2013-11-15T14:58:34-06:00 2012-12-31 391173131 SCHENCK SC 100 MARITIME DRIVE SUITE 2B MANITOWOC WI 54220 990 2012-01-01 390806395 HOLY FAMILY MEMORIAL INC HOLY 9203202011 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 MARK HERZOG 9203203470 2013-11-15 1 KELLY BLOCK CPA P00199509 9206845500 2012 2016-03-07 17:11:31Z MARK HERZOG 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 129906048 0 X WWW.HFMHEALTH.ORG X 1899 WI HEALTH CARE SERVICESSEE SCHEDULE OHOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. HFM PROVIDES ACUTE, OUTPATIENT, CLINIC, HOME CARE AND HOSPICE SERVICES FOR MANITOWOC COUNTY, STRIVING FOR MEDICIAL EXCELLENCE AND VALUED OUTCOMES WITHIN A COMPASSIONATE, VALUES BASED, CHRISTIAN ENVIRONMENT. 20 13 1268 386 7256 -15936 933186 760996 129021726 126777153 3611146 1731265 605790 224576 134171848 129493990 42000 44350 0 0 77340656 78476976 0 0 249566 49572482 48878691 126955138 127400017 7216710 2093973 169230414 170044589 70216195 65733371 99014219 104311218 X HOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. 0 0 115202476 44350 128479133 HOLY FAMILY MEMORIAL IS AN INTEGRATED NETWORK PROVIDING HEALTH CARE SERVICES INTENDED TO BENEFIT THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. THESE SERVICES INCLUDE PRIMARY AND SPECIALTY CLINIC CARE, PREVENTIVE CARE SUCH AS HEALTH SCREENINGS, VACCINATION CLINICS AND HEALTH EDUCATION CLASSES, 24/7 EMERGENCY CARE, URGENT CARE, INPATIENT ACUTE CARE, OUTPATIENT CARE, HOME CARE AND HOSPICE, HOME MEDICAL EQUIPMENT, PRESCRIPTIONS, OCCUPATIONAL HEALTH SERVICES, AND MEDICALLY BASED FITNESS AND WELLNESS CENTER. HOLY FAMILY MEMORIAL HAS BEEN ABLE TO ACHIEVE A GREATER IMPACT IN THE COMMUNITY BY PARTNERING FINANCIAL, HUMAN AND PROGRAMMATIC RESOURCES WITH OTHER ORGANIZATIONS. THESE PARTNERSHIPS INCLUDE A COMMITMENT TO COLLABORATE WITH OTHER HEALTH AND SOCIAL SERVICE AGENCIES TO IMPROVE ACCESS TO CARE, FOCUS ON PREVENTIVE SERVICES, REDUCE COMMUNITY HEALTH RISKS AND CONTRIBUTE TO A HEALTHIER, VIBRANT COMMUNITY.HOLY FAMILY MEMORIAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. IN ASSESSING A PATIENT'S ABILITY TO PAY, HOLY FAMILY MEMORIAL UTILIZES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITIES IT SERVES AND CONSIDERS SITUATIONS WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO THE PATIENT'S FINANCIAL RESOURCES. BECAUSE HOLY FAMILY MEMORIAL DOES NOT EXPECT TO RECEIVE PAYMENT OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. HOLY FAMILY MEMORIAL'S TOTAL COMMUNITY BENEFIT INCLUDES THE COST OF CHARITY CARE AND UNPAID COST OF PUBLIC PROGRAMS (MEDICARE AND MEDICAID) AS WELL AS THOSE DISCUSSED ABOVE. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT WAS APPROXIMATELY $23,755,000 FOR THE YEAR ENDED DECEMBER 2012. THIS AMOUNT INCLUDES THE NET COST OF CHARITY CARE OF APPROXIMATELY $1,304,000. MORE INFORMATION AVAILABLE FROM OUR COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED ON OUR WEBSITE AT WWW.HFMHEALTH.ORG. 115202476 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 20 0 1 1268 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 20 13 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 WI X X MARK HERZOG PRESIDENT CEO 9203203470 2300 WESTERN AVENUE MANITOWOC WI 542211450 X RYAN M DOPIRAK MD 40.00 X 1125856 0 30592 GARY SCHMIDT MD 40.00 X 184896 0 17124 PRADEEP GIRIYAPPA MD 40.00 X 269087 0 28251 MICHAEL B MCCORMICK MD 40.00 X 322828 0 33561 JAMES W HOFTIEZER MD 40.00 X 606786 0 30278 WILLIAM D HAMPTON MD 40.00 X 334244 0 28396 MARY A GOVIER MD 40.00 X 177651 0 24373 LEE KUMMER 2.00 X 0 0 0 DONALD R BRISCH 2.00 X 0 0 0 JANE L PFEFFER 2.00 X X 0 0 0 WILLIAM R CASEY 2.00 X X 0 0 0 MARK SWANSON 2.00 X 0 0 0 WILLIAM C CENSKY 