2013-05-14T15:07:32-05:00 2012-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2011-07-01 390807060 SACRED HEART HOSPITAL OF HOSPITAL SISTERS OF THIRD ORDER OF ST FRANCIS % STEVE PALECEK SACR 7157176122 900 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 Julie Manas 2013-05-10 true 6142492300 2011 2016-02-24 21:20:13Z julie manas 900 West Clairemont Ave EAU CLAIRE WI 54701 228715037 false 0928 X WWW.SACREDHEARTHOSPITAL-EC.ORG X 1890 WI To provide the means whereby Sacred Heart can Continue their apostolic mission to serve the sick, the aged, the poor and the terminally ill without regard to race, color, creed, or national origin. 11 8 1685 291 1431188 0 396423 595165 206954736 215050971 13997746 10636698 3344179 2376911 224693084 228659745 0 0 0 0 88352274 92156664 0 0 0 104100767 100970670 192453041 193127334 32240043 35532411 414270452 443986782 108056774 129631664 306213678 314355118 X SEE SCHEDULE O - ORGANIZATION'S MISSION false false 157561995 215104781 SEE SCHEDULE O - PART III Line 4A 157561995 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false true false false false false true true false false false false true 67 0 1685 true true true false false false false false false false false false X 11 8 false false false false true true true true true false false true true true true true true true true false X STEVE PALECEK 7157173783 900 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 X SISTER MARYBETH CULNAN OSF 1.0 X 0 0 0 Greg Heiler MD 1.0 X 0 0 0 JEFFREY R HALLOIN 1.0 X X 0 0 0 Sr Trudy O'Conner OSF 1.0 X 0 0 0 Dennis Breen MD 1.0 X 0 0 0 JULIE FURST-BOWE EDD 1.0 X 0 0 0 JAMES DOCKSEY 1.0 X 0 0 0 STEPHEN RONSTROM 40.0 X X 0 602330 157718 Karen Hebert 1.0 X 0 0 0 Ann m Carr 0.25 X X 0 225813 215561 JOE FESENMAIER 1.0 X 0 0 0 LARRY SCHUMACHER 1.0 X 0 722931 254068 JAMES THEISEN 1.0 X X 0 0 0 JULIE MANAS 40.0 X X 0 0 0 KENNETH VENUTO 40.0 X 306028 0 41455 FAYE DEICH 40.0 X 287911 0 32089 Amy Dwyer 40.0 X 180043 0 209831 John Lamoureux 40.0 X 320767 0 197226 Lance Levendowski 40.0 X 219433 0 81741 John Waciuma 40.0 X 637631 0 50084 MONICA MCDONALD 32.0 X 368091 0 45972 KEVIN HESS 40.0 X 289840 0 58009 2609744 1551074 1343754 68 false true false Sodexo Inc Affliates 4880 Paysphere Circle CHICAGO IL 60674 Contracted Labor 1485725 Dept of Family Medicine 1100 Delaplaine Court MADISON WI 53715 Contracted Labor 1425821 HT Klatzke and Associates 1511 East Superior St DULUTH MN 55812 Advertising Consult. 1272167 Medical Staffing solutions PO BOX 101 RICE LAKE WI 54868 CONTRACTED LABOR 1224984 Samuels Group 311 Financial Way WAUSAU WI 54401 Constr. Contractor 903806 33 595165 595165 NET PATIENT REVENUE 900099 212711215 212711215 REFERENCE LAB SERVICES 621500 1275745 1275745 DEPARTMENTAL REVENUE 900099 1049238 1049238 OTHER OPERATING REVENUE 900099 14773 14773 215050971 10691990 10691990 0 0 1841327 1841327 1841327 1841327 55292 -55292 -55292 -55292 0 0 0 SHARED SERVICE INCOME 621500 209253 53810 155443 EMPLOYEE & SENIOR CAFETERIA 722210 35546 35546 GIFT SHOP 453220 290785 290785 535584 228659745 213829036 1431188 12804356 0 0 0 0 0 0 0 70068227 62568747 7499480 3860420 3447235 413185 13273762 11853057 1420705 4954255 4423996 530259 9103500 9103500 1090264 1090264 0 0 0 0 18613498 6530010 12083488 1965400 1965400 788282 652103 136179 250191 250191 0 2300188 1792129 508059 44968 21240 23728 0 297281 222576 74705 1545425 1545425 0 13451796 13249011 202785 248082 49601 198481 CLINICAL SUPPLIES 34415468 34108373 307095 0 PROVISION FOR BAD DEBT 5794200 5794200 MEDICAID ASSESSMENT 5611393 5611393 EQUIPMENT RENTAL 1403434 1403434 4047300 4039274 8026 193127334 157561995 35565339 0 611422 567321 1212908 4652546 10755435 0 27874568 25628957 0 0 0 0 0 0 5708568 5382739 527337 743671 222263223 123250326 102467362 99012897 253736297 298004169 0 0 0 0 0 0 11376555 9994482 414270452 443986782 20895477 24159462 0 0 0 0 60712969 59527523 0 0 0 0 0 0 0 0 26448328 45944679 108056774 129631664 X 298997116 307362244 2248106 1883699 4968456 5109175 306213678 314355118 414270452 443986782 X 35532411 -27390971 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8026 8026 false false Schedule C Part IV SACRED HEART HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES AND PART OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. 501443 501443 111556897 48072359 63484538 3478868 2173670 1305198 103809409 73004297 30805112 2916606 2916606 99012897 0 ACCRUED PENSION LIABILITY 37489667 INTEREST RATE SWAP PROGRAMS 7199427 OTHER LONG-TERM LIABILITIES 500000 ESTIMATED SELF-INSURANCE LIAB 755585 45944679 ASC SUBTOPIC 740-10 HSHS HAS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO.109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2012 AND 2011, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS. true true true X true X true true true false true true 1 5586617 5586617 0.02980 1 31451762 23559938 7891824 0.04210 1 1059018 658481 400537 0.00210 3 38097397 24218419 13878978 0.07400 107 33281 1247979 284332 1114524 0.00600 11 767 1507211 9660 1497551 0.00800 3 1650 17364676 12168989 5195687 0.02770 1 0 94 0 94 0.00000 6 45036 128155 10000 118155 0.00060 128 80734 20248115 12472981 7926011 0.04230 131 80734 58345512 36691400 21804989 0.11630 true 1948631 73470475 95061837 -21591362 X true true 1 1 Sacred Heart Hosptial

900 West Clairemont Ave Eau Claire WI 54701

X X X X Behavioral Health Dialysis Inpatient Rehab Sacred Heart Hosptial 1 true X X X X X X X X X 11 true true true X X X X X X X X false true true 150. true 400. true X X X X true true X X X X X X X true false true X false false Part I, Line 3c Not applicable as the organization follows FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals. Part I, Line 6a The hospitals community benefit report can be accessed at www.sacredhearteauclaire.org Part I, Line 7, column (F) The percent of charity care and certain other benefits as a percent of total expenses less bad debt is 11.63%. The percent of bad debt as a percent of total expenses less bad debt is 3.1%. THE AMOUNT OF BAD DEBT EXPENSE REMOVED WHEN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN (F) WAS $5,794,200. Part I, Line 7 Charity care is calculated by determining the total amount from patient billing that is written off to charity care charge codes or allowances. This amount matches the number that is reported on our fiscal year ending 2012 audited financial statements. The total charity care dollar amount is then reduced to cost by applying the hospital's cost to charge ratio as calculated on IRS schedule H - worksheet 2. Part II The hospital continues to be involved in hundreds of community building activities each year that address the root cause of heath care problems or work to lay a foundation for a healthier, safer, and better educated community. These activities are most often conducted through the hospital's two holistic healing centers: The Center for Healthy Living, and The Healing Place: A Center for Life's Journeys. The hospital's Regional Cancer Center also offers numerous, ongoing programs related to cancer care. The hospital offers various health screenings, such as blood pressure screenings, at many health fairs in the community throughout the year. The hospital also conducts numerous "Green" environmental stewardship and sustainability efforts (recycling and reusing) including donating surplus food to the St. Francis Food Pantry, and donating used equipment to Third World countries via the Hospital Sisters Mission Outreach. For