2013-05-14T15:08:29-05:00 2012-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2011-07-01 370661236 ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS % ST FRANCIS HOSPITAL STFR 2173242191 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 Daniel Perryman 2173248368 2013-05-08 true KPMG LLP 6142492300 2011 2016-02-24 21:20:13Z Daniel Perryman 1215 Franciscan Drive Litchfield IL 62056 36916223 false 0928 X WWW.STFRANCIS-LITCHFIELD.ORG X 1955 IL St. Francis Hospital continues the healing ministry of Jesus Christ in the tradition of St. Francis by providing the highest quality healthcare with respect, care, competence, and joy. 11 10 288 30 3586 -595 42334 244704 35851461 34835905 1072396 1293848 566613 428586 37532804 36803043 2000 2000 0 0 15966360 14576655 0 0 0 19159547 17262733 35127907 31841388 2404897 4961655 48301825 51547183 24963688 29211326 23338137 22335857 X ST. FRANCIS HOSPITAL CONTINUES THE HEALING MINISTRY OF JESUS CHRIST IN THE TRADITION OF ST. 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THE ASSOCIATIONS ST FRANCIS PAYS ARE AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 24.60% LOBBY EXPENSE, CATHOLIC HEALTH ASSOCIATION ("CHA") AT 5.15% LOBBY EXPENSE, AND ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 27.00% LOBBY EXPENSE.THE TOTAL AMOUNT OF YEARLY DUES IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBY EXPENSE TOCALCULATE THE LOBBY EXPENDITURES PAID. 99383 99383 23033339 14297103 8736236 0 0 0 16643005 14011801 2631204 2176694 0 2176694 13643517 0 ACCRUED BENEFIT LIABILITY 9716399 SETTLEMENT VALUE OF INTEREST 1445364 RETIRE OBLIGATION - ASBESTOS 855200 WORKERS' COMP TRUST LIABILITY 518895 12535858 Explanation for adoption of ASC Subtopic 740-10 ASC Subtopic 740-10 ON JULY 1, 2007, HSHS 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 125. true X true true true false true true 464 836351 836351 0.02870 7210795 6035070 1175725 0.04040 464 8047146 6035070 2012076 0.06910 15 806 69841 0 69841 0.00240 1 16 150 0 150 4 10070 136494 12156 124338 0.00430 20 10892 206485 12156 194329 0.00670 20 11356 8253631 6047226 2206405 0.07580 1 96 1875 0 1875 0.00010 2 79 1910 0 1910 0.00010 1 0 432 0 432 4 175 4217 0 4217 0.00020 true 1067965 78662 12553940 12438419 115521 X true true 1 1 St Francis Hospital of the Hospital Sis

1215 Franciscan Drive Litchfield IL 62056

X X X St Francis Hospital of the Hospital Sis 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 125. true 300. true X X X X X X X true true X X X true false true X false false PART I, LINE 3C Not applicable as the organization does follow FPG to determine eligibility for providing charity and discounted care to low-income, uninsured, and underinsured individuals. PART I, LINE 6A St Francis Hospital's community benefit report is available upon request at 1215 Franciscan Drive, Litchfield, IL 62056. PART I, LINE 7, COLUMN (F) The percent of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 7.58%. The amount of bad debt expense removed when calculating the percentages in part i, line 7, column (f) was $2,712,471. 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 A workforce development meeting for Montgomery and Macoupin counties was held in early 2011 which was attended by the People Service Manager and the Community Outreach Coordinator of St. Francis Hospital. This meeting of Montgomery and Macoupin county employers, colleges, and the regional office of education, was convened by local economic development offices to discuss current needs of area employers and how best to match those needs with the available workforce. Also discussed was how to improve the skills of the current workforce as well as improve preparation of the future workforce. As a result of this meeting, area school superintendents are working with local economic development coordinators to construct plans to better prepare high school students for the workforce. St. Francis Hospital provides meeting space for this ongoing effort. PART III, LINE 4 The hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients that potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity due to missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures, and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital. The hospital computes the cost of bad debt by applying the ratio of patient care cost to charges to the total charges written off as bad debt expense. The patient care cost is determined by adjusting the total annual operating expense by the cost of nonpatient-care activities, bad debt expenses, Medicaid provider taxes, and community benefit expense. The adjusted operating cost is then divided by the total gross patient charges to calculate the ratio of patient care cost to charges. Part III, Line 8 The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients that are not able to afford it is not compromised and is fairly subsidized by all payers. 