2.00 X X 0 0 0 SISTER PAULA VANDEN HOGEN 2.00 X 0 0 0 LAURIE CRAWFORD 2.00 X X 0 0 0 SISTER JAN VILLEMURE 2.00 X 0 0 0 SISTER LORITA GAFFNEY 2.00 X 0 0 0 KATHLEEN A ZUCCHI 2.00 X 0 0 0 SISTER LAURA WOLF 2.00 X 0 0 0 SISTER MARDELLE MEINHOLZ 2.00 X 0 0 0 SISTER MARY ANN NUGENT 2.00 X 0 0 0 MARK P HERZOG 40.00 X X 596911 0 114507 PATRICIA HUETTL 40.00 X 239906 0 61714 STEVEN D DRIGGERS MD 40.00 X 563702 0 99167 MARY MAURER 40.00 X 261784 0 43336 MARCIA DONLON VP MEDICAL 40.00 X 167060 0 44963 KIRK DIMITRIS MD 40.00 X 1207031 0 28572 DAVID MIKOLYZK MD 40.00 X 803515 0 30454 MILAN JORDAN MD 40.00 X 760253 0 20462 NANCY N BUTLER MD 40.00 X 737863 0 19502 JEFFREY A JACOBY MD 40.00 X 1301264 0 30710 PATRICK J BRANDEL 0.00 X 105893 0 0 9766530 0 685962 71 1 1 0 CARETECH SOLUTIONS 901 WILSHIRE DRIVE STE 250 TROY MI 48084 IT SERVICES 5726012 PATRIOT MEDICAL TECH PO BOX 415000 NASHVILLE TN 372415000 BIO-MED SERVICES 1272347 PHILIPPI QUALITY CONSTRUCTION 1226 SOUTH 32ND STREET MANITOWOC WI 54220 GENERAL CONTRACTOR 470346 RADIATION ONCOLOGY SPECIALISTS PO BOX 678 STURGEON BAY WI 54235 CANCER CARE SERVICES 445674 QUEST DIAGNOSTICS INC PO BOX 12989 CHICAGO IL 60693 LABORATORY 410697 18 42131 146781 572084 6010 760996 INTEGRATED HEALTH CARE 900099 111413262 111413262 0 0 LAB 621500 9604784 9592375 12409 0 PHARMACY 446110 5759107 5688478 0 70629 126777153 1735090 1735090 326061 357194 -31133 -31133 -31133 3185 7010 -3825 -3825 -3825 100622 42131 40698 59924 59924 12410 7156 5254 5254 MISCELLANEOUS 900003 145756 145756 INVESTMENT HFHS & DME 446110 44775 49928 -5153 190531 129493990 128479133 7256 246605 44350 44350 4986176 2695485 2290691 59764578 55412418 4211663 140497 339179 155922 179167 4090 9625202 9003300 569291 52611 3761841 3408803 343410 9628 133576 133576 112781 112781 391945 390721 1224 456520 49958 406562 16541101 16351432 182208 7461 3357944 3357944 2689964 2598688 60304 30972 387005 251293 135034 678 285380 165964 119416 2307214 2307214 9003444 8775471 225302 2671 820857 820857 NON-OP INC TAX 59999 59999 PURCHASED SERVICES 5621315 3516388 2103969 958 STATE PROVIDER ASSESSME 3176800 3176800 MAINTENANCE 2691366 2659345 32021 841480 60123 781357 127400017 115202476 11947975 249566 X 9393054 11487108 3404090 3911962 23190 20269 21425602 18598147 606872 0 2058558 1945539 5411183 6130142 174376001 105100350 71883833 69275651 30122020 34883872 20116445 19549808 3749813 3814204 1035754 427887 169230414 170044589 14880465 13673022 66476 29660 54233175 51602802 1035754 427887 325 0 70216195 65733371 X 97376300 102395650 209193 273086 1428726 1642482 99014219 104311218 169230414 170044589 X 2093973 2984823 218203 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 1242 0 1 12332 13574 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LINE 1 B & G: HFM SENT A REPRESENTATIVE TO WASHINGTON DC ON TWO OCCASIONS TO DISCUSS SPECIFIC LEGISLATIVE MATTERS WITH THEIR FEDERAL REPRESENTATIVES. HFM ALSO ATTENDED ONE DAY WHERE A SMALL NUMBER OF STAFF VISITED THE CAPITAL TO EDUCATE THEIR LEGISLATORS ON VARIOUS HEALTHCARE TOPICS. LINE I: HOLY FAMILY MEMORIAL BELONGS TO HOSPITAL ASSOCIATIONS WHICH USE A PERCENTAGE OF THE DUES FOR LOBBYING PURPOSES. 