a more complete and thorough listing of sustainability efforts and free programs offered throughout the year by Sacred Heart Hospital, see explanation for Part 6, Line 5 of this form. Part III, Line 4 The Hospital has committed significant resources in serving the uninsured. This includes the cost (determined using a cost to charge ratio) of providing services to uninsured beneficiaries in excess of payments received. This population is segregated into those patients who have the ability to pay and chose not to pay (Bad Debt) and those patients who do not have the ability to pay (Community Care) In accordance with the Catholic Health Association guidelines. Any shortfall from servicing the Community Care population is considered a community benefit and thus included in our community benefit calculations. Any shortfall from servicing the Bad Debt population is not considered a community benefit and thus not included in our community benefit calculations. Part III, Line 8 The Hospital has committed significant resources in serving the Medicare population. This includes the cost (determined using a cost to charge ratio) of providing services to primarily elderly beneficiaries of the Medicare program, in excess of governmental and managed care contract payments. In accordance with the Catholic Health Association guidelines, any shortfall from servicing the Medicare population is not to be considered a community benefit and thus not included in our community benefit calculations. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. The hospital Medicare shortfall at cost for fiscal year 2012 was $21,591,362. Part III, Line 9b Patients are informed of our financial payment options (including Community Care) at the time of registration via the registrars and other hospital personnel, and through our patient statement process; information is also available on our website. The hospital employs financial counselors who are responsible for educating patients about potential eligibility for assistance under federal, state, or local government programs, or under the hospital's charity care policy or uninsured patient discount policy. If it is determined that a patient may be eligible for assistance, the financial counselor will assist the patient with applications for the appropriate program. Collection efforts include a series of patient statements, letters, and phone calls; all of which include discussion about the Community Care program. Patients who qualify for the Community Care program can receive up to 100% reduction in their financial obligation. Patients who are granted a partial reduction are expected to set up reasonable payment arrangements to pay the remaining balance. Patients who are referred to a collection agency are encouraged to make payment arrangements with the agency. A 10% prompt payment discount is available to all patients if payment in full is received within 30 days of the first statement. If a patient is unable to pay their balance in full within 30 days of the first statement or need to make alternative payment arrangements, they are responsible for contacting Patient Financial Services to avoid further collection activity. Patients without insurance receive an uninsured discount, which is reflected on the patient statement. Uninsured patients may qualify for an additional discount based on household income and family size, and may take advantage of the prompt payment discount. Patient Financial Services can assist patients in this regard. Patients are informed payment options include: * Cash, Check, or Credit Card (Visa, Mastercard, and Discover) * Helping Hands Lending Program: in collaboration with a local financial institution, the hospital offers a lending program, which provides an interest-bearing monthly payment option. * Community Care: A hospital-based financial assistance program provides full or partial reductions to patients who are not able to meet their obligations and who meet certain income and asset criteria. Patient Financial Services can offer information to patients. Sacred Heart Hospital devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, in accordance with standards defined by the Catholic Health Association USA ("CHAUSA"), Sacred Heart Hospital has recognized an unreimbursed cost of community benefit of $21,804,989. The cost of servicing the people qualifying for public indigent programs (including Medicaid and other public programs) was $8,292,361. The cost of our hospital based community care program was $5,586,617. Sacred Heart also provided benefits of $7,926,011 to the community through many reduced price services and free programs offered throughout the year based upon activities and services that Sacred Heart Hospital believes will serve a bona fide community health need. EVERY EFFORT IS MADE PRIOR TO, DURING AND AFTER PROVISION OF MEDICAL SERVICES TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR CHARITY/COMMUNITY CARE AND TO ASSIST THE PATIENT IN COMPLETING THE APPLICATION AND PROVIDING ADEQUATE DOCUMENTATION. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR THE FULL BALANCE OF THEIR ACCOUNT, THE ENTIRE AMOUNT IS WRITTEN OFF TO CHARITY/COMMUNITY CARE AND HENCE NO DEBT COLLECTION IS PURSUED. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR A PORTION OF THEIR ACCOUNT BALANCE, THAT PORTION IS WRITTEN OFF TO CHARITY/COMMUNITY CARE, WITH THE PATIENT BEING RESPONSIBLE FOR THE REMAINDER OF THE BALANCE. ADDITIONALLY, REASONABLE EFFORT WILL BE MADE TO OBTAIN THIRD-PARTY OR GOVERNMENT PAYER REIMBURSEMENT ON BEHALF OF THE PATIENT. IF THOSE EFFORTS ARE NOT FRUITFUL, AN OFFER WILL BE EXTENDED TO THE PATIENT TO MAKE INSTALLMENT PAYMENTS ON THEIR BALANCE. ONLY AT SUCH POINT THAT THE PATIENT DEFAULTS ON INSTALLMENT PAYMENTS OR REFUSES TO COOPERATE WITH THE HOSPITAL'S EFFORTS TO BE REIMBURSED WILL THE ACCOUNT BE SENT TO COLLECTIONS. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO QUESTION VI, 3. Part V, Section B, line 3 Sacred Heart Hospital conducted a community health needs assessment in 2012 identifying unmet community health needs to develop a plan to help improve the health of our community. Our plan is aimed at enhancing the health and wellness of the community we serve through clinical program and services, community education and outreach, and continued collaboration and partnerships with others. A comprehensive and unique approach was utilized for this assessment. It included an analysis of reliable health, social and demographic data, survey data, and input from local experts in public health, minority health and chronic disease. The CHNA also integrated direct input from over 800 citizens who provided voice to what they believe could enhance the health and well being of their community. Please refer to the response to part v, section b, line 4 below for how sacred heart received feedback from these individuals. Part V, Section B, line 4 As part of the CHNA process, Sacred Heart Hospital and St. Joseph's Hospital in Chippewa Falls, WI, teamed up to conduct two "town hall" meeting sessions with over 800 individuals participating to give voice to what they believe could enhance the health and well being of their community. Part V, Section B, line 5c The entire Community Health Needs Assessment and Community Benefit Plan and Implementation Strategy can be found on our website at: www.sacredhearteauclaire.org/community-health-needs-assessment Part V, Section B, line 7 The hospital's Community Health