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 computes the unpaid costs of providing care to Medicare patients by comparing the cost of the services to the reimbursement received from Medicare during the year. The cost of Medicare services is calculated by applying the ratio of patient care cost to charges to the annual Medicare charges. The patient care cost is determined by adjusting the total annual operating expense by the cost of nonpatient-care activities, bad debt expenses, Medicaid provider taxes, and community benefit expense. The difference between the reimbursement received and the calculated cost of the services is reported as the Medicare shortfall. While St. Francis Hospital receives reimbursement at 101% of cost for most Medicare services, some services provided to Medicare patients are not included in cost-based reimbursement. These services include the Emergency Department Physicians and Anesthesia Services. Part III, Line 9b 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 DEPT 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 EXTENEDED 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, Line 3 Yes. St. Francis Hospital collected both primary as well as secondary data in late 2011 to complete a Community Health Care Needs Assessment. A previous Health Care Needs Assessment was completed in 2009. Primary data collection was conducted through a telephone survey conducted by Leede Research, a marketing research firm specializing in healthcare information programs and tools. The goal of this survey was to identify population perceptions of community issues and needs that could be combined with other information for a Community Health Needs Assessment. The primary research portion of the study consisted of 410 completed telephone interviews conducted by Leede research in December 2011 and January 2012. The questionnaire utilized for this survey process was designed by Leede research in conjunction with leadership input from all thirteen Hospital Sisters Health System institutions including St. Francis Hospital leadership. In addition, Hillsboro Area Hospital also partnered with St. Francis Hospital and Leede Research for the primary telephone survey portion of the Community Health Needs Assessment. Sixty seven percent of respondents to the telephone survey were of ages 18-54 and almost 60% were married. Forty four percent of those responded that they had children living at home, with fifty percent of those children between the ages of 11-16. The majority of respondents are of the Caucasian race with only three percent of other races represented. This is due to the fact that over ninety six percent of the population for both counties is Caucasian. The education level of respondents varied with thirty percent achieving high school or equivalent, thirty seven percent having some college or technical school education, and twenty one percent having graduated from college. Only nine percent of the surveyed population held an advanced or professional degree. Approximately forty percent of respondents reported an annual income of $35,000 or less and forty two percent reported an annual income of $35,000-$75,000. Nineteen percent reported annual income of greater than $75,000. Sixty four percent of telephone survey respondents were female and thirty six percent male. In order to provide representation of all aspects of our community, a cross section of community members were identified by the St. Francis Hospital Internal Needs Assessment Team and were invited to participate in the assessment process. Representatives from law enforcement, education, public health, religious organizations, the medical and dental fields, service organizations, as well as state senator and state representative offices received a personal phone call and email invitation to assist with the needs assessment process. Letters of invitation were also mailed. Representatives from these fields as well as hospital representatives and a hospital board member convened to form the Community Advisory Committee. Community Advisory Committee Members 1. St Francis Hospital Internal Needs Assessment Team: Chief Executive Officer Hospital Board Member Community Outreach Facilitator Administrative Director of Ancillary Services Director of Financial Services Marketing Coordinator Director of Development 2. Local and county law enforcement: Litchfield Chief of Police-120 E, Ryder, Litchfield, IL 3. Director Montgomery County Health Department- Rt. 185 Hillsboro IL 4. Director Macoupin County Health Department-805 N. Broad St. Carlinville, IL 5. State Representative Wayne Rosenthal - 324A N. State St., Litchfield, IL 6. State Senator Sam McCann - 220 N. Broad St., Carlinville, IL. 7. Minister of First Baptist Church, 608 N. Van Buren, Litchfield, IL 8. St. Francis Hospital Auxiliary, Litchfield, IL. 9. Student Council Representative from Litchfield High School, Litchfield, IL The following persons were also invited to participate but were unable to attend: - Macoupin Co. Sheriff - Litchfield High School Guidance Counselor - Hearts United Service Organization Director - Holy Family Church, 410 S. State St. Litchfield, IL - Minister and physician, local representative - Local dental provider The directors of both county health departments, Macoupin County Health Department and Montgomery County Health Department, are very aware of the needs of the uninsured and low income or minority populations as these are the target populations that they serve. Both county health department directors were fully engaged with the needs assessment process and provided valuable insight into the primary and chronic disease needs of the uninsured and low income populations. Part V, Line 4 Yes. Hillsboro Area Hospital also partnered with St. Francis Hospital and Leede Research for the primary telephone survey portion of the Community Health Needs Assessment. Part V, Line 7 The hospital's Community Health Needs Assessment and associated implementation strategy were completed in FY2012, the