0 0 1637918 514026 236377 1915567 1602667 202680 -9775 500 157154 1637918 1429395 240013 162063 500 228304 1602667 1223863 485645 -107593 500 172020 1429395 1372479 316645 -303997 500 160764 1223863 0.94000 0.06000 0 1 1 4885385 4885385 106092798 59624960 46467838 5397801 4220473 1177328 56023850 40526888 15496962 1976167 728029 1248138 69275651 19549808 C 19549808 132359359 2984823 -119454 2865369 129493990 0 129493990 127340008 -60009 -60009 127400017 0 127400017 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: HOLY FAMILY MEMORIAL'S ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE FINANCIAL SUPPORT ON AN ONGOING BASIS TO MEET THE CURRENT AND FUTURE NEEDS OF HOLY FAMILY MEMORIAL AND THE PEOPLE IT SERVES. FUNDS ARE USED FOR CAPITAL EQUIPMENT, MAJOR BUILDING IMPROVEMENTS, PROGRAM DEVELOPMENT, AND OPERATIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: TAXES -59,999. RESTRICTED DONATIONS RECORDED TO BALANCE SHEET -59,455. PART XII, LINE 2D - OTHER ADJUSTMENTS: TAXES -59,999. ROUNDING -10. PAINT THE NIGHT PINK 17792 7850 9942 20349 SAMARITAN DAY 95929 31953 63976 19619 3 29032 2328 26704 730 142753 42131 100622 40698 40698 59924 1 1.00000 DAVID YEGHIAIAN PO BOX 1450 MANITOWOC WI 542211450 1 1 1 X 1 X 1 1 0 1 1 1741 1304494 1304494 0.01020 53719 12345020 3609686 8735334 0.06860 55460 13649514 3609686 10039828 0.07880 9656 136554 136554 0.00110 901 385600 385600 0.00300 34 88811 50656 38155 0.00030 946 140774 140774 0.00110 11537 751739 50656 701083 0.00550 66997 14401253 3660342 10740911 0.08430 200 6432 6432 0.00010 14 2389 2389 0.00000 2264 2264 0.00000 1208 3398 3398 0.00000 1422 14483 14483 0.00010 1 1801769 502695 42849617 55859190 -13009573 X 1 1 1 YORK STREET PROPERTIES LLC REAL ESTATE 0.36000 0.00000 0.00000 2 HOLY FAMILY MEMORIAL CANCER CENTER - ST VINCENT CANCER COLLABORATIVE PROFESSIONAL CANCER CARE SERVICES 0.50000 0.00000 0.00000 1 1 HOLY FAMILY MEMORIAL INC

2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450

X X X HOLY FAMILY MEMORIAL INC 1 1 1 100.000000000000 1 200.000000000000 1 X X X X X 1 1 X X 1 0 1 X 0 0 2 HOLY FAMILY HEALTH SERVICES INC

3310 CALUMET AVENUE MANITOWOC WI 54220

RETAIL PHARMACY NORTH END HOME MEDICAL SERVICES LLC

3310 CALUMET AVENUE MANITOWOC WI 54220

DURABLE MEDICAL EQUIPMENT PART I, LINE 7: COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE CARE AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT PROGRAMS INCLUDE SERVICES FOR THOSE WHO CAN NOT AFFORD HEALTH CARE AND INITIATIVES FOR IMPROVING HEALTH IN THE BROADER COMMUNITY. PROVIDING COMMUNITY BENEFITS DEMONSTRATES THAT HOLY FAMILY MEMORIAL IS FULFILLING ITS CHARITABLE MISSION AND DEMONSTRATING ITS PREFERENTIAL TAX STATUS IS DESERVED. SCHEDULE H, PART 1, LINE 7, COLUMN F PERCENTAGE OF COMMUNITY BENEFIT EXPENSE TO OVERALL ENTITY'S EXPENSES. PART II: COMMUNITY BUILDING ACTIVITIES INDICATED IN PART II PROMOTE THE HEALTH OF THE MANITOWOC COMMUNITY BY ACTIVELY ADDRESSING EXPRESSED AND REPORTED ISSUES. SPECIFICALLY, THROUGH THE PROGRAMS INDICATED, HOLY FAMILY MEMORIAL AND IN PARTNERSHIP WITH OTHERS, WORKS DILIGENTLY TO ACHIEVE AN OVERALL HEALTHIER COMMUNITY. MAJOR INITIATIVES WITH DISCERNABLE POSITIVE RESULTS INCLUDE: IMPROVED ACCESS TO HEALTH INFORMATION AND PROVIDER RESOURCES, REDUCTION IN COMMUNITY FALLS, REDUCTION IN ADULT SMOKING POPULATION RATES, REDUCTION IN TEENAGE PREGNANCY RATES AND REDUCTION IN TEENAGE AND ADULT DRINKING RATES. PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE ORGANIZATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: HOLY FAMILY MEMORIAL IS A LICENSED MEDICARE PROVIDER WITH APPROXIMATLEY 46.8 PERCENT OF ITS PATIENT BASE QUALIFYING FOR THIS PROGRAM. AT PRESENT, THE REIMBURSEMENT RATE FOR THE MEDICARE PROGRAM DOES NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THIS REPRESENTS THE ESTIMATED SHORTFALL CREATED WHEN HOLY FAMILY MEMORIAL RECEIVES PAYMENTS BELOW THE COSTS OF TREATING MEDICARE AND OTHER PUBLIC PROGRAM BENEFICIARIES.COST METHODOLOGY = COST TO CHARGE RATIO PART III, LINE 9B: PAYMENT OPTIONS AS WELL AS COMMUNITY CARE ASSISTANCE IS NOTED ON ALL COLLECTION LETTERS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SDS, MRI, CT AND ER SERVICES. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR INCLUDING, BUT NOT LIMITED TO MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY CARE PROGRAM. IF THEY MAY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, THE ELIGIBILITY SPECIALIST WILL HELP THEM COMPLETE THE APPLICATION PROCESS AND FOLLOW UP ON THEIR APPLICATION THROUGH TO APPROVAL/DISAPPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CALL FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON WHERE TO GO TO APPLY FOR THOSE PROGRAMS. THE ELIGIBILITY SPECIALIST WILL ASSIST AS WELL. SCHEDULE H, PART III, LINE 3: THROUGH ANALYTICAL TOOLS, A COLLECTION PREDICTION SCORE IS APPLIED TO ALL ACCOUNTS WRITTEN OFF TO BAD DEBT THROUGH A COLLECTION AGENCY. THOSE SCORING LOW/UNCOLLECTIBLE ARE ASSUMED CHARITY/COMMUNITY BENEFIT. HOLY FAMILY MEMORIAL INC PART V, SECTION B, LINE 14G: HOLY FAMILY MEMORIAL'S COMMUNITY CARE PROGRAM IS COMMUNICATED ON THE HOSPITAL FACILITY'S WEBSITE SUMMARIZING THE ELIGIBILITY REQUIREMENTS TO INCLUDE SERVICES COVERED, INCOME GUIDELINES, APPLICATION FORM, AND OTHER DOCUMENTS NEEDED FOR COMPLETION OF THE APPLICATION. THE COMMUNITY CARE PROGRAM IS ALSO COMMUNICATED VIA PAYMENT GUIDELINE BROCHURES AVAILABLE IN THE REGISTRATION AREAS AT ALL HFM LOCATIONS THROUGHOUT THE COMMUNITY, AND TO PATIENTS IN COMMUNICATION WITH PRICE ESTIMATIONS AND COLLECTIONS, BOTH VERBAL AND WRITTEN. THE POLICY IS ALSO AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL INC PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE AVERAGE OF ITS FIVE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART VI, LINE 2: HOLY FAMILY MEMORIAL UTILIZES FOUR DISTINCT PROCESSES TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. FIRST, AS A PART OF THE ANNUAL STRATEGIC PLANNING PROCESS, AN ENVIRONMENTAL ASSESSMENT IS DONE. INCLUDED IN THAT REPORT AND ANALYSIS IS CURRENT POPULATION DATA INCLUDING DEMOGRAPHICS, UTILIZATION, MORTALITY INFORMATION, DEMAND FORECASTING, PREVALENT DISEASE STATES AND FEEDBACK FROM VARIOUS CONSTITUENCIES RELATIVE TO PERCEIVED MET AND UNMET COMMUNITY HEALTH NEEDS. SECOND, HOLY FAMILY MEMORIAL PARTICIPATES IN A TRI-ANNUAL FULL COMMUNITY HEALTH ASSESSMENT PROCESS IN CONJUNCTION WITH HEALTHIEST MANITOWOC COUNTY 2020. THIS ASSESSMENT CONSISTS OF INPUT OBTAINED FROM HUNDREDS OF COMMUNITY RESIDENTS, INCLUDING ALL AGE GROUPS, BEGINNING FROM HIGH SCHOOL AGE. THE INFORMATION IS TABULATED, ANALYZED AND UTILIZED TO DETERMINE PRIORITIZED HEALTH NEEDS. HOLY FAMILY MEMORIAL USES THIS INFORMATION IN ITS ANNUAL COMMUNITY BENEFIT PLANS. THIRD, HOLY FAMILY MEMORIAL CONDUCTS REGULAR INPUT SESSSIONS WITH LOCAL EMPLOYERS TO ASCERTAIN HEALTH NEEDS FROM AN OCCUPATIONAL HEALTH PERSPECTIVE. THIS INFORMATION IS THEN UTILIZED TO DEVELOP AND PROVIDE NEEDED EMPLOYER/EMPLOYEE HEALTH SERVICES THROUGHOUT THE BUSINESS COMMUNITY. LASTLY, HOLY FAMILY MEMORIAL UTILIZES A COMBINATION OF PATIENT FEEDBACK FROM ONGOING PATIENT SATISFACTION SURVEYS (CONDUCTED POST PROVISION OF SERVICES) AND COMMUNITY RESEARCH STUDIES COMMISSIONED BY HOLY FAMILY MEMORIAL, TO ASSESS PROGRAM AND SERVICE HEALTH CARE NEEDS OF THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE AREAS / WEBSITE / BROCHURES / ADMISSIONS STAFF / COLLECTION CORRESPONDENTS AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SDS, MRI, CT SERVICES. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES/COMMUNICATES TO SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENT OF ANY PROGRAMS THEY MAY QUALIFY FOR INCLUDING, BUT NOT LIMITED TO MEDICAID, VETERANS ADMINISTRATION OR OUR OWN CHARITY PROGRAM. IF THEY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE ASSIST THEM IN COMPLETING THE APPLICATION AND FOLLOW UP ON THE APPLICATION THROUGH APPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED WHICH INCLUDES WHOM TO CALL FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR OR ELIGIBILITY SPECIALIST IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL ASSIST THOSE PATIENTS ON APPLYING FOR THOSE PROGRAMS. PART VI, LINE 4: THE COMMUNITY THAT HOLY FAMILY MEMORIAL SERVICES IS CONSIDERED TO BE LOCATED IN THE RURAL LAKESHORE REGION OF NORTHEAST WISCONSIN. THE PRIMARY SERVICE AREA IS MANITOWOC COUNTY WITH SECONDARY NEIGHBORING COUNTIES; BROWN, KEWAUNEE, CALUMET AND SHEBOYGAN. SPECIFICALLY, THE COMMUNITY SERVED IS AN OLDER POPULATION WITH 16% OF THE PEOPLE AGE 65 OR OLDER WITH MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $45,000. 14.5% OF OUR SERVICES ARE DEDICATED TO PROVIDING CARE TO MEDICAID AND SELF-PAY PATIENTS. THE 2013 SERVICE AREA IS EXPECTED TO REMAIN AT 2012 LEVELS WITH A SLIGHT GROWTH TOWARD THE 65+ AGE AND RETRACTION OF THOSE 18-44. REFLECTIVE OF THIS NUMBER IS THAT OVER 47% OF OUR SERVICES ARE DEDICATED TO PROVIDING CARE TO MEDICARE PATIENTS. THE COMMUNITY IS MAINLY CAUCASIAN WITH SEVERAL OTHER NATIONALITIES INCLUDING AFRICAN AMERICAN, ASIAN AND HISPANIC. OTHER PROVIDERS IN THE AREA CONSIST OF THE AURORA MEDICAL GROUP, MANITOWOC SURGERY CENTER, AND SEVERAL OTHER INDEPENDENT PROVIDERS. PART VI, LINE 5: ALL OF HOLY FAMILY MEMORIAL'S BOARD MEMBERS RESIDE IN THE PRIMARY SERVICE AREA. THE BOARD CONSISTS OF COMMUNITY REPRESENTATIVES, PHYSICIANS AND REPRESENTATIVES OF THE SPONSOR ORGANIZATION. THE MEDICAL/DENTAL STAFF IS OPEN TO ALL QUALIFIED PROVIDERS WHO MEET THE REQUIREMENTS OF MEDICAL/DENTAL STAFF MEMBERSHIP. THE NETWORK OF PHYSICIANS AND OTHER PROVIDERS IS COMMITTED TO PROVIDING EACH PATIENT WITH THE HIGHEST LEVEL OF PERSONAL CARE, RESPECT AND COMPASSION TO ENHANCE THE PATIENT'S QUALITY OF LIFE AND HEALTH STATUS. ALL SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION TO PURCHASE NECESSARY MEDICAL EQUIPMENT, COMPENSATE EMPLOYEES, AND PLAN FOR FUTURE NEEDS. NONE OF THE SUPRLUS EARNINGS BENEFIT ANY INDIVIDUALS OR OTHER CORPORATE ENTITIES. PART VI, LINE 6: THE HEALTH CARE NETWORK IS SPONSORED BY THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY, LOCATED AT HOLY FAMILY CONVENT, MANITOWOC, WISCONSIN. THE CONVENT, SITUATED ON SILVER LAKE, THREE MILES WEST OF LAKE MICHIGAN, IS HOME FOR OVER 350 CONGREGATION MEMBERS WHO SERVE THROUGHOUT THE UNITED STATES AND ARE PRIMARILY ENGAGED IN EDUCATION, PARISH AND HEALTH MINISTRIES. THE HEALTHCARE MINISTRY SPANS THREE STATES - WISCONSIN, NEBRASKA AND OHIO - AND HAS EXISTED FOR OVER 100 YEARS. THE MISSION OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY IS TO CARRY OUT THE COMMITMENT OF THE SPONSOR IN THE HEALING MISSION OF THE CATHOLIC CHURCH THROUGH THE PROVISION OF QUALITY HEALTHCARE SERVICES TO THE PEOPLE OF GOD IN OUR COMMUNITIES. REPORTS FILED WITH STATES PART VI, LINE 7 WI,NE 1 SCHOLARSHIPS 12 36100 ACTUAL TUITION COST SCHOLARSHIPS - EDUCATION 7 8250 ACTUAL TUITION COST HOLY FAMILY MEMORIAL'S SCHOLARSHIP PROGRAM IS DESIGNED AS A RECRUITMENT TOOL FOR EMPLOYMENT OF CANDIDATES IN SPECIFIED POSITIONS, CONSIDERED DIFFICULT TO FILL AND TO ASSIST STUDENTS IN THEIR PURSUIT OF A HEALTH CARE RELATED DEGREE. AREAS OF STUDY INCLUDE NURSING, PHARMACY, PHYSICAL THERAPY AND OTHERS. IN RETURN FOR THE SCHOLARSHIP, AN EMPLOYMENT SERVICE COMMITMENT IS MADE. IN ORDER TO BE ELIGIBLE: 1) STUDENTS MUST BE ACCEPTED INTO AN ACCREDITED PROGRAM 2) CANDIDATES MUST BE ATTENDING SCHOOL AS A FULL OR PART TIME STUDENT AND REMAIN IN THAT STATUS 3) STUDENTS MUST HAVE AND MAINTAIN A 3.0 CUMULATIVE GRADE POINT AVERAGE. SCHOLARSHIPS ARE AWARDED ON THE BASIS OF GRADE POINT AVERAGE, VERIFIED WITH OFFICIAL TRANSCRIPT