0 0 0 R BRUCE MCDONALD 1.00 X 0 0 0 RANDALL PERRY 1.00 X 0 0 0 ROBERT LYON MD 1.00 X 0 0 0 ROBERT J VENABLE 1.00 X 0 0 0 SISTER THERESA SULLIVAN DC 1.00 X 0 0 0 TINA CHANG 1.00 X 0 0 0 CHRISTINE NUERNBERG 1.00 X 0 0 0 PATRICIA J DOLHUN MD 1.00 X 0 0 0 MICHELLE S NETTLES 1.00 X 0 0 0 LEO P BRIDEAU 1.00 X 1009984 0 37627 RHONDA ANDERSON 5.00 X 411076 0 61167 AMY MARQUARDT 5.00 X 387965 0 4622 CHERYL HILL 5.00 X 286781 0 82120 DAVID H SHAPIRO MD 5.00 X 330924 0 69464 GERRI LIETZ-STAFFILENO 5.00 X 0 312700 103919 KAROL MARCIANO 5.00 X 368483 0 8876 MARY PAUL 5.00 X 0 676110 44176 SUE SANICOLA 5.00 X 223728 0 55026 WILLIAM HART 5.00 X 0 352024 39629 DEBORAH FRIBERG 5.00 X 0 489990 40004 BRUCE MCCARTHY MD 5.00 X 534936 0 40420 CONSTANCE J BRADLEY 5.00 X 0 218742 40191 DAVID OLSON 5.00 X 0 321166 18694 PAUL WESTRICK 5.00 X 231194 0 71573 MITCH QUADE 5.00 X 153817 0 35851 CHRISTOPHER MEYER 5.00 X 169786 0 15566 LYNN STREETER 5.00 X 154934 0 62624 GREGORY J HARTZOG 5.00 X 137900 0 55913 5215348 2961837 1052242 41 0 1 0 ACCRETIVE 401 NORTH MICHIGAN AVE CHICAGO IL 60611 MANAGEMENT SERVICES 48335934 TRIMEDX LLC 6325 DIGITAL WAY INDIANAPOLIS IN 46278 HEALTHCARE EQUIPMENT SERVICES 7261817 ACCENTURE LLP 100 E WISCONSIN AVE MILWAUKEE WI 53202 EHR PROJECT MANAGEMENT 2970272 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 EHR PROJECT MANAGEMENT 1639810 CG SCHMIDT BARTON MALOW 26500 AMERICAN DRIVE SOUTHFIELD MI 48034 PROJECT MANAGEMENT 1604276 32 220032 219111 439143 OVERHEAD ALLOCATION 561000 111731566 111731566 RENTAL INCOME-PHYSICIA 532000 420259 420259 112151825 3500191 3500191 4 0 4 4 4 PENSION ADJUSTMENTS 524292 39438336 39438336 EXPENSE TRANSFERS 561000 19311871 19311871 JOINT VENTURE INCOME 622110 10710000 10710000 10282714 10253714 29000 79742921 195834084 191865750 29000 3500191 436410 436410 4605571 4605571 24286281 22648464 1637817 1680821 1413234 267587 2202063 1851495 350568 1884051 1584110 299941 21867342 20373802 1493540 905360 905360 1001943 1001943 11714914 11714914 1673900 1673900 756205 756205 33478133 33478133 6658204 6658204 210479 210479 118367 88775 29592 16136756 16136756 12776240 12776240 186578 186578 ASCENSION FEES/DUES 4721668 4721668 IMPAIRMENT WRITE-DOWNS 4119005 4119005 COMMUNITY AFFILIATION E 1141183 1141183 PATIENT CARE SUPPLIES 601810 601810 3694331 3694331 156857615 130128940 26728675 0 681105 1190415 24138075 58145560 4126738 20490305 35483443 26366123 899742 81822 6329014 5075855 53333097 26179415 33003676 27153682 41165054 39472562 19651548 38691170 110860626 68711444 276339021 285378938 21978695 28946366 195781311 192015786 217760006 220962152 X 37574016 46601279 15201690 12687910 5803309 5127597 58579015 64416786 276339021 285378938 X 38976469 -33138698 X X 0 1 1 X 0 X X X X 0 0 0 CSM HOSPITAL MILWAUKEE 390806315 3 1 1 1 72236976 CSM HOSPITAL OZAUKEE 390807063 3 1 1 1 32501712 SACRED HEART REHABILITATION INSTITUTE 390902199 3 1 1 1 2924256 SETON CHILDREN'S SCHOOL 391391245 9 1 1 1 0 COLUMBIA COLLEGE OF NURSING INC 391596986 2 1 1 1 0 5 107662944 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 27696 0 1 700 28396 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A 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. 1672816 1672816 24813112 4707332 20105780 2053759 1357728 696031 24309240 19652069 4657171 484170 462286 21884 27153682 ORTHOPAEDIC HOSPITAL OF WISC LLC 17271000 C HOME CARE MEDICAL 967055 C CSM STRATEGIC ALLIANCE 40000 C HORIZON HOMECARE 2368000 C WI MEDICAL CYCLOTRON LLC 40000 C CSM FOUNDATION (RESTRICTED FUNDS) 17815507 C SLEEP SERVICES 871000 C ACCOUNTABLE CARE SOLUTIONS 100000 C 39472562 DEFERRED COMPENSATION 416329 ASSETS HELD FOR SALE 1200000 PENSION PREFUNDING 29846774 DUE FROM AFFILIATES 37248341 68711444 INTERCOMPANY DEBT TO ASCENSION HEALTH ALLIANCE 163319615 ACCRUED PENSION 17588647 DEFERRED COMPENSATION 416088 MISC NONCURRENT LIABILITIES 2930939 MISC CURRENT LIABILITIES 3775508 DEFERRED INCOME 3984989 192015786 PART X: ASC 740 FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS IN AUDITED FINANCIALS: NOT APPLICABLE. 