ST FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ST FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F (EIN 37-0661236)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201231369349302158
Schema version
2010v3.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-15T09:44:01-04:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1191 West Nationwide Blvd Ste 500AddressLine1
CityColumbusCity
StateOHState
ZIP Code432152568ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN370661236EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS HOSPITAL SISTERS OF THE THIRDBusinessNameLine1
Business Name Line2ORDER OF ST FRANCISBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSTFRNameControl
Phone2173242191Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11215 FRANCISCAN DRIVEAddressLine1
CityLITCHFIELDCity
StateILState
ZIP Code62056ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDaniel PerrymanName
TitleCEOTitle
Phone2173248368Phone
Date Signed2012-05-08DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKPMG LLPName
Phone6142492300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDaniel PerrymanNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11215 Franciscan DriveAddressLine1
CityLitchfieldCity
StateILState
ZIP Code62056ZIPCode
FieldValueIRS element (for citing)
Gross Receipts37647028GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.STFRANCIS-LITCHFIELD.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1875YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionSt. 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees294TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI9578TotalGrossUBI
Net Unrelated Business Txbl Income-168NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year106577ContributionsGrantsPriorYear
Contributions Grants Current Year42334ContributionsGrantsCurrentYear
Program Service Revenue Prior Year35153482ProgramServiceRevenuePriorYear
Program Service Revenue CY35851461ProgramServiceRevenueCY
Investment Income Prior Year989076InvestmentIncomePriorYear
Investment Income Current Year1072396InvestmentIncomeCurrentYear
Other Revenue Prior Year262235OtherRevenuePriorYear
Other Revenue Current Year566613OtherRevenueCurrentYear
Total Revenue Prior Year36511370TotalRevenuePriorYear
Total Revenue Current Year37532804TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year4000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year15703259SalariesEtcPriorYear
Salaries Etc Current Year15966360SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year17455421OtherExpensePriorYear
Other Expenses Current Year19159547OtherExpensesCurrentYear
Total Expenses Prior Year33162680TotalExpensesPriorYear
Total Expenses Current Year35127907TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3348690RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2404897RevenuesLessExpensesCY
Total Assets BOY44846973TotalAssetsBOY
Total Assets EOY48301825TotalAssetsEOY
Total Liabilities BOY27722267TotalLiabilitiesBOY
Total Liabilities EOY24963688TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY17124706NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY23338137NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSt. 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense18953117Expense
Grants0Grants
Revenue27730669Revenue
DescriptionSEE SCHEDULE O - OUTPATIENT ACUTE CAREDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense6253152Expense
Revenue6450252Revenue
DescriptionSEE SCHEDULE O - INPATIENT MEDICAL/SURGICALDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense685754Expense
Revenue606532Revenue
DescriptionSEE SCHEDULE O - MATERNITY/GYNECOLOGY SERVICESDescription

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense52817Expense
Grants2000Grants
Revenue1064008Revenue
DescriptionOther Misc ExpensesDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp52817TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt2000TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev1064008TotalOfOtherProgramServiceRev
Total Program Service Expense25944840TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees294NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonST FRANCIS HOSPITALNamePerson
Telephone Number2173248510TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11215 FRANCISCAN DRIVEAddressLine1
CityLITCHFIELDCity
StateILState
ZIP Code62056ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
CHRIS POIROT MD
CHAIRPERSON1.0XX000
Dona McGraw
Board Member1.0X000
DANIEL PERRYMAN
BOARD PRESIDENT/HOSPITAL CEO40.0XX027838597575
LONNIE BATHURST
Vice Chairperson1.0XX000
SISTER MARYBETH CULNAN OSF
BOARD MEMBER1.0X000
SISTER MARGUERITE COOK OSF
BOARD MEMBER1.0X000
Tom Franzen
BOARD MEMBER1.0X000
JOHN FASSERO
Secretary1.0XX000
ROGER WUJEK MD
BOARD MEMBER1.0X000
Timothy Reents
Board Member1.0X000
Sister Janice Schneider OSF
Board Member1.0X000
Sister Kenneth Wildt OSF
Board Member1.0X000
William Cornman
Board Member1.0X000
Robert Ritz
Divisional President/CEO11.25X0626484189574
Larry J Ragel
Divisional CFO3.75X024886456893
Ann Carr
TREASURER0.1X0191336109542
CAROL JACO
COO/CNO50.0X154113037184
DIANE LINDSAY
CFO60.0X143636059026
Kathy Knobloch
Administrative Director45.0104529024770X
JILL MOUTRIA
PHARMACIST40.0121323022894X
AARON HUMPHREYS MD
ORTHOPEDIC PHYSICIAN40.0020576917756X
FieldValueIRS element (for citing)
Total Reportable Comp From Org523601TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1550838TotalReportableCompFrmRltdOrgs
Total Other Compensation615214TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Illinois Emergency Physicians
PO Box 793TRAVERSE CITYMI49685ER Physician Service1796686