OF GRADES, COMPLETION OF EMPLOYMENT APPLICATION AND PERSONAL INTERVIEW. THE SCHOLARSHIP IS USED FOR TUITION COST. THE SCHOLARSHIPS ARE GIVEN OUT EACH SEMESTER AND ARE PAID DIRECTLY TO THE SCHOOL THE STUDENT ATTENDS. APPLICANTS WHO ARE AWARDED THE SCHOLARSHIP MUST MAKE A SIX-MONTH COMMITMENT TO WORK AT HOLY FAMILY MEMORIAL FOR EACH SEMESTER THE SCHOLARSHIP IS AWARDED. THE SCHOLARSHIP RECIPIENT MUST REPAY THE FULL AMOUNT OF THE SCHOLARSHIP IF HE/SHE: 1) DROPS OUT OF SCHOOL 2) FALLS BELOW A 3.0 CUMULATIVE GRADE POINT AVERAGE 3) DOES NOT ACCEPT EMPLOYMENT 4) DOES NOT COMPLETE FULL LENGTH OF EMPLOYMENT COMMITMENT 5) DOES NOT OBTAIN WISCONSIN LICENSURE, AS REQUIRED. THE SCHOLARSHIP AWARD THROUGH EDUCATION ARE USED TO PROMOTE HEALTH CARE CAREERS. THE REQUIREMENTS FOR THE MEDICAL/DENTAL ENDOWMENT INCLUDE ACCEPTANCE AT AN ACCREDITED COLLEGE, UNIVERSITY, OR TECHNICAL SCHOOL, A MANITOWOC COUNTY RESIDENT, A GRADE POINT AVERAGE OF 3.0 OR ABOVE IS DESIRED, DEMONSTRATED HEALTH CAREER INTEREST AND FINANCIAL NEED. THESE SCHOLARSHIPS ARE OFFERED FOR ONE YEAR WITH POSSIBLE CONTINUATION BASED ON MEETING CRITERIA. THE CRITERIA FOR THE RONCALLI SCHOLARSHIP INCLUDES ACCEPTANCE AT AN ACCREDITED COLLEGE, UNIVERSITY, OR TECHNICAL SCHOOL, A MANITOWOC COUNTY RESIDENT, A GRADE POINT AVERAGE OF 3.0 OR ABOVE IS DESIRED, AND DEMONSTRATED HEALTH CAREER INTEREST. THESE SCHOLARSHIPS ARE PROVIDED FOR ONE YEAR. X 1 1 X X X X 1 0 0 0 0 1 0 1 0 RYAN M DOPIRAK MD 495011 0 598497 0 32348 0 9299 0 21293 0 1156448 0 15000 0 GARY SCHMIDT MD 164821 0 2875 0 17200 0 3892 0 13232 0 202020 0 0 0 PRADEEP GIRIYAPPA MD 185351 0 52410 0 31326 0 9299 0 18952 0 297338 0 15000 0 MICHAEL B MCCORMICK MD 270363 0 0 0 52465 0 9299 0 24262 0 356389 0 15000 0 JAMES W HOFTIEZER MD 304802 0 292320 0 9664 0 5549 0 24729 0 637064 0 0 0 WILLIAM D HAMPTON MD 286733 0 24960 0 22551 0 9299 0 19097 0 362640 0 0 0 MARY A GOVIER MD 169468 0 250 0 7933 0 3838 0 20535 0 202024 0 0 0 MARK P HERZOG 413994 0 45284 0 137633 0 92026 0 22481 0 711418 0 117698 0 PATRICIA HUETTL 219778 0 17661 0 2467 0 39460 0 22254 0 301620 0 0 0 STEVEN D DRIGGERS MD 406996 0 36851 0 119855 0 80228 0 18939 0 662869 0 100548 0 MARY MAURER 190009 0 16249 0 55526 0 40160 0 3176 0 305120 0 49237 0 MARCIA DONLON VP MEDICAL 132310 0 12758 0 21992 0 24283 0 20680 0 212023 0 0 0 KIRK DIMITRIS MD 445245 0 702078 0 59708 0 9299 0 19273 0 1235603 0 10000 0 DAVID MIKOLYZK MD 442225 0 342732 0 18558 0 9299 0 21155 0 833969 0 0 0 MILAN JORDAN MD 297027 0 429247 0 33979 0 9299 0 11163 0 780715 0 0 0 NANCY N BUTLER MD 299739 0 389929 0 48195 0 9299 0 10203 0 757365 0 15000 0 JEFFREY A JACOBY MD 498680 0 737072 0 65512 0 9299 0 21411 0 1331974 0 15000 0 PATRICK J BRANDEL 0 0 0 0 105893 0 0 0 0 0 105893 0 0 0 PART I, LINE 1A ONE KEY EMPLOYEE WAS REIMBURSED $1,400 FOR SOCIAL CLUB DUES. PART I, LINE 4A PATRICK BRANDEL, FORMER CFO, RECEIVED SEVERANCE PAYMENTS TOTALING $105,893. PART I, LINE 6 THE SENIOR SUCCESSSHARE PROGRAM IS AN AT RISK COMPENSATION PROGRAM WHICH IS BASED ON BALANCED STRATEGIC ACCOMPLISHMENTS AS APPROVED ANNUALLY BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD OF DIRECTORS. ELIGIBLE PERSONS INCLUDE THE PRESIDENT/CEO, CHIEF MEDICAL OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF INNOVATION OFFICER. PART I, LINE 7 A PORTION OF PHYSICIAN SALARY IS BASED ON INDIVIDUAL PRODUCTION PERSONALLY RENDERED SERVICES. A WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 97710VPE2 2003-09-09 9922000 SEE SCHEDULE K, PART V 0 0 0 B WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 97710V2S6 2007-04-26 45170000 SEE SCHEDULE K, PART V 0 0 0 A 1576000 9922000 244000 9677000 2006 0 0 1 1 B 3607000 45170000 3550000 16347000 