1 1 1 X 1 X 1 1 1 0 1 1 352869 352869 0.00230 4383400 772271 3611129 0.02310 4736269 772271 3963998 0.02540 4736269 772271 3963998 0.02540 1 108269 3864818 13743218 -9878400 X 1 1 1 ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC ORTHOPEDIC SURGERIES 0.50000 0.50000 1 1 ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC

475 WEST RIVER WOODS PARKWAY GLENDALE WI 53212

X ORTHOPAEDIC HOSPITAL OF WISCONSIN 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X 1 X 1 X X 1 X 0 0 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. ORTHOPAEDIC HOSPITAL OF WISCONSIN 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. 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. 1 WISCONSIN PRIMARY HEALTH CARE ASSOCIATION 4600 AMERICAN PARKWAY SUITE 204 MADISON WI 53718 391407034 501(C)(3) 200000 CONTRIBUTION TO MILWAUKEE HEALTH CENTERS UNITED WAY OF GREATER MILWAUKEE 225 W VINE STREET MILWAUKEE WI 53212 390806190 501(C)(3) 210000 2011 UNITED WAY CAMPAIGN CONTRIBUTIONS CAP CORPS MIDWEST 1927 N 4TH ST MILWAUKEE WI 53212 391813186 501(C)(3) 15000 DONATION TO CAPUCHIN FRANCISCAN VOLUNTEER CORPS MIDWEST 3 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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. X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 KEVIN GONIU MD 0 530364 0 41000 0 19741 0 66148 0 54917 0 712170 0 0 MARK R TAYLOR 482149 0 217343 0 114348 0 18446 0 25269 0 857555 0 0 0 LEO P BRIDEAU 388367 0 436894 0 184723 0 13475 0 24152 0 1047611 0 0 0 RHONDA ANDERSON 377857 0 11698 0 21521 0 48250 0 12917 0 472243 0 0 0 AMY MARQUARDT 99244 0 88808 0 199913 0 2079 0 2543 0 392587 0 0 0 CHERYL HILL 242867 0 8613 0 35301 0 63865 0 18255 0 368901 0 0 0 DAVID H SHAPIRO MD 279606 0 18413 0 32905 0 64682 0 4782 0 400388 0 0 0 GERRI LIETZ-STAFFILENO 0 220696 0 28354 0 63650 0 83685 0 20234 0 416619 0 0 KAROL MARCIANO 94745 0 57192 0 216546 0 2095 0 6781 0 377359 0 0 0 MARY PAUL 0 374334 0 207246 0 94530 0 33791 0 10385 0 720286 0 0 SUE SANICOLA 175160 0 0 0 48568 0 31132 0 23894 0 278754 0 0 0 WILLIAM HART 0 291124 0 10122 0 50778 0 24066 0 15563 0 391653 0 0 DEBORAH FRIBERG 0 459908 0 7706 0 22376 0 12250 0 27754 0 529994 0 0 BRUCE MCCARTHY MD 527284 0 3282 0 4370 0 9846 0 30574 0 575356 0 0 0 CONSTANCE J BRADLEY 0 200299 0 0 0 18443 0 29139 0 11052 0 258933 0 0 DAVID OLSON 0 298770 0 4848 0 17548 0 2825 0 15869 0 339860 0 0 PAUL WESTRICK 178005 0 12676 0 40513 0 45767 0 25806 0 302767 0 0 0 MITCH QUADE 145753 0 0 0 8064 0 7734 0 28117 0 189668 0 0 0 CHRISTOPHER MEYER 125368 0 0 0 44418 0 2969 0 12597 0 185352 0 0 0 LYNN STREETER 114943 0 0 0 39991 0 41801 0 20823 0 217558 0 0 0 GREGORY J HARTZOG 114392 0 0 0 23508 0 28449 0 27464 0 193813 0 0 0 PART I, LINE 1A PAYMENTS WERE MADE TO NEW CEO FOR TEMPORARY HOUSING IN CALENDAR YEAR 2012. PART I, LINES 4A-B PART I, LINE 4B: ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B, IN THE YEAR PAID. THE 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 7 BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO ARE EMPLOYED BY THE CSM ORGANIZATIONS AND ARE MEDICAL DOCTORS ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THE REVENUE GENERATED FROM PATIENTS THEY 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. R BRUCE MCDONALD CHAIR 103444 CFO OF JOHNSON CONTROLS, INC., A PUBLIC COMPANY WHICH PROVIDES SERVICES TO CSM AND ITS AFFILIATES. ALL TRANSACTIONS ARE CONDUCTED AT ARMS' LENGTH. 