AMSOL ANESTHETISTS OF LITCHFIELD LL
PO BOX 6633HIGH POINTNC27262CRNA SERVICES497977
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants30098GovernmentGrants
All Other Contributions12236AllOtherContributions
Total Contributions42334TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE REVENUE9000993584188335841883
LAB62150095789578
FieldValueIRS element (for citing)
Total Program Service Revenue35851461TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1072396TotalRevenueColumn
Exclusion$1,072,396ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real82427Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real114224Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-31797Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-31797TotalRevenueColumn
Exclusion-$31,797ExclusionAmount

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OTHER RELATED SERVICES900099191314$191,314
SPECIALTY PHYSICIAN PAYMENTS FOR STAFF, OFFICE900099218695$218,695
REGIONAL REFERRAL RECEIPTS900099128020$128,020

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column60381TotalRevenueColumn
Exclusion$60,381ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue598410TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column37532804TotalRevenueColumn
Related Or Exempt Function Income35841883RelatedOrExemptFunctionIncome
Unrelated Business Revenue9578UnrelatedBusinessRevenue
Exclusion$1,639,009ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2000Total
Program Services2000ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total413195Total
Program Services157833ProgramServices
Management And General255362ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10723938Total
Program Services7892117ProgramServices
Management And General2831821ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total940151Total
Program Services679950ProgramServices
Management And General260201ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3107928Total
Program Services2247762ProgramServices
Management And General860166ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total781148Total
Program Services564954ProgramServices
Management And General216194ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total810721Total
Program Services0ProgramServices
Management And General810721ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total545665Total
Program Services0ProgramServices
Management And General545665ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total60852Total
Program Services0ProgramServices
Management And General60852ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4733392Total
Program Services4302672ProgramServices
Management And General430720ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total56148Total
Program Services0ProgramServices
Management And General56148ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total122255Total
Program Services62365ProgramServices
Management And General59890ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total977279Total
Program Services725403ProgramServices
Management And General251876ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total798918Total
Program Services122825ProgramServices
Management And General676093ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total16171Total
Program Services6011ProgramServices
Management And General10160ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total42903Total
Program Services14830ProgramServices
Management And General28073ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total20722Total
Program Services20684ProgramServices
Management And General38ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1522294Total
Program Services952752ProgramServices
Management And General569542ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total847650Total
Program Services593355ProgramServices
Management And General254295ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
SUPPLIES315484029458102090300
PROVISION FOR BAD DEBT2722683272268300
MAINTENANCE AND REPAIRS9643155808793834360
DEPARTMENT OF PUBLIC AID ASSES65164865164800
PHYSICIAN RECRUITMENT46119246119200

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total649899Total
Program Services237115ProgramServices
Management And General412784ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total35127907Total
Program Services25944840ProgramServices
Management And General9183067ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3042484BOY
EOY3274778EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY58BOY
EOY51EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2806718BOY
EOY1997534EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY880265BOY
EOY407056EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY458766BOY
EOY449241EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY479213BOY
EOY432201EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis34920596LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27532540LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7117263BOY
EOY7388056EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY29281079BOY
EOY33954881EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY781127BOY
EOY398027EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY44846973BOY
EOY48301825EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3097136BOY
EOY3726864EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY12601656BOY
EOY12487021EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12023475BOY
EOY8749803EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY27722267BOY
EOY24963688EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15309074BOY