485000 4990000 2009 1 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATION FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 10/06/2008 ISSUER NAME: WISCONSIN HEALTH AND EDUCATION FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2012 PART I, LINE A, COLUMN F: THE PURPOSE OF THE BOND ISSUE WAS A PROJECT CONSISTING OF THE CONSTRUCTION, RENOVATION AND EQUIPPING OF AMBULATORY CARE, DIAGNOSTIC IMAGING, REHABILITATION, OCCUPATIONAL MEDICINE, PRIMARY CARE AND ORTHOPEDIC FACILITIES AT CERTAIN HOLY FAMILY MEMORIAL HEALTH FACILITIES. PART I, LINE B, COLUMN F: THE PURPOSE OF THE BOND ISSUE WERE 1) THE ACQUISITION, CONSTRUCTION, RENOVATION, REMODELING AND EQUIPPING OF CERTAIN HOSPITAL AND OTHER HEALTHCARE FACILITIES AS IDENTIFIED IN A NOTICE OF PUBLIC HEARING PUBLISHED IN CONNECTION WITH THE ISSUANCE OF THE BONDS INCLUDING THE ACQUISITION OF TELEMETRY MONITORS AND AN MRI SYSTEM 2) THE CURRENT REFUNDING OF ALL THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE (WHEFA) BONDS, SERIES 1995, 3) THE ADVANCE REFUNDING OF ALL OF THE WHEFA BONDS, SERIES 1998A, AND 4) THE ADVANCE REFUNDING OF A PORTION OF THE WHEFA BONDS, SERIES 2003A. LINDA BRANDEL SPOUSE OF FORMER CFO 14625 WAGES 0 CLAIRE JORDAN SPOUSE OF HIGHEST COMPENSATED EMPLOYEE 32181 WAGES 0 NORTH END HOME MED SCS LLC SERVE AS DIRECTORS ON BOTH ORGANIZATIONS 83211 100% OWNED LLC - INCOME FROM CONT. OPS 0 HOLY FAMILY HEALTH SERVICES SERVE AS DIRECTORS ON BOTH ORGANIZATIONS -6745 100% OWNED FOR PROFIT - INCOME FROM CONT. OPS 0 FORM 990, PART VI, SECTION A, LINE 6 HOLY FAMILY MEMORIAL IS SPONSORED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A HOLY FAMILY MEMORIAL OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PRIMARILY TO THE RESIDENTS OF MANITOWOC COUNTY, WISCONSIN. HOLY FAMILY MEMORIAL IS OPERATED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., WHICH IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. IS A NOT-FOR-PROFIT HEALTHCARE HOLDING COMPANY INCORPORATED TO MONITOR AND MANAGE HEALTHCARE OPERATIONS. THE BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN EIGHTEEN INDIVIDUALS. THE PRESIDENT OF THE CORPORATION AND CHAIR OF THE PHYSICIAN COUNCIL SHALL BE EX-OFFICIO MEMBERS WITH FULL VOTING PRIVILEGES. IN ADDITION TO THE EX-OFFICIO BOARD POSITIONS, THE BOARD OF DIRECTORS SHALL INCLUDE FOUR MEMBERS OF FRANCISCAN SISTERS OF CHRISTIAN CHARITY AND AT LEAST FOUR PHYSICIANS. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER AS OUTLINED IN THE CORPORATE BYLAWS. FOR EXAMPLE, THE GOVERNING BOARD SUBMITS NAMES OF NEW BOARD MEMBERS TO THE MEMBER AND THE MEMBER APPOINTS THEM. APPROVAL OF THE PHILOSOPHY, MISSION & VISION STATEMENTS, MORTGAGE, LEASE OR SALE OF REAL ESTATE MUST BE APPROVED BY THE MEMBER. A CERTIFIED AUDIT OF CORPORATE FUNDS OR THE ANNUAL FISCAL AUDITOR MUST BE APPROVED BY THE MEMBER, ETC. FORM 990, PART VI, SECTION B, LINE 11 THE CHAIR OF THE GOVERNING BOARD REVIEWS THE 990 PRIOR TO FILING. AN OVERVIEW OF THE 990 ALONG WITH SPECIFIC SECTIONS ON GOVERNANCE, COMMUNITY BENEFITS, AND CONFLICT OF INTEREST IS PRESENTED TO THE BOARD OR BOARD COMMITTEE. THE COMPENSATION AND EVALUATION SUBCOMMITTEE REVIEWS THE 990 SECTIONS RELATED TO COMPENSATION PRIOR TO FILING. COPIES ARE AVAILABLE TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, GOVERNING BOARD MEMBERS ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY TO REVIEW AND SIGN THE CERTIFICATION ON WHICH THEY DISCLOSE ANY CONFLICTS. AT EACH BOARD OR COMMITTEE MEETING WHERE THERE WILL BE A VOTE, THE CHAIRPERSON ASKS IF THERE ARE ANY CONFLICTS TO THE PARTICULAR ISSUE. IF THERE IS A CONFLICT, THAT PERSON ABSTAINS FROM DISCUSSION & VOTING. ALL PHYSICIANS, NETWORK