0 FORM 990, PART VI, SECTION A, LINE 6 CSM HAS TWO CORPORATE MEMBERS: ASCENSION HEALTH AND COLUMBIA HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A ONE 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 7B ASCENSION 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 11 MANAGEMENT, 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 12C CSM 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 15 IN 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 19 THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII, COLUMN B EMPLOYEE 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 A BOARD 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. FORM 990, PART XII, LINE 2C NO CHANGES SINCE PRIOR YEAR COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390806315 HOSPITAL WI 501(C)(3) 3 COLUMBIA ST MARY'S INC 1 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390807063 HOSPITAL WI 501(C)(3) 3 COLUMBIA ST MARY'S INC 1 SACRED HEART REHABILITATION INSTITUTE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390902199 REHAB FACILITY WI 501(C)(3) 3 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 1 COLUMBIA COLLEGE OF NURSING INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391596986 COLLEGE WI 501(C)(3) 2 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 1 SETON CHILDREN'S SCHOOL INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391391245 SCHOOL WI 501(C)(3) 9 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 1 ASCENSION HEALTH 4600 EDMUNDSON ROAD ST LOUIS MO 63136 311662309 HEALTH SYSTEM MO 501(C)(3) 11 N/A 0 HORIZON HOME CARE & HOSPICE INC 8949 N DEERBROOK TRL MILWAUKEE WI 53223 391171298 HOME CARE/HOSPICE WI 501(C)(3) 3 N/A 0 COLUMBIA HEALTH SYSTEM 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494977 HEALTH SYSTEM WI 501(C)(3) 11 N/A 0 COLUMBIA ST MARY'S FOUNDATION INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494981 FOUNDATION WI 501(C)(3) 7 N/A 0 ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC 575 RIVERWOODS PKWY GLENDALE WI 53212 392015655 HEALTH CARE WI COLUMBIA ST MARY'S INC RELATED 10605000 17271000 0 1 0.50000 SLEEP SERVICES OF WISCONSIN LLC 111 E KILBOURN AVE STE 1300 MILWAUKEE WI 53202 273148310 SLEEP SERVICES WI COLUMBIA ST MARY'S INC RELATED 529000 871000 0 1 0.50000 CSM STRATEGIC ALLIANCE 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391871856 HEALTHCARE WI COLUMBIA ST MARY'S INC C -2000 42000 0.50000 MADISON MEDICAL AFFILIATES INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391855720 HEALTHCARE WI COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC C -8285877 -10359273 1.00000 PROSPECT MEDICAL COMMONS CONDO ASSOCIATION 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 208042108 CONDO ASSOC WI COLUMBIA ST MARY'S INC C 0.70000 0 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 ORTHOPAEDIC HOSPITAL OF WISCONSIN O 653924 ASCENSION HEALTH E 163319615 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE K 72236976 COLUMBIA ST MARY'S HOSPITAL OZAUKEE K 32501712 SACRED HEART REHABILITATION INSTITUTE K 2924256 ORTHOPAEDIC HOSPITAL OF WISCONSIN P 26553000 COLUMBIA COLLEGE OF NURSING P 3487000 SETON CHILDREN'S SCHOOL P 1680000 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE P 131702000 COLUMBIA ST MARY'S HOSPITAL OZAUKEE P 23677000 ASCENSION HEALTH Q 8779729 ASCENSION HEALTH Q 4721668 SLEEP SERVICES OF WISCONSIN B 75000 COLUMBIA HEALTH SYSTEM Q 320016 COLUMBIA ST MARY'S FOUNDATION INC C 220032 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE O 37248341