EOY21313123EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1192399BOY
EOY1401626EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY623233BOY
EOY623388EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17124706BOY
EOY23338137EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY44846973BOY
EOY48301825EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2404897ReconcilationRevenueExpenses
Reconcilation Other Changes3808534ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$15,683OtherActivitiesAmount
Total Lobbying Expenditures IIB15683TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF OTHER LOBBYING ACTIVITIESIdentifier
Return ReferencePART II, LINE 1IReturnReference
ExplanationTHE HOSPITAL PAYS MEMBERSHIP DUES TO DIFFERENT ASSOCIATIONS AND A PERCENTAGE OF THOSE DUES ARE DEDICATED TO LOBBY EXPENSES. THE ASSOCIATIONS ST FRANCIS PAYS ARE AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 24.42% LOBBY EXPENSE, CATHOLIC HEALTH ASSOCIATION ("CHA") AT 4.68% LOBBY EXPENSE, ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 32% LOBBY EXPENSE AND ILLINOIS CATHOLIC HEALTH ASSOCIATION ("ICHA") AT 2% LOBBY EXPENSE. THE TOTAL AMOUNT OF YEARLY DUES IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBY EXPENSE TO CALCULATE THE LOBBY EXPENDITURES PAID.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis99383OtherCostOrOtherBasis
Book Value99383BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis17321893OtherCostOrOtherBasis
Depreciation13854365Depreciation
Book Value3467528BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis16398600OtherCostOrOtherBasis
Depreciation13678175Depreciation
Book Value2720425BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis1100720OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value1100720BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7388056TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
ACCRUED BENEFIT LIABILITY$6,153,594
RETIRE OBLIGATION - ASBESTOS$869,378
WORKERS' COMP TRUST LIABILITY$712,311
SETTLEMENT VALUE OF INTEREST$631,282
MALPRACTICE CLAIMS LIABILITY$383,238
FieldValueIRS element (for citing)
Total Of Amounts8749803TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierExplanation for adoption of ASC Subtopic 740-10Identifier
Return ReferenceASC Subtopic 740-10ReturnReference
ExplanationON 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.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served1142PersonsServed
Total Community Benefit Expense859073TotalCommunityBenefitExpense
Net Community Benefit Expense859073NetCommunityBenefitExpense
Percent Of Total Expense0.02650PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense7640116TotalCommunityBenefitExpense
Direct Offsetting Revenue4814367DirectOffsettingRevenue
Net Community Benefit Expense2825749NetCommunityBenefitExpense
Percent Of Total Expense0.08720PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense233575TotalCommunityBenefitExpense
Direct Offsetting Revenue123260DirectOffsettingRevenue
Net Community Benefit Expense110315NetCommunityBenefitExpense
Percent Of Total Expense0.00340PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served1142PersonsServed
Total Community Benefit Expense8732764TotalCommunityBenefitExpense
Direct Offsetting Revenue4937627DirectOffsettingRevenue
Net Community Benefit Expense3795137NetCommunityBenefitExpense
Percent Of Total Expense0.11710PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served760PersonsServed
Total Community Benefit Expense96195TotalCommunityBenefitExpense
Net Community Benefit Expense96195NetCommunityBenefitExpense
Percent Of Total Expense0.00300PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served2420PersonsServed
Total Community Benefit Expense66272TotalCommunityBenefitExpense
Direct Offsetting Revenue12286DirectOffsettingRevenue
Net Community Benefit Expense53986NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served3180PersonsServed
Total Community Benefit Expense162467TotalCommunityBenefitExpense
Direct Offsetting Revenue12286DirectOffsettingRevenue
Net Community Benefit Expense150181NetCommunityBenefitExpense
Percent Of Total Expense0.00470PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served4322PersonsServed
Total Community Benefit Expense8895231TotalCommunityBenefitExpense
Direct Offsetting Revenue4949913DirectOffsettingRevenue
Net Community Benefit Expense3945318NetCommunityBenefitExpense
Percent Of Total Expense0.12180PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Persons Served603PersonsServed
Total Community Building Expense6872TotalCommunityBuildingExpense
Net Community Building Expense6872NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Persons Served603PersonsServed
Total Community Building Expense6872TotalCommunityBuildingExpense
Net Community Building Expense6872NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,056,401BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare14246987AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare15054521CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-807534MedicareSurplusOrShortfall
Costing Methodology UsedCostingMethodologyUsed
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1St Francis Hospital of the Hospital SisBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11215 Franciscan DriveAddressLine1
CityLitchfieldCity
StateILState
ZIP Code62056ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1St Francis Hospital of the Hospital SisBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 3CNot 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 6ASt Francis Hospital's community benefit report is available upon request at 1215 Franciscan Drive, Litchfield, IL 62056.