LEADERS, AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST ANNUALLY. CONFLICT OF INTEREST IS MONITORED THROUGH HOLY FAMILY MEMORIAL'S COMPLIANCE DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15 LINES 15 A & B - HOLY FAMILY MEMORIAL HAS A SENIOR LEADER COMPENSATION POLICY. THE PROCESS OF DETERMINING THESE SALARIES ARE GOVERNED BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD. THE POLICY COVERS THE FOLLOWING POSITIONS: PRESIDENT AND CEO, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, AND CHIEF INNOVATION OFFICER. EXECUTIVE SALARY DATA IS EVALUATED(LAST DONE 12/10/12) USING THREE OR MORE MAIN DATA SOURCES FROM NATIONALLY RECOGNIZED EXECUTIVE COMPENSATION FIRMS. TOTAL COMPENSATION FOR EACH SENIOR LEADER (SALARY, BENEFITS AND INCENTIVE) IS EVALUATED FOR MEMBERS OF THE SENIOR LEADERSHIP TEAM. ALSO CONSIDERED ARE CURRENT MARKET CONDITIONS, INDEPENDENT CONSULTANT INPUT, EXTERNAL NATIONAL COMPENSATION DATA, AND MARKET COMPETITIVENESS. THE POLICY REFLECTS HFM'S MISSION AND VALUES AND THE LOCAL COMMUNITY EXPERIENCE BY EMPHASIZING REWARDS BASED ON WELL ROUNDED ACCOMPLISHMENTS IN THE AREAS OF MISSION AND RELATIONSHIPS, KEY STRATEGIES, AND OPERATIONS. FORM 990, PART VI, SECTION C, LINE 19 HOLY FAMILY MEMORIAL'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE FROM THE WI DEPARTMENT OF FINANCIAL INSTITUTIONS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE DACBOND.COM WEBSITE AND HOLY FAMILY MEMORIAL SUBMITS FINANCIAL INFORMATION TO THE STATE OF WI ANNUALLY. OUR FORM 990 IS AVAILABLE UPON REQUEST AND CAN BE SEEN ON THE GUIDESTAR WEBSITE. FORM 990, PART VII, SECTION A, PART 1A LINES 1 THROUGH 7: HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS INCLUDES SEVEN EMPLOYED PHYSICIANS. THE COMPENSATION REPORTED FOR THESE DIRECTORS IS FOR THEIR SERVICES AS A PHYSICIAN. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN RESTRICTED ASSETS 277,649. RESTRICTED DONATIONS RECORDED TO BALANCE SHEET -59,455. ROUNDING 9. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX PROCESS. NORTH END HOME MED SCS LLC 3310 CALUMET AVENUE MANITOWOC WI 54220 391868808 MEDICAL EQUIPMENT WI -5153 2067315 HFM INC FRANCISCAN SISTERS OF CHRISTIAN CHARITY 1415 SOUTH RAPIDS ROAD MANITOWOC WI 54220 391530622 HEALTHCARE WI 501(C)(3) LINE 1 N/A 0 ST PAUL ELDER SERVICES INC 316 EAST 14TH STREET KAUKAUNA WI 54130 391029149 ELDER CARE WI 501(C)(3) LINE 1 N/A 0 GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HOLDING CO. OH 501(C)(3) LINE 3 N/A 0 FRANCISCAN CARE SERVICES INC 430 N MONITOR ST WEST POINT NE 68788 470486026 HEALTHCARE NE 501(C)(3) LINE 3 N/A 0 SILVER LAKE COLLEGE OF THE HOLY FAMILY INC 2406 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390980974 HIGHER EDUCATION WI 501(C)(3) LINE 2 N/A 0 HOLY FAMILY CONVENT OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY 2409 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390808523 RELIGIOUS WI 501(C)(3) LINE 1 N/A 0 HOLY FAMILY HEALTH SERVICES 3310 CALUMET AVENUE MANITOWOC WI 54220 391572253 PHARMACY WI HOLY FAMILY MEMORIAL INC C 49928 1344357 1.00000 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 HOLY FAMILY HEALTH SERVICES - INTEREST ON LOAN A 0 ACTUAL EXPENSE HOLY FAMILY HEALTH SERVICES - HFM LOAN TO HOLY FAMILY HEALTH SERVICES D 0 LOAN BALANCE PAID OFF JAN 2012 HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSUPPLIESRENT Q 1109554 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT J 51000 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES P 89600 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES P 704000 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC P 1406934 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS P 10481000 ACTUAL EXPENSE