reporting year. However, the implementation strategy had not yet been executed, so this question will need to be answered in the filing for FY2013. Needs Assessment St. Francis Hospital collected both primary as well as secondary data in late 2011 to complete a Community Health Needs Assessment. A previous Community Health Needs Assessment was completed in 2009. Primary data collection was conducted through a telephone survey conducted by Leede Research, a marketing research firm specializing in healthcare information programs and tools. The goal of this survey was to identify population perceptions of community issues and needs that could be combined with other information for a Community Health Needs Assessment. A total of 410 completed interviews were conducted for the primary data study. The sample used in the study was provided by national sample source Survey Sampling and was a representative sample of members in the targeted geographic area at the time of the study. A proportionate stratified sample was used to give the entire service area equal representation by zip code population. Using random population sampling, the study resulted in a maximum error of + 4.8% based on 95% confidence. All validation, reporting, analysis and presentation materials for the telephone survey were completed by Leede Research. A proportionate stratified sample was used to provide equal input from all geographic areas. Weighting by age and income was used to more accurately represent the actual population in the area. The goal was to give the survey an accurate representation of the actual service area and a random proportionate sample designed to address geographic placement by balancing survey population by zip code was utilized. Preliminary data from the study was reviewed against demographic information from the service area generated through use of Leede's Claritas Demographic Information, a national online database. Based on this review, it was determined that the sample generated through telephone interviewing required weighted adjustments to both income and age ratios. The younger populations and those with lower income levels were under represented in the overall study; thus Leede weighted the study sample by age and income to more accurately match the actual population of the service area. This weighting provides a more accurate view of the needs of the community, and was the basis for all analysis of the telephone survey. Montgomery and Macoupin Counties in Illinois were the geographic areas selected to be surveyed based on the primary service areas of both St. Francis Hospital and Hillsboro Area Hospital. Both hospitals worked together to identify communities to be surveyed, and defined twenty zip code locations with populations over 1,000 to which the telephone survey was administered. Secondary data was readily available and was also incorporated into the needs assessment process for St. Francis Hospital. Sources of this data included the Illinois Project for Local Assessment of Needs (IPLAN), a statewide database which provides access to essential public health data for assessment and planning purposes. IPLAN community health needs assessments from both Montgomery (2010) and Macoupin (2009) counties were reviewed and included. Data for both counties from The Illinois Behavioral Risk Factor Surveillance System (2007-2009), a state based program that gathers information on risk factors among adults, was utilized to provide a broader view of the health needs of the targeted area. Data from the National County Health Rankings (2011) was also considered when assessing the needs of the community. The primary data from the telephone survey was compared with both the state and national data in order to provide a broad perspective of the needs of the local community. The Community Health Needs Assessment can be accessed at: http://www.stfrancis-litchfield.org/uploadedfiles/content/sfl/our_services /community_outreach/sflchna%20report%202012.pdf Patient Education of Eligibility for Assistance Patients are notified of the organization's charity care policy and other available financial assistance through signage in the registration areas, text on the billing statements, hospital web site, and information from the registrars and other hospital personnel. The hospital employs a Financial Counselor who is 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. The Financial Counselor contacts uninsured patients to determine eligibility for Medicaid or other government assistance programs. Eligibility is verify using internet-based products and through contact with government resources. 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. If the patient is not eligible for a government assistance program or if the program does not cover the patient's needs, the counselor will provide an application for the hospital's Christian Care program and assist with the completion of the application. All uninsured patients are eligible for an uninsured patient discount, in accordance with the Illinois Hospital Uninsured Patient Discount Act. The Financial Counselor ensures that the discounts under the Act are applied appropriately. Community Information More than 92% of the inpatients treated at St. Francis Hospital reside in Montgomery and Macoupin Counties. 