PART I, LINE 7gThe 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 12.18%. The amount of bad debt expense removed when calculating the percentages in part i, line 7, column (f) was $2,722,683.
PART I, LINE 7Charity 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 IIThe hospital was involved in a couple community building activities that address the root cause of health care problems, or work to lay a foundation for a healthier, safer, and better educated community. St. Francis collaborated with local dental care providers to coordinate and provide a free day of dental care to uninsured individuals. A 2009 needs assessment determined the dental care among the community. The community day of dental care provided free dental cleanings, X-Rays, and extractions to uninsured individuals. The response was overwhelming and collaborating partners provided services to 90 individuals. Coalition meetings were organized by St. Francis Hospital for the community day of dental care. St. Francis Hospital also actively participates in the Macoupin County Diabetes Coalition with the goal of increasing awareness and providing education about diabetes. Success stories from the free dental care day: A military veteran who has been unable to obtain dental care due to the closure of the St. Louis facility was able to have five bad teeth extracted. He will also be returning to receive additional care that he is in need of at no charge. A new widow with limited funds was provided dental care that will end some chronic dental related pain that she was having. She told the staff that she was very grateful to be able to babysit her grandchildren without pain! A young woman with some frontal dental issues received 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 herself and with a new smile.
PART III, LINE 4The 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 8The 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 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.
Part III, Line 9bIf a patient is known to qualify for financial assistance, collection efforts are discontinued, The patient is notified that financial assistance is available and the account is written off to charity care or sent to the appropriate agency.
Needs AssessmentSt. Francis Hospital plans to contract with Leede Research Group during fiscal year 2012 to provide a community healthcare needs assessment. The program will provide a community healthcare needs assessment that will help the hospital develop a community benefit strategy, identify existing health resources and social service programming in the hospital service area, identify gaps in healthcare access, help prioritize community healthcare needs, and help determine the best use of resources to help our community. To assist with the assessment process, St. Francis is planning to organize a local healthcare assessment steering committee, identify groups and local residents to participate in various stages of the process, help with the organizing and scheduling of focus groups, and aid in the assembly of a local contact list of health and social service providers. The assessment will be conducted using focus groups, telephone surveys of health and social service providers along with interviews. The Leede Research Group is planning to analyze existing and collected data and provide the hospital with a written report of the findings. The needs assessment and the community benefit strategy are expected to be completed by June 30, 2012.
Patient Education of Eligibility for AssistancePatients 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 and hospital web site, and information from the registrars and other hospital personnel. The hospital employs two Financial Counselors who are responsible for educating patients about potential eligibility for assistance under federal, state, or local government programs, or under the hospital's charity care policy or uninsured patient discount policy. The Financial Counselors contact uninsured patients to determine eligibility for Medicaid or other government assistance programs. Eligibility is verified 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 Counselors ensure that the discounts under the Act are applied appropriately.
