2013-08-06T10:50:57-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2011-10-01 410693877 SAINT ELIZABETH'S HOSPITAL OF WABASHA INC SAIN 6515655553 1200 GRANT BLVD WEST WABASHA MN 55981 TOM CROWLEY 6515655553 2013-07-30 1 SHERRI WESSELS P00888088 5074347000 2011 2016-02-24 21:20:13Z TOM CROWLEY 1200 GRANT BLVD WEST WABASHA MN 55981 25635586 0 0928 X WWW.STELIZABETHSWABASHA.ORG X 1955 MN OUR MISSION AS A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES WE SERVE. 9 9 408 150 0 0 365265 538961 23663601 25017636 40136 76082 0 0 24069002 25632679 0 0 0 0 14309260 14917446 0 0 0 8780475 9055810 23089735 23973256 979267 1659423 20076430 21247779 3707192 3543062 16369238 17704717 OUR MISSION AS A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES WE SERVE. 0 0 21175404 25017636 SINCE 1898 ST. ELIZABETH'S HAS BEEN SERVING THE HEALTHCARE NEEDS OF EASTERN MINNESOTA AND WESTERN WISCONSIN RESIDENTS, AND IS A MEMBER OF MINISTRY HEALTH CARE AND SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER. SINCE MAY, 1992, ST. ELIZABETH'S HAS BEEN A CRITICAL ACCESS HOSPITAL AND IS MEDICARE CERTIFIED FOR 25 ACUTE CARE/SWING BEDS. WE OFFER A BROAD RANGE OF ACUTE CARE, DIAGNOSTIC, EDUCATIONAL, EMERGENCY, AND SURGICAL SERVICES TO RESIDENTS WITHIN OUR SERVICE AREA. IN FY 2012, ST. ELIZABETH'S HAD 1,238 ACUTE CARE DAYS, 593 SWING BED DAYS, AND 23,508 OUTPATIENT ENCOUNTERS. ADDITIONALLY, ST. ELIZABETH'S IS CURRENTLY LICENSED FOR 100 NURSING HOME BEDS AND 45 ASSISTED LIVING APARTMENTS. ALL NURSING HOME BEDS ARE MEDICARE CERTIFIED. IN FY 2012, WE HAD 35,891 NURSING HOME DAYS AND 17,040 APARTMENT DAYS. 21175404 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 85 0 408 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JOHN WOLFE 6515655553 1200 GRANT BLVD W WABASHA MN 55981 SISTER BARBARA HOLLWECK 0.50 X 0 0 0 BRIAN KELLY MD 0.50 X 0 0 0 DONALD JACOBY 0.50 X 0 0 0 THOMAS CROWLEY 40.00 X X 269191 0 58613 STEVEN SEDLMAYR 0.50 X 0 0 0 JEREMY SOLBERG MD 0.50 X 0 0 0 RICHARD ZABEL 0.50 X 0 0 0 REBECCA LUCKSTEIN 0.50 X 0 0 0 MIKE EBERSOLD MD 0.50 X 0 0 0 JOHN WOLFE 40.00 X 152537 0 24247 JONI LOMMEN 40.00 X 162248 0 23969 JOHN HUST 40.00 X 182500 0 14287 DR JOHN PETERSON 40.00 X 154724 0 10924 KURT HENN 40.00 X 119120 0 24182 JAMES ROOT 40.00 X 121414 0 11516 KATHY LEUDERS 40.00 X 107955 0 8153 1269689 0 175891 8 0 1 0 ENHANCEMED MEDICAL PROFESSIONAL SERVICES PO BOX 4004 ROCHESTER MN 55903 E.R. COVERAGE 211578 MAYO CLINIC HEALTH SYSTEMS 500 W GRANT STREET LAKE CITY MN 550411143 LAB SERVICES 147092 MAYO MEDICAL LABORATORIES PO BOX 9146 ROCHESTER MN 554809146 LAB SERVICES 132928 NORTHERN SHARED MEDICAL SERVICES INC PO BOX 330 COTTAGE GROVE WI 53527 MOBILE MRI SERVICES 122450 PATRICIA P PEYLA CRNA MS 68034 COUNTY ROAD 76 WABASHA MN 55981 CRNA SERVICES 117425 5 23733 515228 538961 PATIENT & RESIDENT 623000 24827982 24827982 OTHER OPERATING 623000 189654 189654 25017636 71489 71489 7500 2907 4593 4593 4593 25632679 