56% of the inpatients live in Montgomery County and 36% live in the neighboring Macoupin County. Both of the counties are located in central Illinois, between the cities of Springfield, Illinois and St. Louis, Missouri. Combined population is 77,535 and the median household income is less than $45,000 per year. The percentage of people living below the poverty level averages 12.0% in Macoupin County and 14.0% in Montgomery County and the current unemployment rate is 8.9% and 11.1%, respectively. Persons eligible for Medicare account for 46% of the patient revenue generated at the hospital and Medicaid-eligible patients generate 23%. Likewise, 26% of the revenue is derived from patients who have managed care/commercial insurance coverage. The remaining 5% of the patient revenue comes from patients with no insurance. Most of the Medicaid revenue originates in the Maternity unit. Over 65.4% of the Maternity unit revenue came from treating patients eligible for Medicaid. Provision of maternity services is financially detrimental to the hospital, since the hospital is a Critical Access Hospital (CAH) and is reimbursed by Medicare based on the Medicare-eligible costs incurred. Maintaining a maternity unit limits the number of Medicare patients that can be admitted to the hospital, as a CAH is allowed only 25 inpatients at a time, including maternity patients. Also, the maternity unit absorbs hospital overhead costs that would otherwise be eligible for Medicare cost-based reimbursement. In FY 2012, over $890,713 of the hospital's total operating cost was allocated to maternity services and was excluded from the computation of Medicare reimbursement. But since St. Francis is the only hospital offering maternity services between Springfield and Maryville, IL, maternity services continue to be provided as a service to the community. Promotion of Community Health St. Francis 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), St. Francis is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 135 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. St. Francis is a Critical Access Hospital. Because of the hospital's purpose and tradition, it is organized to promote the health of Litchfield 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 St. Francis 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. Also consistent with its exempt purpose, St. Francis 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, St. Francis 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, St. Francis 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. St. Francis also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, St. Francis provided over $2.2 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, St. Francis provided $1.1 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance and over $400,000((at cost) in excess of Medicare payment for health care services. Responding to Community Need The range of benefits provided by St. Francis 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 St. Francis and they often relieve a burden that would otherwise be carried by government. The Community Outreach Coordinator of St. Francis Hospital serves the community by participating on the Macoupin County Diabetes Coalition which provides diabetes education programs for the community. As a part of this coalition the Diabetes Self-Management Program, which was developed by Stanford University, was launched throughout central Illinois in the fall of 2011. A group of 10 individuals from Montgomery, Macoupin, Jersey, and Bond counties completed a week of training to become facilitators to teach this 6 week course to area residents. All facilitators are working together as part of a regional approach to provide diabetic education to these four counties, which is coordinated by Macoupin County Health Department. The Community Outreach Facilitator from St. Francis Hospital and a local citizen both completed the training and provided the initial course in Montgomery County in early 2012. The hospital also partners with the Illinois Kidney Mobile and the Montgomery County Health Department to provide free screenings for diabetes and renal disease. This free service provides a large mobile van full of diabetic and renal disease education displays in addition to a health screening process. The health screenings consist of free urinalysis, blood glucose testing, hemoglobin A1C testing if appropriate, height, weight, body mass index, and additional chemistry testing for those meeting specific criteria. Once all screenings are completed a nurse practitioner reviews results with each individual and referrals for care are arranged if needed. A team of four individuals with the Kidney Mobile are assisted by staff from the Montgomery County Health Department and St. Francis Hospital, which sponsor this free day of screening and education. Many individuals who normally would not be able to afford these tests have been able to obtain much needed testing and screening through this program. In addition, another diabetes collaborative effort has been established by the Community Outreach Coordinator. This collaboration is working to establish a communication and referral system between nurse navigators at local medical offices, physicians, Diabetes Self-Management Program instructors, and health departments. The goal is to identify patients in need of diabetes education, communicate patient needs related to diabetes, improve enrollment in local Diabetes Self-Management Courses, and track and measure outcomes. St. Francis Hospital also partners with the Montgomery County Health