Needs Assessment and associated implementation strategy were completed in FY2012, the reporting year. The implementation strategy started to be executed in FY2012. additional information will be provided on the FY2013 return detailing the hospital's execution of the implementation strategy. Part V, Section B, line 13g Patients are informed of our financial payment options (including Community Care) at the time of registration via the registrars and other hospital personnel, and through our patient statement process; information is also available on our website. The hospital employs financial counselors who are responsible for educating patients about potential eligibility for assistance under federal, state or local government programs or under the hospital's charity care policy or uninsured patient discount policy. If it is determined that a patient may be eligible for assistance, the financial counselor will assist the patient with applications for the appropriate program. Complete information on our Community Care Program can be found on the hospital's website. This information includes information on what community care is, who is eligible, guidelines to determine household income, needed proof of income and assets, what services are covered, how to apply, and notification of community care decision. Needs assessment The FY2012 Community Health Needs Assessment began with a thorough review of Healthiest Wisconsin 2020, the 2010 Community Needs Assessment published by the United Way of the Greater Eau Claire, and the 2008 Clear Vision Eau Claire report. Several additional sources of quantitative health, social and demographic data specific to the Hospital's service area provided by local public health agencies, healthcare associations and other data sources were utilized to update this information. Qualitative information included in the assessment was derived from National Research Corporation (NRC) which conducted an internet-based survey of over 300 households in the Eau Claire core-based statistical area (CBSA) in 2010, and from over 800 individuals who participated in the 'visioning' process comprised of over 30 focus groups and two 'town hall' meeting sessions conducted by Sacred Heart and St. Joseph's hospitals. Sacred Heart Hospital's Community Needs Assessment Team (CNAT) was responsible for facilitating the assessment process as well as implementation plan development. The CNAT was comprised of individuals from Sacred Heart Hospital involved in the development and provision of programs and services aimed at meeting the needs of patients and residents of the Eau Claire area and surrounding communities. Their engagement with this process was vital, as each member brought direct knowledge of the population served, their needs, and the services currently available to address these needs. Many of the members were also actively involved in other community health-related groups and non-profit organizations and conveyed input from these groups throughout the process. The Community Health Needs Assessment and associated implementation strategy will be used to guide our efforts in FY2013. For prior years, we used a similar approach to identify community need - although the "visioning" process was new for FY2012. Patient education of eligibility for assistance. Upon admission to Sacred Heart Hospital, patients are given a "Guide to Services" booklet which includes a section about Hospital Bills and the availability of financial assistance. The availability of Financial Counselors and their contact information is also provided in the guide. Additionally, patients in Admitting have available to them a print brochure About Your Hospital Bill that thoroughly explains financial assistance, medical claims, charity care, etc., another print brochure is devoted specifically to thoroughly explaining the hospital's Charity Care program. Social Services staff informs and assist patients and family members about financial assistance programs the hospital offers and their eligibility and provides assistance in helping patients and family members access financial assistance. A public notice of medical assistance regarding prescriptions and pharmaceuticals for Social Security members is also posted outside the Admitting area. Sacred Heart Hospital has devoted significant, in-depth information and education on its web homepage focusing on financial assistance, hospital billing, medical claims and charity care. Patients that do not have health insurance are informed of the hospital discount available to them, how to access hospital financial counselors and the availability of charity care and eligibility requirements. Eligibility forms and application forms are available for downloading from the website. THE COMMUNITY HEALTH NEEDS AND ASSOCIATED IMPLEMENTATION STRATEGY WILL BE USED TO GUIDE OUR EFFORTS IN FY2013 AND IS AVAILABLE AT http://www.sacredhearteauclaire.org/community-report. Community Information Sacred Heart Hospital serves a population of approximately 400,000 people in western Wisconsin. The Hospital's service area includes urban and rural areas and encompasses all of Eau Claire, Chippewa and Rusk counties, as well as portions of Barron, Buffalo, Clark, Dunn, Jackson, Pepin, Sawyer, Trempealeau, and Washburn counties. About 40% of the population lives in Eau Claire and Chippewa counties (51% with the addition of Dunn County). The population in the remaining counties is significantly less, with 10 out of 12 service area counties considered rural by the U.S. Department of Agriculture. The majority (approximately 45%) of all inpatient admissions at Sacred Heart Hospital originate from Eau Claire County. The City of Eau Claire is located 90 miles east of the Twin Cities and is the ninth largest city in the state of Wisconsin, with a population of just over 65,800. The Hospital's service area population is aging, much like the rest of the nation. Though western Wisconsin is less diverse than the nation as a whole (92.9%) white/non-Hispanic), there are several unique minority populations found within the Hospital's service area, including the Amish, Mennonite and Hmong communities. Wisconsin has the fourth highest Amish population in the nation. Sacred Heart's service area mean household income is about $43,000, roughly $7,000 lower than the national average. Promotion of Community Health Sacred Heart Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), Sacred Heart Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 122 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Eau Claire and surrounding areas. The hospital is governed by a Board of Directors, the majority of which is comprised of persons who reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that Sacred Heart Hospital is responding to community need. During the last year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. There are also other bodies that assist Sacred Heart Hospital connect with the community, such as our Advisory council, Friends of Sacred Heart Hospital Foundation, and our Volunteer Partners Board. Also consistent with its exempt purpose, Sacred Heart Hospital has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, Sacred Heart Hospital reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, Sacred Heart Hospital is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. Sacred Heart Hospital also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, Sacred Heart Hospital provided over $21.8 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, during this period, Sacred Heart Hospital provided $21.6 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance and over $21.6 million (at cost) in excess of Medicare payment for health care services. Responding to Community Need The range of benefits provided by Sacred Heart Hospital flows from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by Sacred Heart Hospital, and they often relieve a burden that would otherwise be carried by government. As part of Sacred Heart Hospital's mission to provide healing and hope to the people we serve, we have developed community benefit initiatives that 1) expand access to health care, 2) enhance overall health status, and 3) promote medical education. The hospital strengthens the health of our communities by continually reinvesting any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services. These investments ensure that our hospital can continue to provide high quality, compassionate care to all who walk through our doors. In accordance with standards defined by the Catholic Health Association USA (CHAUSA), Sacred Heart Hospital has recognized an unreimbursed cost of community benefit of $21,804,989. The cost of servicing the people qualifying for public indigent programs (including Medicaid and other public programs) was $8,292,361. The cost of our hospital based community care program was $5,586,617. Sacred Heart also provided benefits of $7,926,011 to the community through many reduced price services and free programs offered throughout the year based upon activities and services that Sacred Heart Hospital believes will serve a bona fide community health need. These include: * The Healing Place: A Center for Life's Journeys is Sacred Heart Hospital's free grief and holistic healing center for those experiencing loss and/or adjustment issues, such as those brought about by death, divorce, disability/illness, unemployment, military service, etc. Support services include: grief support groups, 1:1 counseling, workshops, presentations for individuals and families dealing with loss and major life transitions. During the past year, The Healing Place has offered: o 1:1 counseling to anyone needing help with a life adjustment issue o Evening and Daytime Spouse Loss groups for those who have lost a spouse, both time limited and on-going o Pregnancy and Infant Loss Support Group for miscarriage, stillbirth and early infant death o Parents Grief Group for parents who have lost a child o Sponsor of International Survivor's of Suicide Day o Classes for teaching resiliency/coping skills/stress management o Workshops and presentations for various institutions and businesses on topics related to grief, loss, and coping o Special programs and workshops including Grief in the Workplace and Grief and the Holidays o Support groups for those experiencing divorce or loss of a parent * Center for Healthy Living and other educational classes and resources including: o Prepared Childbirth (expectant parent classes, sibling classes, breastfeeding classes, and lactation consulting) o CPR classes o Babysitting Seminars o Pediatric Health Fair with hands-on activities in health, wellness and safety for second grade students in Eau Claire County o Wellness programs, services and retreats o Participation in community and local business health fairs o Caring for the Caregiver Workshop o Center for Medical Excellence Community Health Information Room with access to print and electronic medical journals and other health resources for patient, family, and community use o Annual "Woman to Woman" Healthcare Expo, includes health and prevention services with motivational speaker and screenings o Indoor Sports Center "Get Hooked on Health" Kids Expo (safety education, health & wellness) o Spirit of Women education programs, speakers and free screenings o Monthly car seat installations and education programs specific for WIC families o Helmet fitting clinics o Celebration of Woman Event (with Junior League of Eau Claire) o "Day of Dance" to celebrate health and learn about cardiovascular disease, including BMI testing, blood pressure and sleep apnea screenings o Joint Renew Camp for patients who will undergo joint replacement surgery o Safety Town program - specific for pre K-K students to teach basic safety (taught in Bloomer, Menomonie and Eau Claire) o Coat Drive collects over 6,000 coats annually and given to those in need * Cancer care related programs: o Look Good, Feel Better - A program for women to help them cope with the impact of cancer treatment on body image. Includes beauty makeovers and wigs as needed. Monthly program o Touched by Cancer - A support group for cancer patients and their families. Seminars on cancer-related issues such as nutrition, stress-reduction, family issues, cancer in the workplace, spiritual support. Meets twice a month. o Eau Claire Partners- A support group of breast cancer patients and survivors. Dealing with issues related to body image, sexuality, finding clothes and lingerie that fit, side-effects of breast cancer treatment, etc. Meets twice a month. o Yoga - Stress-reduction yoga class for cancer patients and survivors. Meets weekly in 6-week sessions. o C.L.I.M.B./C.H.A.T. - Programs for school age children (CLIMB) and teens (CHAT) to help them understand and cope with having a parent or family member in treatment for cancer. Meets weekly in 6-week sessions. o Livestrong - A program co-sponsored by the Lance Armstrong Foundation in conjunction with the YMCA. This is a program of exercise for cancer patients that helps them maintain conditioning and decrease fatigue during treatment. It starts in the cancer center with volunteers from the UW-EC physical therapy program hosting a 6 week session. Patients wishing to continue af AFFILIATED HEALTH CARE SYSTEM SACRED HEART HOSPITAL is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and more than 2,000 physician partners across Illinois and Wisconsin. The Mission of HSHS is to reveal and embody Christs healing love for all people through our high quality Franciscan health care ministry. We live our Mission by healing those who seek our care, as well as through our Community Benefit initiatives. Working collaboratively with others in the 12 communities we serve, our Community Benefit efforts are successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. Across HSHS, we collectively provided $174.2 million in Community Benefits (or 9.7% of total hospital expenses) in FY2012. Included in this amount was $43.1 million provided for Charity Care and $97.9 million for unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources to care for Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $168.4 million. HSHS hospitals also recorded $106.6 million in uncollectible accounts. Beyond the dollars invested in our Community Benefit programs, HSHS also continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing do, we ensure we are able to meet the ongoing demand for high quality, efficient and easily accessible health care. Recognizing that the health care delivery model in the U.S. is evolving, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care around the needs of each patient. During FY2012, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for the individual. Our efforts to ensure residents in the communities we serve receive the right care at the right time often involve partnering with others to achieve this goal. Across our two-state system, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. In western Wisconsin, St. Josephs Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,216 patient visits, a 25% increase from the prior year. With more than 150 individuals volunteering, the clinic provided over 6,500 hours (including 700 physician hours and 1,500 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In northeastern Wisconsin, St. Vincent Hospital in Green Bay supports patient care for the uninsured at the NEW Community Clinic by paying a nurses salary and offering free and discounted laboratory and radiology services. More than 70% of patients who use the clinic report the care they received helped keep them out of the Emergency Department. St. Nicholas Hospital in Sheboygan proactively reaches out to local Hmong and Hispanic organizations to ensure these populations can participate in free screenings and health education programs. Through this ongoing outreach initiative, St. Nicholas engaged more than 350 people last year, and in many cases was able to identify critical health conditions early and provide appropriate follow-up care. A Woman's Place at St. Mary's Hospital Medical Center in Green Bay reaches out to Hispanic neighbors to provide health and wellness education, health screenings, resources and referral services. Last year A Woman's Place touched the lives of more than 7,000 women through health screenings, educational events, classes and its resource center. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St.Anthonys Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthonys helped underwrite the cost of prescription medications for more than 430 residents. In southwest Illinois, St. Joseph's Hospital in Highland recognized many rural residents did not have a reliable means of transportation and partnered with generous individuals in the community to offer a free transportation service. The Friends Van, fully supported by the Friends of St. Joseph's Hospital, provides free rides to medical, dental and other personal appointments within a 20-mile radius of Highland. In FY2012, the Friends Van transported 2,050 individuals for a total of 12,561 miles. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Charity Care program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Charity Care programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our charity care policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our mission to embody Christs healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiativesthat promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. To address metabolic disease management, St. Francis Hospital in Litchfield, Illinois, partners with Montgomery County Health Department to provide screening for diabetes and renal disease. St. Francis Hospital teams up with Macoupin County Health Department to provide Diabetes Self-Management classes. St. Josephs Hospital in Breese, Illinois coordinates several community education seminars and health fairs on cardiovascular disease and healthy eating each year. Over 3,000 residents participated in these health events last year. Recognizing the importance of proper food and nutrition to overall health, St. Johns Hospital in Springfield initiated the Destination Dinner program which teaches families how to cook healthy, from-scratch meals, and eat together as a family. Families meet quarterly to learn new cooking skills. They also learn how to prepare a meal for a family of four on a budget of $8.00. In addition to raising awareness about how to eat healthy on a limited budget, the program brings families together around the dinner table, which research shows promotes healthy relationships, increased academic performance and decreased risk for substance abuse and risky sexual behavior. Sacred Heart Hospital in Eau Claire, Wisconsin addressed the need for access to mental health services for children and adolescents by opening an outpatient behavioral health clinic. Sacred Heart has also adopted screening tools for behavioral and mental health risk factors for use at affiliated clinics. The goal is to better identify mental health issues and provide earlier intervention. Sacred Heart Hospital is also working with the Chippewa Valley Free Clinic (CVFC) to develop expanded provider coverage for CVFC patients who require mental health services. St. Mary's Hospital in S STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI WI, X X X X X X true true false false false false false false false STEPHEN RONSTROM 0 214814 0 0 0 387516 0 133769 0 28265 0 764364 0 0 Ann m Carr 0 180382 0 0 0 45431 0 197622 0 18652 0 442087 0 15440 John Lamoureux 290767 0 30000 0 0 0 196755 0 1291 0 518813 0 0 0 Lance Levendowski 219433 0 0 0 0 0 49556 0 33005 0 301994 0 0 0 John Waciuma 637631 0 0 0 0 0 42764 0 8140 0 688535 0 0 0 FAYE DEICH 287911 0 0 0 0 0 0 0 32909 0 320820 0 0 0 Amy Dwyer 180043 0 0 0 0 0 195949 0 14622 0 390614 0 0 0 MONICA MCDONALD 342732 0 23000 0 2359 0 26271 0 20426 0 414788 0 0 0 KENNETH VENUTO 217013 0 25000 0 64015 0 27039 0 15268 0 348335 0 0 0 KEVIN HESS 285535 0 0 0 4305 0 25920 0 32909 0 348669 0 0 0 LARRY SCHUMACHER 0 676477 0 0 0 46454 0 239154 0 15734 0 977819 0 100520 KENNETH VENUTO'S SEVERANCE PACKAGE SCHEDULE J, PART I, LINE 4A kenneth venuto RECEIVED A SEVERANCE PACKAGE DURING THE YEAR IN THE AMOUNT OF $61,154 FOR his SERVICES AS CFO OF sacred heart hospital - eau claire. stephen ronstrom'S SEVERANCE PACKAGE SCHEDULE J, PART I, LINE 4A stephen ronstrom RECEIVED A SEVERANCE PACKAGE DURING THE YEAR IN THE AMOUNT OF $169,231 FOR his SERVICES AS CeO OF sacred heart hospital - eau claire. Ann M. Carr Schedule J, Part I, Line 4b Ann M. Carr participated in a SERP plan during the year in the amount of $33,655. larry schumacher schedule j, part i, line 4b larry schumacher participated in a SERP plan during the year in the amount of $193,508. stephen ronstrom schedule j, part i, line 4b stephen ronstrom participated in a SERP plan during the year in the amount of $91,636. pathology service corporation board member is a partner 360900 hospital based pathology svcs. false business transactions with interested persons schedule l, part iv business transactions with interested persons were compliant with the organization's conflict of interest policy. any transactions requiring board approval were reviewed by an independent board prior to being approved. ORGANIZATION'S MISSION PART III LINE 1 THE PRIMARY PURPOSE OF SACRED HEART HOSPITAL IS TO PROVIDE A STRUCTURE AND THE MEANS WHEREBY THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS CAN CONTINUE THEIR APOSTOLIC MISSION TO SERVE THE SICK, THE AGED, THE POOR AND THE TERMINALLY ILL WITHOUT REGARD TO RACE, COLOR, CREED OR NATIONAL ORIGIN. THE PRIMARY CONCERN OF SACRED HEART HOSPITAL AND THE HOSPITAL SISTERS IS THE PATIENT'S WELL BEING... SPIRITUALLY, PHYSICALLY, PSYCHOLOGICAL AND SOCIAL. PROGRAM SERVICES REVENUE - ACCOMPLISHMENTS FORM 990 PART III, LINE 4A Sacred Heart Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Sacred Heart Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Furthermore, our mission is to serve the community with respect to providing healthcare services and healthcare education. Health activities and programs to support the community are considered where there is a demonstrated need. These activities include behavioral health services, wellness programs, community education programs, special