Community InformationMore than 94% of the inpatients treated at St. Francis Hospital reside in Montgomery and Macoupin Counties. 56% of the inpatients live in Montgomery County, and 38% 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 79,123. The median household income is less than $45,000 per year. The percentage of people living below the poverty level averages 12.6% in Macoupin County and 14.9% in Montgomery County. The current unemployment rate is 9.5% and 11.9%, respectively. Persons eligible for Medicare account for 47% of the patient revenue generated at the hospital. Medicaid-eligible patients generate 23%. Likewise, 25% 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 71.9% 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 2011, over $1,071,910 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 HealthSt. 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. 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 in accordance with the process described under the needs assessment section above. 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 serves as a designated "critical access" facility, reflecting our role in ensuring availability of important hospital services to people who live in the rural areas surrounding Litchfield. 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 the facility, 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 2011, St. Francis provided $3.9 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and various programs designed to enhance access and improve community health. Additionally, during this period, St. Francis provided nearly $900,000 (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance, and over $840,000 (at cost) in excess of Medicare payment for health care services. Responding to Community Needs: The range of benefits provided by St. Francis flows from our mission and long-standing commitment to our communities needs. In many cases, these programs would be unlikely to exist without the leadership role played by St Francis, and often relieve a burden that would otherwise be carried by government. Outreach Facilitator: The hospital has appointed an Outreach Facilitator to evaluate the health education needs of the community and to organize public programs to meet those needs. Some of the programs that have been provided during the past year include Senior Fitness programs, Breast Cancer Awareness, Diabetes Awareness and education programs, Poison Prevention for mothers of young children, and an Elder Abuse seminar for local healthcare providers. Free health screenings for body mass index, colorectal cancer, cholesterol, and blood pressure were provided. Educational sessions were held about high sodium and the correlation to hypertension. Approximately 1,300 individuals were served by these activities. Food Pantry: Recognizing the large number of families in the local area who live on incomes below the poverty level, the hospital established the St. Clare Food Pantry to help those families obtain food. The food pantry now serves over 2,330 individuals from throughout the community with 336 hours volunteered by individuals helping serve the community's needs. Employees donated over $12,236 towards that cause during the past fiscal year. Over $45,298 was contributed from hospital operations to support the purchase of food and other needed items. Success Story: A gentleman who had been a consistent user of the St. Clare Food Pantry came in one week carrying his recyclable bags. He appeared in the same fashion as all our other clients do and so I assumed he was there to ask for food. Instead, he handed me his bags and said, "I am not here to receive food today. I just came to return my bags and say thank you for getting me through a rough time in my life. I now have employment and will not need to use your services anymore." Farmer's Market Fresh Produce Program: St. Francis co-founded a pilot program called the Farmer's Market Fresh Produce Program. This program provided fresh local fruit to low income families in the community. During fiscal year 2011, this program served 332 families. Kidney Mobile & Diabetes: Kidney Mobile of Illinois provided free screenings for diabetes and renal disease. Screenings included: BP, BMI, Urinalysis, Glucose, Hgb. A1C, Waist circumference, and additional chem. labs if needed. Nutrition counseling and review of results with a nurse practitioner were additionally provided. The number of people served for these events totaled 52 with a total expense of $1,653. Room Rental: St. Francis offers a hospital meeting room free of charge to the Al-Anon group that meets at the hospital every Tuesday. The Safe Food Handling classes are also held in a hospital meeting room free of charge.
Affiliated Health Care SystemSt. Francis Hospital 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. Joseph's Hospital in Chippewa F
STATE FILING OF COMMUNITY BENEFIT REPORTIL,990 SCHEDULE H, PART VI

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DANIEL PERRYMAN
025572901558207074072919027013037831700
Robert Ritz
053697904970003980501483090420850816878065249
Larry J Ragel
02401640870000037258020455030657700
Ann Carr
0152228011100028008092165018090030159100
CAROL JACO
14971304400000262960108880191297000
DIANE LINDSAY
13983603800000424550165710202662000
AARON HUMPHREYS MD
0205769000001775600022352500

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICES REVENUE - ACCOMPLISHMENTS990 PART III LINE 4AThe 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, 2011 St. Francis Hospital operated as a Critical Access Hospital. The Hospital provided 5,295 adult, pediatric and skilled nursing days of care and accommodated 52,323 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 programs, and special programs for the elderly, handicapped and medically underserved and a variety of broad community support activities. 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: * Educational sessions for heart health, choices for living, strong bones/body, smoking cessation, poison prevention, and asthma program; * Assistance with community blood drives, kidney mobile, dental care and Fresh Fruit Program; * Employee speakers at health fairs, schools and other community organizations; * Nutritional and diabetes 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, drug prevention and other current health issues; * Screenings for colorectal cancer, hypertension, cholesterol and obesity; * Donation of used equipment and supplies 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 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 $843,573 for the year ended June 30, 2011. The State of Illinois (the State) renewed an assessment program to assist in the financing of its Medicaid program in December of 2006 for the State's fiscal years ended June 30, 2006, 2007, 2008, 2009, and 2010. The program was approved in 2008 and has been renewed each year since then. 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 2011 assessment and reimbursement included in the Hospital's 2011 statement of operations is $2.1 million.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODYFORM 990, PART VI, LINE 6 & 7ATHE 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 POWERSFORM 990, PART VI, LINE 7BResponsibility 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 PROCESSFORM 990, PART VI, LINE 11BThe 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 POLICYFORM 990, PART VI, LINE 12CThe 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 POLICYFORM 990, PART VI, LINE 13PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
RECORD RETENTION AND DESTRUCTION POLICYFORM 990, PART VI, LINE 14THE HOSPITAL IS CURRENTLY FOLLOWING THE SYSTEM-WIDE RECORD RETENTION AND DESTRUCTION POLICY.