Department, Hillsboro Area Hospital, and the University of Illinois Extension Service to provide locally grown fresh produce to families who participate in the WIC program of the county health department. Free bags of produce are provided along with information about food handling, storage, and preparation, as well as recipes and cooking suggestions. Produce programs are provided in the summer and fall in order to offer a variety of vegetables. St. Francis Hospital also participates on the Health Services Advisory Board for the Macoupin County Head Start Program. This board reviews the health programs in place for the Head Start Preschool Program and provides guidance for program development. Dental care was identified as an area of need through the Community Health Needs Assessment. As a result of this need, St. Francis Hospital reached out to local dental care providers to coordinate a free day of dental care for the uninsured in our community. Participants had the choice of receiving a filling, extraction, or hygiene services free of charge. Two local dental offices participated and donated staff time and supplies to provide the much needed dental care to approximately 90 individuals. St. Francis Hospital also partnered with the dental hygiene program at Lewis and Clark Community College to bring their mobile dental van to the Litchfield area. This pilot program provided free or low cost dental exams and cleanings to the uninsured in the spring of 2012. Both programs were well received and attended by the community. Plans for Responding to the FY2012 CHNA During FY2013, the following activities will be modified or supplemented to focus on the priority needs identified by the FY2012 community health needs assessment process. Produce Program: In partnership with the Montgomery County Health Department and Hillsboro Area Hospital, fresh, locally grown produce was provided to families participating in the WIC program. A new program was piloted in the spring of 2012 to provide potted tomato plants to WIC families to encourage growing produce at home. Dental Program: A new service was provided to our community by partnering with Lewis & Clark Community College. Their mobile dental service provided dental exams, x-rays, and cleanings at very low cost (or free). This was a new venture for the mobile unit and was very well received by the college as well as the community. Plans are to repeat services again in the fall of 2012. Immunizations & Screenings: In conjunction with an Illinois Department of Public Health grant, a variety of information was provided to area residents about vaccines and immunizations. Adult vaccine information was provided to seniors at the Senior Health Expo in Carlinville and Staunton. Vaccines for both adults and children were discussed with the Elizabeth Ann Seton Program (young mother's support group) of Litchfield. Blood Pressure, Body Mass Index, and Cholesterol screenings were provided at numerous events within the surrounding community including at the Gillespie High School Health Fair, at Fusion for the Lighten UP 4 Montgomery County kick off, Litchfield Health Fai Affiliated Health Care System St. Francis 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 Christ's 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. Joseph's 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 nurse's 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. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's 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 Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that 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. Joseph's 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. John's 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 H STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL, X true true X X X X X X false true false false false false false false false DANIEL PERRYMAN 0 263676 0 0 0 6719 0 91279 0 19115 0 380789 0 27633 Robert Ritz 0 550340 0 0 0 38122 0 162878 0 56610 0 807950 0 61170 Larry J Ragel 0 247925 0 25 0 0 0 55206 0 19389 0 322545 0 0 ANN M CARR 0 180382 0 0 0 45430 0 197622 0 18652 0 442086 0 0 CAROL JACO 152903 0 0 0 0 0 38069 0 8028 0 199000 0 0 0 DIANE LINDSAY 153000 0 0 0 0 0 82567 0 14454 0 250021 0 0 0 Kathryn Knobloch 105431 0 0 0 0 0 67664 0 771 0 173866 0 0 0 JILL MOUTRIA 125414 0 0 0 0 0 48991 0 7879 0 182284 0 0 0 Peter Mannix 0 292045 0 0 0 18160 0 117575 0 29851 0 457631 0 31910 Susan Stromsland 100344 0 0 0 0 0 39367 0 18926 0 158637 0 0 0 ROBERT RITZ SCHEDULE J, PART I, LINE 4B ROBERT RITZ PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $118,775. ANN M. CARR SCHEDULE J, PART I, LINE 4B ANN M. CARR PARTCIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $33,655. PETER MANNIX SCHEDULE J, PART I, LINE 4B PETER MANNIX PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $62,037. DANIEL PERRYMAN SCHEDULE J, PART I, LINE 4B DANIEL PERRYMAN PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $54,360. PROGRAM SERVICES REVENUE - ACCOMPLISHMENTS 990 PART III LINE 4A The community benefit contribution of St. Francis Hospital includes programs and activities that improve access to health care and improve health in our communities. In order to portray the full breadth of our contribution, our community benefit information is described below: SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT: During the fiscal year ended June 30, 2012 St. Francis Hospital operated as a Critical