programs for the elderly, and a variety of broad community support activities. Sacred Heart Hospital provided 46,734 adult and pediatric days of care and 113,448 outpatient visits during fiscal year ended June 30, 2012. Sacred Heart Hospital provides care to persons covered by governmental programs at or below cost. Recognizing our mission to the community, services are provided to both Medicare and Medicaid Patients. In accordance with standards defined by the Catholic Health Association USA ("CHAUSA"), Sacred Heart Hospital has recognized an unreimbursed cost of community benefit of $21,804,989. The cost of servicing the people qualifying for public indigent programs (including Medicaid and other public programs) was $8,292,361. The cost of our hospital based community care program was $5,586,617. Sacred Heart also provided benefits of $1,232,733 to the community through many reduced price services and free programs offered throughout the year based upon activities and services that Sacred Heart Hospital believes will serve a bona fide community health need. These include: * The Healing Place: A Center for Life's Journeys is Sacred Heart Hospital's free grief and holistic healing center for individuals who have experienced a loss or are dealing with a major life transition. Support includes: grief support groups, counseling, workshops, presentations to grieving individuals and families such as: o Evening and Daytime Spouse Loss groups for those who have lost a spouse o SHARE Support Group for miscarriage, stillbirth and early infant death o Parents Grief Group for parents who have lost a child o Adult Loss of a Parent for those who have lost a parent o Suicide Survivor's Group for those who have lost a loved one to suicide o Workshops and presentations to healthcare, spirituality, educational and mental health institutions on topics related to grief and loss. o Special programs and workshops including Grief in the Workplace and Grief and the Holidays o New support services, short-term counseling, classes and workshops provide support for those coping with non-death-related life transitions including: divorce or separation, illness, disability, job changes, military deployment and retirement * Center for Healthy Living and other educational classes and resources including: o Prepared Childbirth (Lamaze, prenatal, sibling classes and lactation consulting) o CPR classes o Babysitting/Smarter Sitter Seminars o Pediatric Health Fair with hands-on activities in health, wellness and safety for second grade students in Eau Claire County o Wellness programs, services and retreats o Participation in health fairs o Caring for the Caregiver Workshop o Center for Medical Excellence Community Health Information Room with access to print and electronic medical journals and other health resources for patient, family, and community use o Annual "Woman to Woman" Healthcare Expo o Indoor Sports Center "Get Hooked on Health" Kids Expo (safety education, health & wellness) o Spirit of Women education programs, speakers and screenings o Car seat installations and education programs o Helmet fitting clinics o Celebration of Woman Event (with Junior League of Eau Claire) o Monthly Meditation Program * Cancer care related programs: o Look Good, Feel Better - A program for women to help them cope with the impact of cancer treatment on body image. Includes beauty makeovers and wigs as needed. Monthly program o Touched by Cancer - A support group for cancer patients and their families. Seminars on cancer-related issues such as nutrition, stress-reduction, family issues, cancer in the workplace, spiritual support. Meets twice a month. o Eau Claire Partners- A support group of breast cancer patients and survivors. Dealing with issues related to body image, sexuality, finding clothes and lingerie that fit, side-effects of breast cancer treatment, etc. Meets twice a month. o Yoga - Stress-reduction yoga class for cancer patients and survivors. Meets weekly in 6-week sessions. o C.L.I.M.B./C.H.A.T. - Programs for school age children (CLIMB) and teens (CHAT) to help them understand and cope with having a parent or family member in treatment for cancer. Meets weekly in 6-week sessions. o Livestrong - A program co-sponsored by the Lance Armstrong Foundation in conjunction with the YMCA. This is a program of exercise for cancer patients that helps them maintain conditioning and decrease fatigue during treatment. It starts in the cancer center with volunteers from the UW-EC physical therapy program hosting a 6 week session. Patients wishing to continue after 6 weeks can do so at no charge at the EC YMCA through a grant from the Lance Armstrong Foundation. o I Can Cope - A discussion group for cancer patient and their families that is independent and involves open discussion as to issues patients encounter and coping strategies. Meets once a month o Music Therapy - Led by student volunteers of the UW-EC music program. Students provide music and song for patients waiting for treatment. The Threshold singers, another volunteer group, provide a capella song at the bedside for cancer patients on the oncology unit. o Pet Therapy - Numerous volunteers bring AKC-certified pet therapy dogs to the cancer center to visit with patients and their families awaiting treatment. o Oncology Nurse Navigator - a free, mission-driven program of support for newly diagnosed cancer patients. The navigator assist patients in setting up appointments, arranging transportation, finding appropriate support groups, and accessing counseling and spiritual support. o Pastoral Counseling - Spiritual support is available to any patient upon request through Pastoral Care Department. * Support groups for diseases/disorders such as Alzheimer's, Amputee Clinic, Multiple Sclerosis, Spinal Cord injury, and others * Breastfeeding support group * Meal programs & support including: o Meals for Senior Citizens and congregate site meals o Thanksgiving St. Francis Food Pantry food drive collection program for needy families o Coat, mitten, linen and blanket drive o Christmas Sponsor-A-Family drive program service revenue * Health screenings including: o Blood pressure screenings at health fairs o Stroke Prevention Clinic/screenings o "HeartAware" online cardiovascular disease screening tool * Services to the community, including: o Center for Spiritual Care pastoral care chaplain and volunteer assistance with over 500 Power of Attorney for Health Care (Advance Directive) forms o Symposium on Advance Directives and end-of-life decisions o A variety of student intern programs, work shadowing, and tours o Overnight accommodations for families of critically ill patients o Patient follow-up post discharge calls program o Medical equipment, supplies, laboratory services, imaging services donated to the Chippewa Valley Free Clinic and its patients below the federal poverty level o Symposium support and sponsorship for the Catholic Medical Association o Disaster preparedness planning o Influenza/H1N1 community education * Hosting meetings, drives and sponsorships for: o Red Cross blood drives o Catholic Charities events and education o Sojourner House - Eau Claire homeless shelter o Diocese of La Crosse Office of Family Life o United Way events o Relay for Life - American Cancer Society o Special Olympics Polar Plunge o American Heart Association Heart Walk o Brain Injury Association of Wisconsin o Breakfast in the Valley o Red Cross Real Heroes banquet o Producers & Buyers Co-op: Linking Local Farms and Institutions, organizational support for meetings and organizational and secretarial support to encourage local food sourcing by institutions to benefit the local economy (in partnership with River Country RC&D and local family farms) o Logistical support and meeting space for the Chippewa Valley Internetworking Consortium to help expand fiber broadband infrastructure and service to the community and to rural and underserved areas to support telemedicine and other health projects, along with city/county governments, EMS, libraries and schools/education o Local "green" and environmental sustainability educational events * First Aid booths for community events/festivals, including: o Buckshot Run o Country Jam o Festival in the Pines o International Fall Festival * "Green" environmental stewardship and sustainability efforts (recycling and reusing) including: o Food scrap produce were donated to a local ranch for animal feed o The hospital donated leftover food to the St. Francis Food Pantry o Donated used equipment to Third World countries via the Hospital Sisters Mission Outreach: Medical equipment went to needy hospitals and clinics in third world countries such as Mongolia and Ukraine and to U.S. Navy Project Handclasp. Equipment included beds, wheelchairs, exam lights, walkers, x-ray aprons, medical carts, surgical instruments, stretchers, linens and various other items * The "Imagining the Future" listening campaign, a grassroots approach to discover what services the community believes an ideal healthcare system ought to provide, was conducted from October to December 2010. Deeply rooted in the hospital's Franciscan mission, it was a holistic and spiritual process of discernment which stimulated open, honest, and non-judgmental sharing of insights about healthcare delivery in the context of the physical, emotional and spiritual needs of the broader community. o The initiative included more than 1,400 participants and began with two large town hall-like meetings hosted by the hospital CEO and 35 smaller visioning sessions led by hospital leaders. Community members also participated online and through social media (Facebook and Twitter). In all, we received 2,830 ideas regarding the future of healthcare. o Focus groups included constituents that are often overlooked: low-income, vulnerable populations and minority groups. It captured the voices of special populations, Hmong Mutual Assistance Association members, Amish farmers, seniors, young children and other diverse groups. The visioning sessions allowed us to gather mission-critical information, and gave community members the opportunity to articulate their vision of an ideal healthcare system for their community that improved health, healing and well-being. The goal was to engage and empower community members and hospital leaders so that together we could shape an ideal local healthcare system. o A committee was commissioned to divide the 2,830 comments into 600 categories. A Community Dream Team and a Colleague Dream Team were formed to assess each request to determine if it was something that could be responded to in the short term or long term range. More than 100 actionable items were assessed and/or implemented over the first six months. Sacred Heart Hospital has prepared the financial information in this report in accordance with CHAUSA community benefit reporting guidelines. These guidelines recommend the following: * Report community care at cost, not charges. * Do not include bad debt, contractual allowances, and quick pay discounts as part of charity care expense. * Do not count Medicare shortfall as a community benefit. * Report the net expense for community benefit services, i.e., the total community benefit expense minus any associated revenue from patients, payers, and other external sources. The Catholic Health Association's reporting guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the reporting guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health. In summary Sacred Heart Hospital financially contributed to the community $21,804,989 for fiscal year ended June 30, 2012 as follows: Charity care - at cost, not including bad debt $5,586,617 Government sponsored health care - net expense 8,292,361 Unpaid cost of public indigent care programs (includes Medicaid and other public programs) Community Benefit Programs - net expense 7,926,011 ------------ Total quantifiable community benefit $21,804,989 ============ In addition to the amounts reported above, Sacred Heart Hospital committed significant resources to service the Medicare population. The cost (as determined using the cost to charge ratio) of providing services to primarily elderly beneficiaries of the Medicare program in excess of governmental and managed care contract payments was $21,591,362 for the year ended June 30, 2012. TAX-EXEMPT BONDS FORM 990, PART IV, LINE 24 SACRED HEART HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. RIGHTS OF MEMBERS TO ELECT GOVERNING BODY FORM 990 PART VI, LINES 6 & 7A THE SENIOR GOVERNING BODY OF SACRED HEART HOSPITAL (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT. MEMBER RESERVED POWERS FORM 990 PART VI, LINE 7B Responsibility for the policy and operations of Sacred Heart Hospital (the "Corporation") is vested in its Board of Directors, except with respect to specific powers reserved in the Corporation's Bylaws to the Corporation's Member, Hospital Sisters Health Services, Inc. ("HSSI"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The member of HSSI is Hospital Sisters Health System ("HSHS"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The members of HSHS are the individual sisters who from time to time are the duly elected Provincial Superior and Provincial Councilors, respectively of the American Province of the Hospital Sisters of St. Francis ("American Province"). The American Province is the United States organization of the Congregation of the Hospital Sisters of the Third Order Regular of St. Francis, a religious institute of the Roman Catholic Church. The governance and operations of the Corporation are subject to HSSI's right to exercise these reserved powers with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or a controlling shareholder ("Affiliates"). HSSI's right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS and HSHS' members. The reserved powers include all rights granted to HSSI by law and the right to: (a) Adopt, approve amendments to, or amend any statement of philosophy, mission, mission integration or values or any name, logo, or mark of the Corporation or of any Affiliate; (b) Adopt, approve amendments to, or amend the Articles of Incorporation of the Corporation or of any Affiliate; (c) Adopt, approve amendments to, or amend the Bylaws of the Corporation or of any Affiliate; (d) Appoint and remove the Board of Directors, any one or more of the Directors of the Corporation or of any Affiliate, and the Chairperson and President of the Corporation or of any Affiliate; (e) Approve the recommendation of the Board of Directors to appoint or remove the Board of Directors, any one or more Directors of the Corporation or of any Affiliate, or the Chairperson and President of the Corporation or of any Affiliate. (f) With respect to the Corporation or any Affiliate, approve the purchase, sale, alienation, exchange, lease or encumbrance of any real property of the Corporation or of any Affiliate, which