25017636 0 76082 690805 690805 10686463 9946478 739985 457462 466139 -8677 2311423 2071759 239664 771293 680688 90605 1673235 1205649 467586 498320 498320 118229 111342 6887 69602 69602 1394093 1394093 78644 78644 SUPPLIES 1708684 1687512 21172 PURCHASED SERVICES 1161919 827259 334660 DRUGS 887352 887352 BAD DEBT EXPENSE 585000 585000 880732 744211 136521 23973256 21175404 2797852 0 1659150 1652714 4779219 5208904 396457 404054 1300 -3083 30549152 19560878 11257541 10988274 1910109 2824802 72654 172114 20076430 21247779 2221473 2261540 71883 74583 1029321 951980 384515 254959 3707192 3543062 X 16369238 17704717 16369238 17704717 20076430 21247779 X 1659423 -323944 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 344 0 0 0 344 0 22023 22023 17660353 10222387 7437966 12866776 9338491 3528285 10988274 INVESTMENTS BY BOARD FOR CAPITAL PURPOSES 2824802 F 2824802 DUE TO THIRD-PARTY PAYORS 200000 ASSET RETIREMENT OBLIGATION 54959 254959 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: PER NOTE 2 OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDING SEPTEMBER 30, 2012, MINISTRY AND ITS AFFILIATES, EXCEPT NHP AND NHIC, ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY NET UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. NHP AND NHIC ACCOUNT FOR TAXES USING THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE ESTIMATED FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES. MINISTRY RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUBSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS FOR MINISTRY'S NOT-FOR-PROFIT CORPORATIONS INCLUDE THEIR TAX-EXEMPT STATUS AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. 1 1 X 1 X 1 X 1 1 0 1 0 76175 76175 0.00320 5376491 4521357 855134 0.03570 5452666 4521357 931309 0.03890 100 21526 648 20878 0.00090 2 31808 31808 0.00130 9460543 8714062 746481 0.03110 850 26263 26263 0.00110 952 9540140 8714710 825430 0.03440 952 14992806 13236067 1756739 0.07330 2456 2456 0.00010 10245 10245 0.00040 7256 7256 0.00030 9247 9247 0.00040 29204 29204 0.00120 1 585000 0 5794980 5847578 -52598 X 1 1 1 1 ST ELIZABETH HOSPITAL OF WABASHA INC

1200 GRANT BLVD WEST WABASHA MN 55981

X X X ST ELIZABETH'S HOSPITAL OF WABASHA INC 1 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X 0 0 1 X 0 0 2 ST ELIZABETH NURSING HOME

1200 GRANT BLVD WEST WABASHA MN 55981

NURSING HOME ST ELIZABETH ASSISTED LIVING APARTMENT

1200 GRANT BLVD WEST WABASHA MN 55981

RESIDENTIAL HOUSING W/SERVICES PART I, LINE 3C: IT IS THE POLICY OF THE ORGANIZATION TO PROVIDE MEDICALLY NECESSARY HEALTH CARE SERVICES TO PEOPLE IN THE COMMUNITIES IT SERVES, REGARDLESS OF THEIR ABILITY TO PAY. COMMUNITY CARE FINANCIAL ASSISTANCE IS GRANTED BASED UPON THE PATIENT'S INABILITY TO PAY AND TO INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED OR MEDICALLY INDIGENT. COMMUNITY CARE WORKS IN COLLABORATION WITH OTHER FINANCIAL (BOTH PUBLIC AND PRIVATE) ASSISTANCE PROGRAMS. THIS IS TO ENSURE