COMPENSATION PROCESSFORM 990, PART VI, LINE 15The 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 PUBLICFORM 990, PART VI, LINE 19BOARD-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 ACCOUNTFORM 990, PART X, LINE 11St. 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 ASSETSFORM 990, Part XI, Line 5CHANGES IN PENSION FUNDED STATUS 2,491,925 UNREALIZED GAINS 1,681,897 increase in temporarily restricted net assets 209,227 increase in permanently restricted net assets 155 TRANSFER FROM AFFILIATES (574,670) ---------- TOTAL 3,808,534 ==========
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Robert Ritz TITLE:Divisional President/CEO HOURS:64
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Larry J. Ragel TITLE:Divisional CFO HOURS:71
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:Ann Carr TITLE:TREASURER HOURS:75

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Springfield Health Partners LLC
4936 Laverna RoadspringfieldIL62707371364419healthcareIL00hshs mg
Kiara Clinical Integration Network LLC
4936 Laverna RdspringfieldIL62707261417684healthcareIL00kiara inc

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Hospital Sisters Health System
4936 laverna RoadSPRINGFIELDIL62707371058692HEALTHCAREIL501(c)(3)11aNA
Hospital Sisters Services Inc
4936 laverna RoadSPRINGFIELDIL62707371163402HEALTHCAREIL501(c)(3)11aNA
Hospital Sisters of St Francis Fdtn
4936 laverna RoadSPRINGFIELDIL62707371186514HEALTHCAREIL501(c)(3)11aNA
HSHS Self Insurance Trust Fund
4936 laverna RoadSPRINGFIELDIL62707371120626INSURANCEIL501(c)(3)11aNA
HSHS Health Care Plan Trust Fund
4936 laverna RoadSPRINGFIELDIL62707371137724HEALTHCAREIL501(c)(9)N/ANA
Hospital Sisters Healthcare West Inc
2661 COUNTY HIGHWAY ICHIPPEWA FALLSWI54729510157933HEALTHCAREWI501(c)(3)11aNA
Sacred Heart Hospital
900 WEST CLAIREMONT AVENUEEAU CLAIREWI54701390807060HEALTHCAREWI501(c)(3)3NA
St Anthony's Hospital
503 N MAPLE STREETEFFINGHAMIL624012099370661233HEALTHCAREIL501(c)(3)3NA
St Elizabeth's Hospital
211 SOUTH THIRD STREETBELLEVILLEIL622201998370663567HEALTHCAREIL501(c)(3)3NA
St Nicholas Hospital
3100 SUPERIOR AVENUESHEBOYGANWI53081390808480HEALTHCAREWI501(c)(3)3NA
St John's Hospital
800 EAST CARPENTER STREETSPRINGFIELDIL62769370661238HEALTHCAREIL501(c)(3)3NA
St Joseph's Hospital
9515 Holy Cross Lane PO Box 99BREESEIL622300099371208459HEALTHCAREIL501(c)(3)3NA
St Joseph's Hospital
2661 COUNTY HIGHWAY 1CHIPPEWA FALLSWI54729390810545HEALTHCAREWI501(c)(3)3NA
St Mary's Hospital
1800 E LAKE SHORE DRIVEDECATURIL62521370661244HEALTHCAREIL501(c)(3)3NA
St Mary's Hospital
111 SPRING STREETSTREATORIL613643332362169181HEALTHCAREIL501(c)(3)3NA
St Mary's Medical Center
1726 SHAWANO AVENUEGREEN BAYWI54303390818682HEALTHCAREWI501(c)(3)3NA
St Vincent Hospital
835 S VAN BURENGREEN BAYWI54301390817529HEALTHCAREWI501(c)(3)3NA
St Joseph's Hospital
1515 MAIN STREETHIGHLANDIL62249370663568HEALTHCAREIL501(c)(3)3NA
HSHS MEDICAL GROUP INC
4936 LAVERNA ROADSPRINGFIELDIL62707263956318HEALTHCAREIL501(c)(3)11aNA
HSHS WISCONSIN MEDICAL GROUP INC
8040 Excelsior Drive STE 200MADISONWI53717264515959HEALTHCAREWI501(c)(3)11ANA
Orange Cross Ambulance Inc
919 Ashland AveSheboyganWI53081391860942HealthcareWI501(c)(3)9St Nicholas
Wisconsin Upper Pen Ocn Mngmt Services
835 S Van BurenGreen BayWI543013256391677100healthcareWI501(c)(3)3St Vincent
Unity Limited Partnership
2366 Oak Ridge CircleDe PereWI54115391750729HealthcareWI501(c)(3)9HSSI

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
Memorial and St Elizabeth's Healthcare
4000 North Illinois StreetSwanseaIL62226371312961HealthCareILSt Elizabeth'sRelated00false$0false0.00000
Prairie Heart Institute - CarbondaleLLC
800 East Carpenter StreetSpringfieldIL62769371321197HealthCareILSt John'sRelated00false$0false0.00000
Northeast Wisconsin Radiation Therapy Se
1821 S Webster Avenue STE 300Green BayWI543079047263749065HealthCareWIHSSIRelated00false$0false0.00000
Pain Center of Wisconsin
4131 W Loomis Road STE 300GreenfieldWI53221263155343HealthCareWISt VincentRelated00false$0false0.00000
Surgery Center of Sheboygan LLC
3141 Saemann AveSheboyganWI53081260822209HealthCareWISt NicholasRelated00false$0false0.00000
Prevea Ventures LLC
2710 EXECUTIVE DRGreen BayWI54304203775127HealthCareWIHSSIRelated00false$0false0.00000
CARPENTER STREET HOTEL LLC 36-
HOTELILLASANTE INCRELATED00false$0false0.00000
SPRINGFIELD URGENT CARE REAL ESTATE
RENT. REAL ESTATEILLASANTE INCRELATED00false$0false0.00000

Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
Kiara Inc
4936 Laverna RdSpringfieldIL62707371163401HealthCareILHSHSC Corp000.00000
LaSante Wisconsin Inc
4936 Laverna RdSpringfieldIL62707391572196HealthCareILKiara IncC Corp000.00000
LaSante Inc
4936 Laverna RdSpringfieldIL62707371163400HealthCareILKiara IncC Corp000.00000
Prairie Cardiovascular
619 East Mason STE 4P57SpringfieldIL62701371071858HealthCareILKiara IncC Corp000.00000
Prevea Health Services
2710 EXECUTIVE DRGreen BayWI54304391839351HealthCareWIHSSIC Corp000.00000
Prevea Clinic Inc
2710 EXECUTIVE DRGreen BayWI54304391839349HealthCareWIHSSIC Corp000.00000
Prevea Health Network
2710 EXECUTIVE DRGreen BayWI54304392000537HealthCareWIHSSIC Corp000.00000
Renaissance Quality Insurance
980669953insuranceHSSIc corp000.00000PO Box 1159Grand CaymansCJKY1-1102CJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED ENTITIESIdentifier
Return ReferenceSCHEDULE R, PART V, LINE 2ReturnReference
ExplanationTHE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.Explanation

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