property has a value in excess of limits set from time to time by HSSI; (g) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSSI from time to time; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI. FORM 990 REVIEW PROCESS FORM 990 PART VI, LINE 11b The hospital employs KPMG to assist in the overall review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS. CONFLICT OF INTEREST POLICY FORM 990 PART VI, LINE 12C The organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, and ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, Hospital Sisters Health System, ("HSHS") DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS, AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. WHISTLEBLOWER POLICY FORM 990 PART VI, LINE 13 Provisions within the Corporate Compliance Program and Conflict of Interest Policy provide protections for whistleblower type activities. Determination of CEO & Key employee Compensation FORM 990 PART VI, LINE 15 The Compensation Committee ("Committee") is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies ("IHS"), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges, and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting. FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC FORM 990 PART VI, LINE 19 Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time. GRANTS, SCHOLARSHIPS, FELLOWSHIPS, STUDENT LOAN FORM 990 PART IX, LINE 2 Sacred Heart Hospital participates in various Federal loan and grant programs. These programs are administered in accordance with guidelines established by the U.S. Department of Education and the U.S. Department of Health and Human Services. These programs are audited annually in accordance with OMB Circular A-133 "Audits of Institutions of Higher Education and Other Nonprofit Institutions". POOLED INVESTMENT ACCOUNT FORM 990 PART X, LINE 11 SACRED HEART HOSPITAL USES ITS POOLED INVESTMENTS TO CARRY ON ITS MISSION OF CARING FOR THE SICK. THE HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS ("SFAS") NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. Other Changes in Net Assets Part XI, Line 5 Pension Related Funding Change (14,921,760) increase in temporarily restricted net assets (364,407) increase in permanently restricted net assets 140,719 UNREALIZED LOSSES (10,176,523) transfer to affiliates (2,069,000) ------------ Total (27,390,971) ============ HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER MARYBETH CULNAN, O.S.F. TITLE:DIRECTOR HOURS:59 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ann m. Carr TITLE:Treasurer HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARRY SCHUMACHER TITLE:DIRECTOR HOURS:59 SPRINGFIELD HEALTH PARTNERS LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371364419 HEALTHCARE IL 0 0 HSHS MG Kiara Clinical Integration Network LLC 4936 Laverna Road springfield IL 62707 261417684 healthcare IL 0 0 HSSI Physician Clinical Integration Network L 4936 Laverna Road SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 0 0 KCIN Hospital Sisters Health System 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) 11A NA false Hospital Sisters Services Inc 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) 11A NA false Hospital Sisters of St Francis FDTN 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 11A NA false HSHS Health Care PLAN Trust Fund 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371137724 HEALTHCARE IL 501(c)(9) None NA false St Anthony's Hospital 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 NA false St Elizabeth's Hospital 211 SOUTH THIRD STREET BELLEVILLE IL 62220 370663567 HEALTHCARE IL 501(c)(3) 3 NA false St Francis Hospital 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 NA false St John's Hospital 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 NA false St Joseph's Hospital 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(c)(3) 3 NA false St Joseph's Hospital 1515 MAIN STREET HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 NA false St Joseph's Hospital 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 NA false St Mary's Hospital 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 NA false St Mary's Hospital 111 SPRING STREET STREATOR IL 61364 372169181 HEALTHCARE IL 501(c)(3) 3 NA false St Mary's Medical Center 1726 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 NA false St Nicholas Hospital 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(c)(3) 3 NA false St Vincent Hospital 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 501(c)(3) 3 NA false Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY I CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) 11A NA false HSHS Self Insurance TRUST Fund 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(c)(3) 11A NA false HSHS Medical Group Inc 3215 Executive Park Drive springfield IL 62703 263956318 healthcare IL 501(c)(3) 11A NA false hshs WISCONSIN MEDICAL GROUP INC 3215 Executive Park Drive SPRINGFIELD IL 62703 264515959 healthcare WI 501(c)(3) 11a na false Orange Cross Ambulance Inc 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 9 ST NICHOLAS false WISCONSIN UPPER PENINSULA ONCOLOGY MGMT 835 S VAN BUREN GREEN BAY WI 54301 391677100 HEALTHCARE WI 501(c)(3) 3 ST VINCENT false UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 9 HSSI false Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea IL 62226 371312961 Healthcare IL St Elizabeth's related 0 0 false 0 false 0.00000 Prairie Heart Institute - Carbondale LLC 800 EAst Carpenter Street Springfield IL 62769 371321197 Healthcare IL St John's related 0 0 false 0 false 0.00000 Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay WI 543079047 263749065 Healthcare WI HSSI related 0 0 false 0 false 0.00000 Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield WI 53221 263155343 Healthcare WI St Vincent related 0 0 false 0 false 0.00000 Surgery Center of Sheboygan LLC 3141 Saemann Avenue Sheboygan WI 53081 260822209 Healthcare WI St Nicholas related 0 0 false 0 false 0.00000 Prevea Ventures LLC 2710 Executive Drive Green Bay WI 54304 203775127 Healthcare WI HSSI related 0 0 false 0 false 0.00000 Carpenter Street Hotel LLC 525 North Sixth Street springfield IL 62702 364128127 hotel IL lasante inc related 0 0 false 0 false 0.00000 Springfield Urgent Care Real Estate LLC PO Box 19456 springfield IL 627949456 030413258 rent. real es IL lasante inc related 0 0 false 0 false 0.00000 Kiara Inc 4936 Laverna ROAd Springfield IL 62707 371163401 HealthCare IL HSHS C Corp 0 0 0.00000 LaSante Wisconsin Inc 4936 Laverna ROAd Springfield IL 62707 391572196 HealthCare IL Kiara Inc C Corp 0 0 0.00000 LaSante Inc 4936 Laverna ROAd Springfield IL 62707 371163400 HealthCare IL Kiara Inc C Corp 0 0 0.00000 Prairie Cardiovascular 619 East Mason STE 4P57 Springfield IL 62701 371071858 HealthCare IL Kiara Inc C Corp 0 0 0.00000 Prevea Health Services 2710 EXECUTIVE DRIVE Green Bay WI 54304 391839351 HealthCare WI HSSI C Corp 0 0 0.00000 Prevea Clinic Inc 2710 EXECUTIVE DRIVE Green Bay WI 54304 391839349 HealthCare WI HSSI C Corp 0 0 0.00000 Prevea Health Network 2710 EXECUTIVE DRIVE Green Bay WI 54304 392000537 HealthCare WI HSSI C Corp 0 0 0.00000 Renaissance quality insurance 980669953 Insurance CJ HSSI C Corp 0 0 0.00000 false false false false false false false false false true false false false false true false false false Transactions with related entities Form 990, Schedule R, Part V, Line 2 THE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.