HOLISTIC WELLNESS OF PATIENTS BY FACILITATING KNOWLEDGE OF AVAILABLE SERVICES AND PROGRAMS FOR HEALTH WHILE PRACTICING GOOD STEWARDSHIP OF FUNDS. KEY CRITERIA UTILIZED TO DETERMINE ELIGIBILITY FOR COMMUNITY CARE FINANCIAL ASSISTANCE IS FAMILY SIZE, FEDERAL POVERTY INCOME GUIDELINES AND AVAILABLE ASSETS. THE AVAILABLE ASSET TEST INCLUDES CONSIDERATION OF THE AMOUNT OF EQUITY IN A HOME, AUTOMOBILES, AND SAVINGS ACCOUNTS WHICH ARE CONSIDERED PART OF TOTAL ALLOWABLE INCOME WHEN ASSESSING AGAINST THE FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: ST ELIZABETH'S IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED MINISTRY HEALTH CARE, INC. WHICH CONSISTS OF A NUMBER OF HEALTH CARE FACILITIES LOCATED THROUGHOUT CENTRAL AND NORTH CENTRAL WISCONSIN AND WESTERN MINNESOTA. THE CONSOLIDATED COMMUNITY BENEFITS REPORT IS AVAILABLE ON MINISTRY HEALTH CARE'S WEBSITE. PART I, LINE 7: AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BOTH ON A COST ACCOUNTING SYSTEM AND A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. DETAIL FOR EACH PROGRAM/ACTIVITY IS MAINTAINED AND DETERMINED AT THE DEPARTMENT LEVEL. CHARITY CARE AND MEANS-TESTED PROGRAMS ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO CONSISTENT WITH WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PRIOR YEAR COST REPORT SETTLEMENTS ARE EXLCUDED FROM A SHORTFALL CALCULATION IN ORDER TO GET A TRUE FISCAL YEAR SHORTFALL AMOUNT. PART I, LINE 7G: PROGRAMS THAT ARE CONSIDERED SUBSIDIZED HEALTH SERVICES OF ST. ELIZABETH'S AND INCLUDED ON PART I, LINE 7G ARE NURSING HOME, APARTMENTS, CARDIAC REHAB, DIABETES MANAGEMNT, AND MENTAL HEALTH. PART I, L7 COL(F): BAD DEBT EXPENSE THAT WAS SUBTRACTED FROM TOTAL EXPENSE TO OBTAIN THE % OF COMMUNITY BENEFIT TO TOTAL EXPENSE AMOUNTED TO $585,000. PART II: COMMUNITY-BUILDING ACTIVITIES INCLUDE PROGRAMS THAT, WHILE NOT DIRECTLY RELATED TO HEALTH CARE, PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL PROBLEMS. THESE ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF THE ORGANIZATION. COSTS FOR THESE ACTIVITIES INCLUDE CASH, IN-KIND DONATIONS, AND EXPENDITURES FOR THE DEVELOPMENT OF A VARIETY OF COMMUNITY HEALTH PROGRAMS AND PARTNERSHIPS. SAINT ELIZABETH'S HAS SPONSORED A NUMBER OF COMMUNITY-WIDE EDUCATIONAL OPPORTUNITIES, INLCUDING WOMEN'S WELLNESS, EDUCATIONAL LECTURES TO OUTSIDE ORGANIZATIONS, AND SENIOR WELLNESS BY SPONSORING A PROGRAM CALLED "FIT CITY SENIORS". CPR EDUCATION IS ALSO OFFERRED TO THE OVERALL COMMUNITY, AND SAINT ELIZABETH'S ALSO SPONSORS AN ALZHEIMER'S SUPPORT GROUP. PART III, LINE 4: NO FOOTNOTE EXISTS IN THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. BAD DEBT EXPENSE IS RECORDED IN A CONSISTENT MANNER WITH THE ORGANIZATION'S COLLECTION POLICIES. BAD DEBT EXPENSE INCLUDES ACCOUNTS WHICH ARE WRITTEN OFF AND ESTIMATES MADE ON LIVE ACCOUNTS BASED ON HISTORICAL PAYMENT TRENDS AND ACCOUNT MODELING. A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT-OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE CHARITY APPLICATION, SO THE BAD DEBT EXPENSE ASSOCIATED WITH TREATING THEM SHOULD BE TREATED AS COMMUNITY BENEFIT. FOR 2012, WE HAVE INCLUDED $0 ON PART III, LINE 3 AS WE WEREN'T ABLE TO QUANTIFY THESE AMOUNTS. THE ORGANIZATION DOES HAVE A PRESUMPTIVE ELIGIBILITY PROGRAM IN PLACE TO HELP IDENTIFY INDIGENT PATIENTS AND MINIMIZE THE INSTANCES OF WHEN THEY BECOME A BAD DEBT. THE ADMINISTRATIVE REQUIREMENTS TO DETERMINE WHETHER PATIENTS WHO DO NOT COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS WOULD HAVE QUALIFIED FOR CHARITY CARE CAN BE BURDENSOME, PARTICULARLY FOR SMALL BALANCES. THE ORGANIZATION CONTINUES SERVING PATIENTS EVEN AFTER THE PATIENTS HAVE GENERATED SIGNIFICANT BAD DEBT WHICH IS EVIDENCE THAT THE CARE IS GIVEN FOR COMMUNITY BENEFIT MOTIVATIONS. PART III, LINE 8: THE SHORTFALL ASSOCIATED WITH MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT FOR SEVERAL REASONS. FIRST, IRS REV. RUL. 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. SECOND, FOR-PROFIT SPECIALTY HOSPITALS HAVE BEEN CARVING OUT CERTAIN HIGH-MARGIN SERVICES (I.E. CARDIAC, ORTHOPEDICS, AND ONCOLOGY), LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS INDICATES THAT MEDICARE LOSSES CAN BE A RESULT OF RENDERING THESE LOWER-MARGIN SERVICES (WHICH BENEFIT THE COMMUNITY) RATHER THAN INEFFICIENT OPERATIONS. LASTLY, THE COMMUNITY WHICH THE ORGANIZATION SERVES HAS MEDICARE AS THE LARGEST PAYER. THE ORGANIZATION MUST ACCEPT THESE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SUCH SERVICES. IF THE MEDICARE PARTICIPATION IS PREMISED ON THIS FACT, THEN PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT. THE DEMOGRAPHIC OF THE COMMUNITY IS ALSO AN AGING AND UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE SERVICES, CMS WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY. PART III, LINE 9B: THE ORGANIZATION HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICE SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS. ST. ELIZABETH'S HOSPITAL OF WABASHA, INC PART V, SECTION B, LINE 19D: WE ESTIMATE THAT THE AVERAGE DISCOUNT PROVIDED TO INSURANCE COMPANIES IS 10%, WHICH IS THE SMALLEST DISCOUNT AVAILABLE UNDER OUR FAP. WE ARE IN THE PROCESS OF IMPLEMENTING A MORE FORMAL PROCESS TO ENSURE THAT WE APPROPRIATELY LIMIT OUR CHARGES TO THOSE WHO QUALIFY FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: THE ORGANIZATION PERFORMS COMMUNITY NEEDS ASSESSMENTS AS NEEDED. PLANNING WORKGROUPS CONSISTING OF COMMUNITY PARTNERS ARE FORMED TO DEFINE THE COMMUNITY AND ITS NEEDS THROUGH REVIEW OF HEALTH PEOPLE INITIATIVES, CENSUS DOCUMENTS, AND LOCAL GOVERNMENT HEALTH AND WELFARE AGENCIES. CONSIDERING OTHER COMMUNITY RESOURCES/ASSETS, DATA COLLECTION METHODS ARE USED TO IDENTIFY PARTICULAR PROBLEMS OR SUBGROUPS AND AREAS KNOWN TO HAVE HIGH POVERTY RATES AND TO BE UNDERSERVED. THE DATA IS ANALYZED AND PRIORITIES ARE SET BASED ON TRENDING INFORMATION WHICH MAY