2012-05-15T09:48:11-05:00 2011-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2010-07-01 390818682 ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC - HOSPITAL SISTERS STMA 9204984200 1726 SHAWANO AVENUE GREEN BAY WI 54303 Therese Pandl 9204984622 2012-05-14 true KPMG LLP 6142492300 2010 2016-02-24 21:20:13Z GREEN BAY INC - HOSPITAL SISTERS THERESE PANDL 1726 SHAWANO AVENUE GREEN BAY WI 54303 121436525 false 0928 X WWW.STMGB.ORG X 1900 WI TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. 11 8 843 115 1853537 -2178035 81278 315925 109687964 113895764 376304 3340201 1253834 773655 111399380 118325545 0 0 0 0 45023380 47558268 0 0 0 58515830 64383917 103539210 111942185 7860170 6383360 150181055 158314133 75301348 66139699 74879707 92174434 X SEE SCHEDULE O false false 13604151 24773481 SURGERY - see schedule O 6409016 19134186 RADIOLOGY SERVICES - see schedule O 4076410 10936717 HEART & VASCULAR CENTER - see schedule O 69101791 59585520 93191368 true true false true false false false false false false true false true false true true false true false false false false false false false false true true false false true false false false true false false false true false false false false true true false false false false true 37 0 843 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 true true X GREG SIMIA 9208845595 1726 SHAWANO AVENUE GREEN BAY WI 54303 X SISTER MARYBETH CULNAN OSF 1.0 X 0 0 0 THERESE PANDL 20.0 X X 0 600501 157220 JUDY NAGEL 1.0 X X 0 0 0 SISTER BERNADINE GUTOWSKI OSF 1.0 X 0 0 0 BOB BURNS 1.0 X 0 0 0 JOHN HAGER 1.0 X X 0 0 0 KENNETH JOHNSON MD 1.0 X X 0 0 0 DJ LONG 1.0 X 0 0 0 ROLF LULLOFF MD 1.0 X 0 0 0 Daniel J Platkowski 1.0 X 0 0 0 ROBERT ATWELL 1.0 X 0 0 0 ANN CARR 0.25 X 0 191336 109542 LAWRENCE J CONNORS 40.0 X 189491 0 70963 DONNA A HUTCHinSON 40.0 X 182261 0 76796 greg simia 20.0 X 0 0 0 AMY J UNRATH 40.0 X 181853 0 106513 JOHN DAUL 40.0 X 177760 0 58903 MARY ALLICE JOHNSON 40.0 X 169516 0 70964 CRAIG BABIARZ 40.0 X 174599 0 16855 STEPHEN KORDIYAK 40.0 X 169595 0 51798 GABRIEL LEIS 40.0 X 184488 0 31922 JAMES COLLER 40.0 X 0 236891 -32105 1429563 1028728 719371 32 true true false ST VINCENT HOSPITAL 835 S VAN BUREN STREET GREEN BAY WI 54303 SHARED SERVICES 18295626 PREVEA CLINIC PO BOX 19070 GREEN BAY WI 54307 SHARED LABOR 2544545 TRIMEDX 6325 DIGITAL WAY 400 INDIANAPOLIS IN 46278 CLINICAL ENGINEERING 1507436 Alliance Healthcare Services PO box 6600 NEWPORT BEACH CA 92658 MRI Leasing 756000 universal hospital services po box 86 MINNEAPOLIS MN 554860940 medical rentals 438410 57 315925 315925 PATIENT SERVICES 900099 111918867 111918867 LABORATORY SERVICES 621500 1558280 1558280 PREVEA INVESTMENT GAIN/LOSS 900099 418617 418617 113895764 1636718 1636718 0 0 2415930 2754207 -338277 -338277 -338277 1872753 526043 356773 1872753 169270 1703483 1703483 0 0 0 OTHER REVENUE 900099 282535 282535 NONEMPLOYEE CHILDCARE REVENUE 624410 829397 534140 295257 1111932 118325545 112871624 1853537 3284459 0 0 0 0 771435 771435 0 33483157 30971313 2511844 2864712 2590273 274439 8084591 7310087 774504 2354373 2128824 225549 5581200 5581200 139290 139290 0 0 0 0 10033908 7657799 2376109 727345 4525 722820 426527 390628 35899 0 0 4373483 4152454 221029 64010 42004 22006 0 116278 60652 55626 915087 915087 0 4881007 4440679 440328 46310 92402 -46092 SUPPLIES - MED/SURG/O2/DRUGS 16059733 16059733 PREVEA INVESTMENT AND LEASE 9059532 9059532 BAD DEBT EXPENSE 6079445 6079445 MEDICAID TAX ASSESSMENT 3128500 3128500 FEES, LICENSES & TAXES 716603 546583 170020 2035659 1604435 431224 111942185 93191368 18750817 0 4335 2584 5940922 5222105 14377432 13730953 250000 250000 487268 476737 2441759 2477670 606705 442018 152682289 77257357 79286133 75424932 37124405 49928874 7054073 8627051 2608023 1731209 150181055 158314133 14180020 15576505 34262494 33637883 26858834 16925311 75301348 66139699 X 67698987 84324387 4884151 5552567 2296569 2297480 74879707 92174434 150181055 158314133 X 6383360 10911367 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 4287 4287 false Description of other lobbying activities schedule C, Part II-B, Question 1I ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, with PART OF THESE DUES being ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. 2276732 2276732 62397755 23602312 38795443 639692 223843 415849 34905990 26407939 8498051 52462120 27023263 25438857 75424932 INVESTMENT IN PREVEA 5681121 C INV. - COMMUNITY MEMORIAL HOSP 1460988 C INVESTMENT IN UNITY 1154376 C INV. IN ONCOLOGY JOINT VENTURE 304395 C INV. IN CATHOLIC FOUNDATION 26171 F 8627051 0 ACCRUED PENSION LIABILITY 16232068 SETTLEMENT VALUE OF CONSTR RET 353860 RETIRE OBLIGATION ABESTOS 217364 ESTIMATED SELF-INSURANCE 122019 16925311 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, 2011 AND 2010, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS. true true true X 225. true X true true false true true 1 2087 1627260 1627260 0.01540 1 21979 15913584 11058497 4855087 0.04580 2 537 976723 708431 268292 0.00250 4 24603 18517567 11766928 6750639 0.06370 62 7904 5956207 3254643 2701564 0.02550 8 15 60750 60750 0.00060 8 1274 150219 150219 0.00140 78 9193 6167176 3254643 2912533 0.02750 82 33796 24684743 15021571 9663172 0.09120 3 144 265 265 0.00000 1 120 104 104 0.00000 4 264 369 369 0.00000 true 2437923 0 32464416 44860722 -12396306 X true true Prevea Clinic - PHS HEALTHCARE 0.25000 0.00000 0.50000 Prevea Health Ntwrk healthcare 0.25000 0.00000 0.50000 Prevea Ventures healthcare 0.25000 0.00000 0.50000 Prevea health srvcs healthcare 0.25000 0.00000 0.50000 unity limited pship healthcare 0.10000 0.00000 0.00000 NE WI RAD THERAPY healthcare 0.25000 0.00000 0.50000 community mem hospit healthcare 0.07200 0.00000 0.00000 1 1 ST MARY'S HOSPITAL MEDICAL CENTER

1726 SHAWANO AVENUE GREEN BAY WI 54303

X X X ST MARY'S HOSPITAL MEDICAL CENTER 1 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. Mary's community benefit report is available upon request at www.stmgb.org. Part I, Line 7g The hospital does not have sufficient information at this time to determine if subsidized services exist based on the definition and calculations required by the IRS and will continue to work and provide such information in next year's return. 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 9.12%. The amount of bad debt expense removed when calculating the percentages in Part I, line 7, column f was $6,079,445. 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 2011 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 Our hospital has a long standing commitment to being environmentally sensitive, as part of our Franciscan heritage. There are many examples of how this is demonstrated, one of which is our participation in the Brown County Sharps programs. The hospital serves as a drop-off site for sharps, such as needles used to inject insulin. Community members drop these items at the hospital, which then pays to have them disposed of properly. In an effort to ensure that pharmaceuticals and other medications do not end up in local waste streams, St. Mary's hosted a pharmaceutical take-back event in collaboration with the Green Bay Police Department. Households were encouraged to bring in their old or expired medicines for proper disposal. We actively contribute to the Hospital Sisters Mission Outreach program, whereby surplus or otherwise unused hospital supplies are collected and distributed to missions in the US and many other countries. In addition, we participate in the Wisconsin Hospital Emergency Preparedness Plan ("WHEPP"). The purpose of WHEPP is to develop processes to help participating institutions in Wisconsin meet community needs in a collaborative and organized manner during an incident emergency. The State of Wisconsin recognized that a mass casualty incident due to a biological, chemical, radiological, or natural disaster can easily overwhelm or damage the ability of local healthcare resources to meet community needs. Accordingly, WHEPP, a mutual aid plan, was developed to address this concern. We have actively participated in the organization and development of this group and led efforts in our region. As leaders in this group, we have helped to initiate the preparedness efforts by WHEPP that assist hospitals in our state to maintain the minimum levels of readiness that are expected by the federal and state governments. Another significant portion of the community building dollars is dedicated to workforce assistance and growth through support of the Green Bay Area Chamber of Commerce Youth Apprenticeship Program (on-the-job training) and Partners in Education, a local program which recognizes exceptional teachers and provides students with a variety of career exploration and experience programs. We support those who are related to the acute health care industry by maintaining regular communication and updating on trends and issues in the industry and fostering collaborative relationships. This is done through regular luncheon meetings with nursing home administrators and clergy, as well as through health care career talks to local students. 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 may include 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 reducing the total annual operating expense by the 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. Our mission calls us to serve all patients with the highest possible quality and efficiency, even if we are not paid fully for doing so. 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 reducing the total annual operating expense by 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. 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 QUALIFIES 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 QUALIFIES 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 PAYOR 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. Needs Assessment We employ a number of methods to assess health care needs: 1) we have a community advisory committee broadly representative of the community. This committee meets regularly to discuss hospital services and advise us on how well we are meeting community needs. As terms expire, committee members assist in identifying new members who can continue to assist us in this way. We make an effort to include members from the neighboring communities we serve, as well as some potentially underserved groups-such as Hmong or Native American leaders. 2) Hospital leadership meets with each committee member individually to learn more about their opinions about community needs. 3) We examine the reasons that self-pay and Medical Assistance patients come to our emergency department for care. 4) Hospital leadership serve on local social service agency boards, such as the N.E.W. Community Clinic (a "free clinic"), and meet with representatives of the Catholic Diocese to discuss community needs. 5) Our Hispanic Health Educator/Cultural Liaisons assist us in identifying needs of special subgroups of patients. During FY2011, St. Mary's leadership assisted with, and participated in, the Brown County Health Department's Community Health Improvement Process, a community needs assessment that reviews how Brown County compares to the rest of the state on indicators contained in "Healthy Wisconsin 2020". A group widely representative of the community has been convened to review the data and determine the high priority issues for Brown County. St. Mary's will examine the results of this study to determine how to best address the high priority needs. Patient Education of Eligibility for Assistance Our hospital posts our charity care policy and application on our website. In addition, charity care applications are available and prominently displayed in our registration areas. Our financial counselors are available to meet with patients on site before, or at, the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. Our collectors are trained to provide this assistance as well. Last but not least, we have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. Community Information St. Mary's Hospital is located in Brown County, Wisconsin, an urban county with a population of about 250,000 people. Most of St. Mary's patients come from the west side of Green Bay, but patients also come from the nearby rural areas in Brown, Shawano, and Oconto counties. Brown County's population is primarily Caucasian, but there is a notable Native American population, as well as a growing Asian and Hispanic population. Over 50 languages are spoken in Brown County, and we provide interpretation services for all. Promotion of Community Health Our hospital has an open medical staff and boards comprised of community members. Funds over and above what is needed for operations are reinvested in the facility and program services, using generally accepted accounting principles and market assessment to ensure that the funds are being used wisely. Our hospitals were founded over 100 years ago by a group of Catholic sisters whose purpose was to extend Christ's healing love throughout our area. Because of that, we comply with the Ethical and Religious Directives for Health Care issued by the US Council of Catholic Bishops. We also actively offer a variety of no-charge community and health education programs locally to assist community members in learning more about their health condition or possible health issues. St. Mary's Hospital Medical Center provides significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2011, St. Mary's provided over $9 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. During this period, St. Mary's provided $12 million (at cost) in excess of Medicare payment for health care services. An example of our community benefit initiatives is the support we provide to patients that pass each year through the doors of the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St Mary's provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinic's care prevented a trip to the emergency department. A Woman's Place at St. Mary's Hospital Medical Center has been a valued and trusted outreach center for women and their families throughout our area. Through A Woman's Place, we reach our Hispanic neighbors to provide health and wellness education, health screenings, resources, and referral services, facilitated by the role of a Hispanic Health Educator. Last year A Woman's Place touched the lives of more than 7,000 women through its Resource Center and consumer lending library, screenings for cardiovascular disease, osteoporosis and reproductive cancer; educational events and classes on a variety of health topics. An additional 65,000 women were touched through its quarterly health newsletter. St. Mary's sponsors a walking club at the local mall. More than 490 active members participate in a variety of health-related screenings and informational sessions throughout the season which runs from September through May each year. In addition to using the mall as a venue for walking, the program has been extended to include routes throughout the city. Routes and incentives for walking are posted on our website to encourage people of all ages to lead an active lifestyle. Hospital employees provide information at educational and public forums, such as the YMCA Healthy Kids Day, A Day Just for Women, Brown County Aging Resource Center, the Big Event for Little Kids, a series of events during National Women's Health Week, and the Einstein Project. Many underserved and uninsured of our community attend these events. The American Cancer Society Loan Closet - located at A Woman's Place - provides wigs, scarves, turbans, hats, and breast prostheses for women living with the side effects of cancer treatments. Additionally, the Look Good, Feel Better program offers information and guidance to cancer patients looking to enhance their appearance. This gives patients a sense of control over physical changes they may experience. St. Mary's Hospital, along with St. Vincent Hospital and Bellin Health, supports Unity Hospice, a provider of appropriate care for the terminally ill. These various efforts to serve the needs of our community result in real benefits for the people of Green Bay. Affiliated Health Care System St. Mary's Hospital Medical Center - Green Bay is an affiliate of Hospital Sisters Health System. The mission of Hospital Sisters Health System ("HSHS") is to serve those in need through a health care ministry that values compassion, respect and reverence for life. The nearly 14,000 colleagues who make up HSHS are dedicated to this mission and to providing high quality health care to whoever seeks our services. By living our mission each day, HSHS colleagues constantly strive to provide the highest quality and most cost-effective and compassionate health care to those we are privileged to serve. Our health care ministry extends across 12 communities in Wisconsin and Illinois and includes 13 hospitals, dozens of community-based health centers and clinics, and more than 2,000 physician partners. As part of our mission to provide healing and hope to the three million 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. In the Fiscal Year that ended June 30, 2011, HSHS hospitals provided $166.1 million in Community Benefits (or 8.7% of total expenses), an increase of $15.7 million from FY 2010. Of this amount, $37.1 million was provided for charity care and $99.8 million was the amount of unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources in serving the Medicare population. The cost of providing services to primarily elderly beneficiaries of the Medicare program, in excess of governmental and managed care contract payments, was $183.8 million during Fiscal Year 2011. HSHS hospitals also recorded $103.9 million in uncollectible accounts. HSHS 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 hospitals can continue to provide high quality, compassionate care to our patients. During Fiscal Year 2011, HSHS also continued to invest in our Care Integration strategy that places the patient at the center of our work while allowing us to deliver care in a more cost-effective and efficient manner. These investments are 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. Our Care Integration strategy is delivering promising results. An example is our three Medical Home pilot projects. Diabetic Patients enrolled in Medical Homes in rural Illinois experienced an average 42 percent decrease in their blood glucose levels while their unplanned readmissions to the hospital dropped to zero. HSHS is making significant progress implementing interoperable health information technologies and robust health information exchanges. In central Illinois, HSHS is joining with other health care providers to develop a statewide Health Information Exchange ("HIE") that will allow health care providers to exchange clinical information, such as medication histories and test results, access that information at the point of care and make better informed decisions with their patients. HSHS understands that our investments in information technology will have a positive impact on the quality, safety and efficiency of health care. 1. Expanding access to health care An integral component of our Community Benefit initiatives is to provide care to every patient who seeks our services without exception. To that end, HSHS hospitals have established Charity Care program guidelines that cover 100% of hospital charges for individuals and families who earn 125% to 250% of the federal poverty level. HSHS hospital's Charity Care guidelines have sliding scales, in some instances providing up to a 50% discount on charges for those earning up to 600% of the federal poverty level. HSHS hospitals have created simple forms for those wishing to apply for Charity Care and assign counselors to visit with inpatients who are uninsured to let them know about our charity care policies and provide assistance filling out applications for financial assistance or enrollment in publicly funded health care programs. HSHS hospitals also work collaboratively with others to enhance access to health care services for those in need. St. John's Hospital in Springfield, IL has partnered with Memorial Medical Center, Southern Illinois University School and Medicine and other community partners to support the Coordinated Access to Community Health ("CATCH") initiative. The free program is being made available to uninsured adults in Sangamon County to help them access routine medical care, specialty doctors and affordable medicine. Launched in May 2011, CATCH enrolls patients as they visit social service agencies or when they leave hospital emergency rooms. Enrollees are then referred to Springfield's federally funded primary care clinic, Capitol Community Health Center, or participating doctors' private offices. Grants from St. John's Hospital, Memorial Medical Center, United Way of Central Illinois and the Dominican Sisters offset CATCH's first year of expenses. Patient advocates at St. John's Hospital and Memorial Medical Center help uninsured patients find primary or specialty doctors and make appointments, and arrange for financial assistance from participating social service agencies for prescription drugs. In the first three months since the program was launched, CATCH signed up more than 250 physicians in the community who agreed to see patients at no charge. The program endeavors to enroll up to 6,000 uninsured patients within the next few years. By making it easier for uninsured residents to get preventive health care services, CATCH organizers believe uninsured patients' medical problems will be addressed early, helping improve their quality of life. St. Mary's Hospital Medical Center in Green Bay, WI supports the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St. Mary's provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinic's care allowed them to avoid having to seek care in a local Emergency Room. For the past decade, St. Anthony's Memorial Hospital in Effingham, IL has teamed up with Effingham Catholic Charities to co-sponsor the Prescription Assistance Program. Catholic Charities' staff members work with clients who need prescription medication but may not be able to afford them because they are uninsured or underinsured. Due to the financial support of St. Anthony's, the program is able to provide needed prescriptions to dozens of residents each month. St. Francis Hospital in Litchfield, IL collaborated with local dental care providers to coordinate and provide a free day of dental care to uninsured individuals. The collaboration was the result of a community needs assessment that determined access to dental care was a priority in the community. The "Community Day of Dental Care" provided free dental cleanings, X-Rays, and extractions to 90 uninsured individuals. Among those 90 people served included a military veteran who has been unable to obtain dental care after a St. Louis facility closed. He was able to have five teeth extracted. Another person served was a young woman who needed some minor restorative care which greatly improved her appearance. She was very grateful because she had a job interview coming up and would be able to attend the interview feeling better about her appearance. 2. Enhancing the health status of the community Another component of our Community Benefit initiatives is to improve the quality of life in our communities. Our hospitals work closely with a wide array of public and private organizations that share our commitment to enhancing health and wellness. We know that by working together, we can maximize our efforts by sharing resources, reduce duplication of services, and make it easier for residents to get the services and knowledge they need to live healthier lives. HSHS hospitals also understand they need to listen closely to the residents of the communities they serve to ensure the health care needs of all are being met. Sacred Heart Hospital in Eau Claire, WI invited more than 1,400 area residents to share their vision for health care during a series of focus groups. Participants included constituents that are often overlooked: low-income, vulnerable populations and minority groups. The visioning sessions captured the voices of special populations, Among Mutual Assistance Association members, Amish farmers, seniors, young children and other diverse groups. The feedback provided led to more than 100 actionable items that were assessed and/or implemented over the first six months since the sessions concluded. One action taken by Sacred Heart Hospital and St. Josep STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI WI X X X X X X false false false false false false false false false THERESE PANDL 0 544799 0 35400 0 20302 0 132192 0 29068 0 761761 0 38561 JAMES COLLER 0 73026 0 0 0 163865 0 -34718 0 3291 0 205464 0 0 ANN CARR 0 152228 0 11100 0 28008 0 92165 0 18090 0 301591 0 0 LAWRENCE J CONNORS 183791 0 5600 0 100 0 46427 0 25312 0 261230 0 0 0 AMY J UNRATH 181753 0 0 0 100 0 98641 0 8623 0 289117 0 0 0 DONNA A HUTCHinSON 176369 0 5300 0 592 0 72762 0 4778 0 259801 0 0 0 JOHN DAUL 177660 0 0 0 100 0 39319 0 20276 0 237355 0 0 0 MARY ALLICE JOHNSON 169416 0 0 0 100 0 46744 0 24912 0 241172 0 0 0 CRAIG BABIARZ 174599 0 0 0 0 0 9009 0 8539 0 192147 0 0 0 STEPHEN KORDIYAK 167408 0 0 0 2187 0 29814 0 22676 0 222085 0 0 0 GABRIEL LEIS 176554 0 5000 0 2934 0 9053 0 23562 0 217103 0 0 0 Greg Simia GREG SIMIA, DIVISION CFO, BEGAN HIS EMPLOYMENT DURING CALENDAR YEAR 2011. ACCORDINGLY, HE WOULD HAVE NO CALENDAR YEAR 2010 COMPENSATION FOR PURPOSES OF REPORTING ON FORM 990, PART VII, OR SCHEDULE J, PART II. THERESE PANDL MORTGAGE EXTENSION X 250000 250000 false true true 250000 PREVEA CLINIC OFFICER 2544545 PHYSICIAN SERVICES false Loans to/from interested persons Schedule L, Part II All transactions involving interested persons are determined to be consistent with the organization's conflict of interest policy. Any transactions requiring Board approval are approved by an independent Board prior to occurring. business transactions with interested persons schedule l, part iv All transactions involving interested persons are determined to be consistent with the organization's conflict of interest policy. Any transactions requiring Board approval are approved by an independent Board prior to occurring. Organization's Mission form 990 Part III, Line 1 TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS. PROGRAM SERVICE REVENUE - SURGERY Form 990 Part III, Line 4a SURGERY St. Mary's Hospital Medical Center Surgical Services: Surgical Services at St. Mary's Hospital Medical Center are comprised of Central Processing, Anesthesia, Surgery, and Recovery. This includes eight O.R. Suites, a C-Section Room, and two minor treatment rooms, Services are available 24/7 and include both inpatient and outpatient procedures. In fiscal year 2010-2011, over 4,900 surgical procedures were performed. Surgical procedures include General, Orthopedic, Urology, Gynecology, Oral - Maxillofacial, and Organ procurement. Anesthesia and Central Processing also provide Hospital-wide services to Inpatient Nursing, Labor and Delivery, and the Emergency Department. The Anesthesia department is comprised of nine employed Nurse Anesthetists and three or four Anesthesiologists on campus daily. PROGRAM SERVICE REVENUE - RADIOLOGY SERVICES FORM 990, PART III, Line 4b RADIOLOGY St. Mary's Hospital Medical Center Imaging Services: The Imaging services department at St. Mary's Hospital Medical Center provides Inpatient, Outpatient, and Emergency care. Overall, the department performs more than 51,000 inpatient and outpatient exams and procedures annually. Patients have access to the latest technology in Digital Mammography, Computed Tomography, MRI, Nuclear Medicine, and Ultrasound. Four Interventional Radiologists provide minimally invasive procedures using image guidance. The staff consists of Board Certified radiologists as well as licensed and certified technologists, nurses, and sonographers. The modalities utilize state-of-the-art equipment to afford the radiologists optimal images for interpretation. The department and hospital are accredited by the Joint Commission. A new state of the art wide bore scanner will be available next year. PROGRAM SERVICE REVENUE - HEART & VASCULAR CENTER FORM 990, PART III, Line 4c HEART & VASCULAR CENTER St. Mary's Hospital Medical Center Cath Lab: The Cath Lab offers a complete array of catheterization laboratory procedures and noninvasive cardiovascular diagnostic procedures, doing over 900 cardiac catheterizations in FY2011. If needed, a state-of-the-art Cardiovascular operating center ("CVOR") is available nearby at our sister facility, St. Vincent Hospital, for cutting-edge open heart procedures by our highly-skilled cardiothoracic surgeons. CVICU suites are also offered there. For those patients who need follow-up, a Cardio-Pulmonary Rehabilitation Program is offered on site at St. Mary's. TAX EXEMPT BONDS FORM 990, PART IV, LINE 24 ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. 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, LINE 6 & 7A THE SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (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. Mary's Hospital Medical Center of Green Bay Inc. (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. 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, 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. COMPENSATION PROCESS FORM 990, PART VI, LINE 15a and 15b 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 THE HOSPITALS 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. 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 or fund balances Form 990, Part XI, Line 5 Unrealized gain $3,191,469 temporarily restricted income in foundation 668,416 permanently restricted income in foundation 913 Recognition of changes in pension funded status 7,789,971 transfer to affiliates (739,402) ----------- total other change in net assets or fund balances 10,911,367 =========== HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER MARYBETH CULNAN, OSF TITLE:DIRECTOR HOURS:74 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THERESE PANDL TITLE:PRESIDENT/CEO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANN CARR TITLE:TREASURER HOURS:75 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:greg simia TITLE:division cfo HOURS:40 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 Kiara Inc HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) 11A NA HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) 11A NA HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 11A NA HSHS HEALTH CARE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371137724 HEALTHCARE IL 501(c)(9) N/A NA ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 624012099 370661233 HEALTHCARE IL 501(c)(3) 3 NA ST ELIZABETH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILLE IL 622201998 370663567 HEALTHCARE IL 501(c)(3) 3 NA ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 NA ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 NA ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 622300099 371208459 HEALTHCARE IL 501(c)(3) 3 NA ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 NA ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 NA ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 NA ST MARY'S HOSPITAL 111 SPRING STREET STREATOR IL 613643332 372169181 HEALTHCARE IL 501(c)(3) 3 NA SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 NA ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN WI 530811948 390808480 HEALTHCARE IL 501(c)(3) 3 NA ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 501(c)(3) 3 NA Hospital Sisters Healthcare West - Inc 2661 COUNTY HIGHWAY I CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) 11A NA HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(c)(3) 11A NA HSHS Medical Group Inc 4936 Laverna Road Springfield IL 62707 263956318 healthcare IL 501(c)(3) 11a na HSHS Wisconsin Medical Group Inc 8040 Excelsior Drive STE 200 madison WI 53717 264515959 healthcare WI 501(c)(3) 11a na Orange Cross Ambulance Inc 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 9 ST NICHOLAS WISCONSIN UPPER PENINSULA ONCOLOGY MGMT 835 S VAN BUREN GREEN BAY WI 543013256 391677100 HEALTHCARE WI 501(c)(3) 3 ST VINCENT UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 9 HSSI 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 HSSI 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 DR Green Bay WI 54304 203775127 HealthCare WI HSSI RElated 0 0 false 0 false 0.00000 CARPENTER STREET HOTEL LLC 3 Hotel IL LASANTE INC related 0 0 false 0 false 0.00000 SPRINGFIELD URGENT CARE REAL E Rent. Real Estate 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 Qual Insurance PO BOX 1159 KY1-1102 GRAND CAYMANS CJ 980669953 INSURANCE CJ HSSI C CORP 0 0 0.00000 false false false false false true true false true false false false false true false true false true TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V, LINE 2 THE TRANSACTIONS REPORTED IN LINE 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.