Access Hospital. The Hospital provided 5,010 adult, pediatric and skilled nursing days of care and accommodated 50,244 outpatient visits during the fiscal year. Quality medical services were provided to all patients regardless of race, creed, sex, national origin, handicap, age or financial status. Although reimbursement for services rendered is critical to the operation and stability of the Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. St. Francis Hospital's mission is to serve the community by providing healthcare services and education. To accomplish this mission, the Hospital provides care to the poor, the elderly and the needy of the community through various programs and services. These activities include wellness programs, community education, and community support activities, and programs specifically designed for the elderly,handicapped and medically underserved. Benefits for the poor include services provided to persons who cannot afford health care because of inadequate resources and who are uninsured or underinsured. These benefits are provided in the form of charity care for those who cannot afford to pay, through the Hospital's uninsured discount program and through public programs such as Medicaid. St. Francis provides charity care through its Christian Care program. The Christian Care program is designed to ensure that the resources used to assist patients are provided for those who are unable to pay for their medical care. Financial assistance is determined by comparing the applicant's gross family income to the most recent Federal Poverty Guidelines. In order to qualify for assistance applicants must complete an application form, provide documentation of current family income, provide documentation of medical expenses and available assets, and provide evidence of investigation of all other means of assistance. Applications are reviewed by the Hospital's Christian Care Committee and selection for assistance is determined by the Hospital's available funds and the eligibility of the applicant. All uninsured patients are allowed a discount of at least 10% from the charges billed for the patients' hospital services. In accordance with the State of Illinois Public Act 095-0965, St. Francis provides uninsured patients the ability to apply for further discounts. Under the Hospital Uninsured Patient Discount Act, uninsured patients may be eligible for discounts ensuring that they pay no more than 135% of the cost of the services provided. Benefits for the broader community include services provided to needy populations that may not qualify as poor but need special services and support. St. Francis provides these benefits through the provision of unbilled services for community members. Nonbilled community services include the cost of health education and community health clinics and screenings. Specific services provided by St. Francis include: * Assistance with community blood drives, kidney mobile, dental care and Fresh Fruit Program; * Employee speakers at health fairs, schools and other community organizations; * Nutritional management consulting services and educational materials; * Educational seminars for the general public on senior fitness programs, breast cancer awareness, diabetes, cardiac rehabilitation, congestive heart failure, elder abuse, stroke and drug prevention; * Screenings for colorectal cancer, hypertension, cholesterol and obesity; * Donation of medical supplies and used equipment to missions in underdeveloped countries; * Donation of cash and supplies to local agencies; * Educational sessions for healthcare providers on blood borne pathogens, stress management and CPR; * St. Clare Food Pantry to provide food for needy families. QUANTIFIABLE COMMUNITY BENEFIT: The financial information in this report was prepared in accordance with the Catholic Health Association's ("CHA") community benefit reporting guidelines. These guidelines recommend the following: * Report charity care at cost, not charges; * Do not include bad debt, contractual allowances, and prompt pay discounts as part of charity care expense; * Do not count a Medicare shortfall as a community benefit; * Report the net expense for community services, i.e., the total community benefit expense minus any associated revenue from patients, payers, and external sources; The CHA 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 addition, the Hospital committed significant resources to serving the Medicare population. The cost (determined using a cost to charge ratio) of providing services to primarily elderly beneficiaries of the Medicare program, in excess of governmental payments, was $404,715 for the year ended June 30, 2012. The hospital also committed significant resources to serving the Medicaid population.The cost of providing services to pregnant women and their newborns was $890,713 for the year ended June 30, 2012. St. Francis Hospital is the only hospital between Springfield and Maryville that offers Maternity Services. The State of Illinois (the State) renewed an assessment program to assist in financing of its Medicaid program in December of 2006 for the State's fiscal years ended June 30, 2006, 2007, 2008, 2009, 2010, and 2011. The program was approved in 2008 and has been renewed each year since. Pursuant to this program, hospitals within the State are required to remit payment to the State of Illinois Medicaid program under an assessment formula approved by the Centers for