TARGET A SPECIFIC NEED. WHEN A NEED IS IDENTIFIED, THE HOSPITAL DEVELOPS A PLAN TO IMPLEMENT A PROGRAM EITHER THROUGH COMMUNITY COLLABORATION OR INDIVIDUALLY. OUTCOMES FROM THE PROGRAMS ARE MEASURED AND CONSIDERED IN SUBSEQUENT COMMUNITY NEEDS ASSESSMENTS. COMMUNITY BENEFIT PLANS ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE INCORPORATED INTO THE ORGANIZATION'S STRATEGY AND POLICY DEVELOPMENT. FOR EXAMPLE, SENIOR LEADERS ARE REQUIRED TO PROVIDE DIRECT SERVICE TO THE POOR HOURS AS PART OF THEIR PERFORMANCE GOALS. PART VI, LINE 3: THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS, SOCIAL SERVICES, AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, CARE ENCOUNTER, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE CHARITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE (SPANISH). PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. PART VI, LINE 4: SAINT ELIZABETH'S SERVES THE RESIDENTS OF ALL AGES IN WABASHA COUNTY, MINNESOTA AND BUFFALO AND PEPIN COUNTY IN WISCONSIN. 62% OF OUR PATIENTS RESIDE IN WABASHA COUNTY, WHICH IS OUR PRIMARY SERVICE AREA. COMMUNITIES SERVED WITHIN THIS SERVICE AREA INCLUDE: WABASHA, KELLOGG, PLAINVIEW, READS LANDING, MINNIESKA, AND THEILMANN. THE TOTAL POPULATION OF WABASHA COUNTY IS 21,731. WABASHA COUNTY'S POPULATION INCREASED 9.5% FROM 1990 TO 2000. OUR SECONDARY SERVICE AREA INCLUDES SURROUNDING COMMUNITIES IN MINNESOTA AND THE COMMUNITIES OF ALMA, NELSON, PEPIN, ARKANSAW, MAIDEN ROCK IN BUFFALO, PEPIN, AND PIERCE COUNTIES OF WESTERN WISCONSIN. 15% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER; 4% LACK HEALTH INSURANCE; AND 10% LIVE AT OR BELOW THE POVERTY LEVEL. ALL PATIENTS ARE CARED FOR REGARDLESS OF GENDER, AGE, RELIGION, RACE OR FINANCIAL STATUS. 60% OF ACUTE CARE VOLUME IS FROM MEDICARE AND 7% IS MEDICAID. THE REMAINING 33% OF PAYER MIX IS DIVIDED AMONG MANAGED CARE, COMMERCIAL INSURANCE, SELF-PAY, AND CHARITY CARE. PART VI, LINE 6: THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED MINISTRY HEALTH CARE, INC. THE MISSION OF MINISTRY AS A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES SERVED. MINISTRY SUPPORTS SUCH NON-HOSPITAL FACILITIES AS THE AGAPE COMMUNITY CENTER. AS A COMMUNITY CENTER, IT HAS THE UNIQUE ADVANTAGE OF WELCOMING YOUTH, ADULTS, FAMILIES AND SENIORS INTO THE FACILITY THROUGH A BROAD RANGE OF EDUCATIONAL, SOCIAL, RECREATIONAL, CULTURAL, HEALTH AND LIFE-LONG LEARNING OPPORTUNITIES IN AN IMPOVERISHED PORTION OF MILWAUKEE. OUR CATHOLIC IDENTITY EXPECTS LEADERS TO INITIATE AND SUPPORT EFFORTS TO REACH OUT TO THE POOR AND VULNERABLE PEOPLE, ESPECIALLY WHERE NO ONE ELSE WANTS TO GO. HEALTH CARE CAN BECOME VERY BUREAUCRATIC AND BURDENED WITH OVERSIGHT OF FINANCES, REGULATORY REQUIREMENTS AND STRATEGIC PLANNING. OUR FOCUS ON THESE ISSUES MAY CAUSE US TO LOSE TOUCH WITH THOSE FOR WHOM WE HAVE A PRIMARY RESPONSIBILITY-THOSE WHO ARE POOR AND VULNERABLE. TITHING OF TIME ALLOWS US TO LOOK INTO THE FACE OF THE POOR, HEAR THE VOICE OF THE POOR, AND HELP US BETTER UNDERSTAND THE DAILY CHALLENGES AND BARRIERS THEY FACE. AS AN AFFILIATED HEALTH SYSTEM, ALL LEADERS WITH DIRECT REPORTS ARE REQUIRED TO PROVIDE SERVICE TO THE POOR. THIS ALSO INCLUDES PHYSICIAN LEADERS AND HOURLY SUPERVISORY STAFF. THE ORGANIZATION ALSO PARTICIPATES IN THE MINISTRY HEALTH CARE FUND WHICH PROVIDES MONIES FOR SPECIAL PROJECTS WITHIN THE COMMUNITIES WE SERVE. ALL ORGANIZATIONS SPONSORED OR CO-SPONSORED BY MINISTRY HEALTH CARE, INC. SET ASIDE MONIES EACH YEAR TO ASSIST WITH THE NEEDS OF THE COMMUNITY AND THE POOR. AS THE MINISTRY HEALTH CARE FUND, THESE DOLLARS ARE FUNNELED BACK INTO OUR COMMUNITIES FOR A VARIETY OF PROGRAMS AND SERVICES THROUGH A COMMUNITY ASSETS AND NEEDS ASSESSMENT PROCESS. THE ORGANIZATION HAS A FOUNDATION WHICH IS NOT INCLUDED WITHIN THE OPERATIONS OF THE ORGANIZATION. THE FOUNDATION PROVIDES PROGRAMS AND CASH DONATIONS WHICH HELP SUPPORT THE MISSION OF THE ORGANIZATION. DURING FY 2011, ST. ELIZABETH'S RECEIVED JUST OVER $472,000 TO HELP FUND VARIOUS CAPITAL EXPENDITURES THROUGHOUT THE YEAR. REPORTS FILED WITH STATES PART VI, LINE 7 MN X X X X X 0 0 0 0 0 0 0 0 0 THOMAS CROWLEY 167685 0 39985 0 61521 0 43520 0 15093 0 327804 0 0 0 JOHN WOLFE 103298 0 23263 0 25976 0 7326 0 16921 0 176784 0 0 0 JONI LOMMEN 108810 0 25681 0 27757 0 19878 0 4091 0 186217 0 0 0 JOHN HUST 175124 0 0 0 7376 0 13178 0 1109 0 196787 0 0 0 DR JOHN PETERSON 138224 0 0 0 16500 0 10484 0 440 0 165648 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED AT A REGULARLY SCHEDULED BOARD MEETING, PRIOR TO THE 990 BEING FILED WITH THE IRS. THE CFO PRESENTS TO THE BOARD, AND INCLUDES A GENERAL OVERVIEW OF THE 990, AS WELL AS SOME OF THE CHANGES NOW IMPLEMENTED AS PART OF THE REVISED 990 FORM. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, EACH BOARD MEMBER IS REQUIRED TO COMPLETE A "CONFLICT AND DUALITY OF INTEREST QUESTIONNAIRE" WHICH ASKS IF THEY, OR MEMBERS OF THEIR FAMILY, HAVE AFFILIATIONS OR INTERESTS THAT MIGHT POSSIBLY CONSTITUTE OR BE PERCEIVED TO CONSTITUTE A CONFLICT OR DUALITY OF INTEREST. WE HAVE NEVER HAD A MEMBER INDICATE SUCH A RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 15 THE MINISTRY HEALTH CARE BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, SULLIVAN COTTER. SULLIVAN COTTER, IN PARTNERSHIP WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, REVIEWS MARKET DATA FOR COMPENSATION AND BENEFITS AND COMPARABILITY DATA ON EVERY MINISTRY HEALTH CARE EXECUTIVE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -23,944. FIN 47 CUMMULATIVE EFFECT -300,000. TOTAL TO FORM 990, PART XI, LINE 5: -323,944. MINISTRY HEALTH CARE 11925 WEST LAKE PARK DRIVE SUITE 10 MILWAUKEE WI 53224 391490371 CORP OFFICE/PARENT CO OF ST ELIZABETH'S AND SEVERAL WI HEALTHCARE FACILITIES WI 501(C)(3) LINE 11-D,TYPE III-O N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 SCHEDULE R, PAGE 1, PART II, COLUMN (E) LINE 11-D,TYPE III-O