Medicare and Medicaid Services (CMS). The assessment program also provides hospitals within the State with additional Medicaid reimbursement based on funding formulas, also approved by CMS. The net effect of the 2012 assessment and reimbursement included in the Hospital's 2012 statement of operations is $2.1 million. RIGHTS OF MEMBERS TO ELECT GOVERNING BODY FORM 990, PART VI, LINE 6 & 7A THE SENIOR GOVERNING BODY OF ST. FRANCIS HOSPITAL (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS 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 St. Francis 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 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. REVIEW PROCESS FORM 990, PART VI, LINE 11B The hospital employs KPMG to assist in the overall preparation, 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, 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. RECORD RETENTION AND DESTRUCTION POLICY FORM 990, PART VI, LINE 14 THE HOSPITAL IS CURRENTLY FOLLOWING THE SYSTEM-WIDE RECORD RETENTION AND DESTRUCTION POLICY. COMPENSATION PROCESS 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. DOCUMENTS 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. POOLED INVESTMENT ACCOUNT FORM 990, PART X, LINE 11 St. Francis Hospital's cash reserves are invested in a pooled investment account. Participation in the pooled fund is limited to the 501(C)(3) Hospitals and related health services organizations sponsored by the Hospital Sisters Health System. The pooled account consists of cash, and equity and debt securities that are publicly traded. In accordance with the provisions of SFAS No. 124 "Accounting for certain investments held by Not-For-Profit Organizations," investments in equity securities with readily determinable 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 participants. OTHER CHANGES IN NET ASSETS FORM 990, Part XI, Line 5 Reversal of changes in pension funded status (3,562,805) Unrealized Gains (1,746,466) Increase in temporarily restricted net assets 613,774 Transfer from affiliates (1,224,000) Proceeds from restricted grant used to acquire equipment 205,037 Temporarily restricted net assets-investment income (34,294) Interest Income capitalized as part of construction in progress (10,148) ----------- Total (5,758,902) =========== HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Peter Mannix TITLE:Board Member HOURS:59 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANN M. CARR TITLE:TREASURER HOURS:60 Springfield Health Partners LLC 4936 Laverna Road springfield IL 62707 371364419 healthcare IL 0 0 hshs mg Kiara Clinical Integration Network LLC 4936 Laverna Rd springfield IL 62707 261417684 healthcare IL 0 0 HSSI Physician Clinical Integration Network 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 Self Insurance Trust Fund 4936 laverna Road SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(c)(3) 11a NA false HSHS Health Care Plan Trust Fund 4936 laverna Road SPRINGFIELD IL 62707 371137724 HEALTHCARE IL 501(c)(3) N/A NA false Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY I CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) 11a NA false Sacred Heart Hospital 900 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 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 Nicholas Hospital 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 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 PO Box 99 BREESE IL 62230 371208459 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 362169181 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 Vincent Hospital 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 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 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 Ave Sheboygan WI 53081 391860942 Healthcare WI 501(c)(3) 9 St Nicholas false Wisconsin Upper Pen Ocn Mngmt Services 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) 11A 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 - CarbondaleLLC 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 Ave Sheboygan WI 53081 260822209 HealthCare WI St Nicholas Related 0 0 false 0 false 0.00000 Prevea Ventures LLC 2710 EXECUTIVE DR Green Bay WI 54304 203775127 HealthCare WI HSSI Related 0 0 false 0 false 0.00000 CARPENTER STREET HOTEL LLC 36- HOTEL IL LASANTE INC Related 0 0 false 0 false 0.00000 SPRINGFIELD URGENT CARE REAL ESTATE RENT. REAL ES IL LASANTE INC Related 0 0 false 0 false 0.00000 Kiara Inc 4936 Laverna Rd Springfield IL 62707 371163401 HealthCare IL HSHS C Corp 0 0 LaSante Wisconsin Inc 4936 Laverna Rd Springfield IL 62707 391572196 HealthCare IL Kiara Inc C Corp 0 0 LaSante Inc 4936 Laverna Rd Springfield IL 62707 371163400 HealthCare IL Kiara Inc C Corp 0 0 Prairie Cardiovascular 619 East Mason STE 4P57 Springfield IL 62701 371071858 HealthCare IL Kiara Inc C Corp 0 0 Prevea Health Services 2710 EXECUTIVE DR Green Bay WI 54304 391839351 HealthCare WI HSSI C Corp 0 0 0.00000 Prevea Clinic Inc 2710 EXECUTIVE DR Green Bay WI 54304 391839349 HealthCare WI HSSI C Corp 0 0 0.00000 Prevea Health Network 2710 EXECUTIVE DR Green Bay WI 54304 392000537 HealthCare WI HSSI C Corp 0 0 0.00000 Renaissance Quality Insurance PO Box 1159 Grand Caymans CJ KY1-1102 980669953 insurance CJ HSSI c corp 0 0 0.00000 true true true true false false false false false true false false true true true true true true TRANSACTIONS WITH RELATED ENTITIES SCHEDULE R, PART V, LINE 2 ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION.