HOLY FAMILY MEMORIAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
HOLY FAMILY MEMORIAL INC (EIN 39-0806395)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201103189349302965
Schema version
2010v3.4
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)
Timestamp2011-11-14T10:30:52-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SCHENCK SCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1100 MARITIME DRIVE SUITE 2BAddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code54220ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390806395EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOLYNameControl
Phone9203202011Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code542211450ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARK HERZOGName
TitlePRESIDENT / CEOTitle
Phone9203203470Phone
Date Signed2011-11-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKELLY BLOCK CPAName
Phone9206845500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARK HERZOGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code542211450ZIPCode
FieldValueIRS element (for citing)
Gross Receipts134031261GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HFMHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1899YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionHEALTH CARE SERVICESSEE SCHEDULE 0HOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS, WHO ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. HFM PROVIDES ACUTE, OUTPATIENT, CLINIC AND HOME CARE SERVICES FOR MANITOWOC COUNTY, STRIVING FOR MEDICIAL EXCELLENCE AND VALUED OUTCOMES WITHIN A COMPASSIONATE, VALUES BASED, CHRISTIAN ENVIRONMENT.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees1303TotalNbrEmployees
Total Nbr Volunteers352TotalNbrVolunteers
Total Gross UBI141272TotalGrossUBI
Net Unrelated Business Txbl Income53470NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year651476ContributionsGrantsPriorYear
Contributions Grants Current Year1756485ContributionsGrantsCurrentYear
Program Service Revenue Prior Year122728522ProgramServiceRevenuePriorYear
Program Service Revenue CY130165998ProgramServiceRevenueCY
Investment Income Prior Year-1267836InvestmentIncomePriorYear
Investment Income Current Year908139InvestmentIncomeCurrentYear
Other Revenue Prior Year844870OtherRevenuePriorYear
Other Revenue Current Year741752OtherRevenueCurrentYear
Total Revenue Prior Year122957032TotalRevenuePriorYear
Total Revenue Current Year133572374TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year62262GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY46000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year72460714SalariesEtcPriorYear
Salaries Etc Current Year77600710SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year222037TotalFundrsngExpCurrentYear
Other Expense Prior Year47783445OtherExpensePriorYear
Other Expenses Current Year49777158OtherExpensesCurrentYear
Total Expenses Prior Year120306421TotalExpensesPriorYear
Total Expenses Current Year127423868TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2650611RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6148506RevenuesLessExpensesCY
Total Assets BOY154436345TotalAssetsBOY
Total Assets EOY165522146TotalAssetsEOY
Total Liabilities BOY70473285TotalLiabilitiesBOY
Total Liabilities EOY71786359TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY83963060NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY93735787NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense115306701Expense
Revenue131403818Revenue
DescriptionHOLY FAMILY MEMORIAL PROVIDES COMMUNITY SERVICES INTENDED TO BENEFIT THE UNDERSERVED AND ENHANCE THE HEALTH STATUS OF THE COMMUNITIES IT SERVES. THESE SERVICES INCLUDE 24 HOUR A DAY EMERGENCY ROOMS, COMMUNITY HEALTH SCREENINGS, FORUMS FOR VARIOUS SUPPORT GROUPS, HEALTH EDUCATION CLASSES, SPEAKERS AND PUBLICATIONS AND HOSPICE CARE. HOLY FAMILY MEMORIAL HAS BEEN ABLE TO ACHIEVE A GREATER IMPACT IN THE COMMUNITY BY PARTNERING FINANCIAL, HUMAN AND PROGRAMMATIC RESOURCES WITH OTHER ORGANIZATIONS. THESE EXPENDITURES INCLUDE A COMMITMENT TO COLLABORATE WITH OTHER HEALTH AND SOCIAL SERVICE AGENCIES TO IMPROVE ACCESS TO CARE, FOCUS ON PREVENTIVE SERVICES, REDUCE COMMUNITY HEALTH RISKS AND CONTRIBUTE TO A HEALTHIER, VIBRANT COMMUNITY.HOLY FAMILY MEMORIAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. IN ASSESSING A PATIENT'S ABILITY TO PAY, HOLY FAMILY MEMORIAL NOT ONLY UTILIZES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITIES IT SERVES AND INCLUDES CERTAIN CASES WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO THE PATIENT'S FINANCIAL RESOURCES. BECAUSE HOLY FAMILY MEMORIAL DOES NOT EXPECT TO RECEIVE PAYMENT OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. HOLY FAMILY MEMORIAL'S TOTAL COMMUNITY BENEFIT INCLUDES THE COST OF CHARITY CARE AND UNPAID COST OF PUBLIC PROGRAMS (MEDICARE AND MEDICAID) AS WELL AS THOSE DISCUSSED ABOVE. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT WAS APPROXIMATELY $22,295,000 FOR THE YEAR ENDED DECEMBER 2010. THIS AMOUNT INCLUDES THE NET COST OF CHARITY CARE OF APPROXIMATELY $1,748,000.MORE INFORMATION AVAILABLE FROM OUR COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED ON OUR WEBSITE AT WWW.HFMHEALTH.ORG.Description
Total Program Service Expense115306701TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming1Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109631NumberFormsTransmittedWith1096
Number W2 G Included1NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1303NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed1Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MARK HERZOG PRESIDENT CEOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9203203470TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1450AddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code542211450ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SISTER LORITA GAFFNEY
DIRECTOR2.00X000
PRADEEP GIRIYAPPA MD
DIRECTOR40.00X278777038969X
MICHAEL B MCCORMICK MD
DIRECTOR40.00X292475042163X
SISTER MARDELLE MEINHOLZ
DIRECTOR2.00X000
AMY L STOCKHAUSEN MD
PHYSICIAN COUNCIL CO-CHAIR40.00X198395036357X
WILLIAM R CASEY
DIRECTOR2.00X000
JAY A STREU
CHAIRMAN3.00X000
SISTER PAULA VANDEN HOGE
DIRECTOR2.00X000
JOHN J ZIMMER
TREASURER3.00X000
SISTER LAURA WOLF
DIRECTOR2.00X000
GARY SCHMIDT MD
DIRECTOR40.00X171731013463
KATHLEEN A ZUCCHI
DIRECTOR2.00X000
WILLIAM C CENSKY
VICE CHAIR3.00X000
MARY A GOVIER MD
DIRECTOR40.00X176773030689X
SISTER MARY ANN NUGENT
DIRECTOR2.00X000
EVELYN D SBAR MD
PHYSICIAN COUNCIL CO-CHAIR40.00X159588015403X
LAURIE CRAWFORD
SECRETARY2.00X000
LEE KUMMER
DIRECTOR2.00X000
JANE PFEFFER
DIRECTOR2.00X000
JOSEPH H BRISCH
DIRECTOR2.00X000
SISTER CHRISTINE MARIE BEACH
DIRECTOR2.00X000
NORMAN C SCHROEDER
DIRECTOR2.00X1383800
MARK P HERZOG
DIRECTOR, PRESIDENT, CEO40.005063650106258X
PATRICIA HUETTL
CHIEF FINANCIAL OFFICER40.00215009037647X
STEVEN DRIGGERS MD
CHIEF MEDICAL OFFICER40.00462301091376X
MARY MAURER
CHIEF INNOVATION OFFICER40.00221464044025X
RYAN DOPIRAK MD
PHYSICIAN40.001673021041490X
NANCY BUTLER MD
PHYSICIAN40.00991092029912X
JEFFREY JACOBY MD
PHYSICIAN40.001304819040402X
TRACY RUPKE MD
PHYSICIAN40.00660445041451X
KIRK DIMITRIS MD
PHYSICIAN40.00968389026182X
PATRICK BRANDEL
FORMER CHIEF FINANCIAL OFFICER0.009837808493X
JON RING
FORMER VP-PHYSICAN SERVICES0.0022557806961X
MARY DEBILZEN
FORMER INTERIM CFO40.00104934013374X
FieldValueIRS element (for citing)
Total Reportable Comp From Org8723372TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation664615TotalOtherCompensation
Number Individuals GT100 K81NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CARETECH SOLUTIONS
901 WILSHIRE DRIVE STE 250TROYMI48084IT SERVICES2739505
PATRIOT MEDICAL TECH
PO BOX 415000NASHVILLETN372415000BIO-MED SERVICES978435
SCHINDLER ELEVATOR CORPORATION
PO BOX 70433CHICAGOIL606730433CONSTRUCTION SRVCS573748
PETERS CONSTRUCTION SRVCS LLC
PO BOX 427MANITOWOCWI54220CONSTRUCTION SRVCS545126
RADIATION ONCOLOGY SPECIALISTS
PO BOX 678STURGEON BAYWI54235CANCER CARE SERVICES411862
FieldValueIRS element (for citing)
Number Of Contractors GT100 K12NumberOfContractorsGT100K
Fundraising Events71128FundraisingEvents
Government Grants258210GovernmentGrants
All Other Contributions1427147AllOtherContributions
Noncash Contributions15161NoncashContributions
Total Contributions1756485TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
INTEGRATED HEALTH CARE900099113304296113304296
LAB6215009857802984300414798
PHARMACY44611070039006970742$33,158
FieldValueIRS element (for citing)
Total Program Service Revenue130165998TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1031429TotalRevenueColumn
Related Or Exempt Function Income998933RelatedOrExemptFunctionIncome
Unrelated Business Revenue32496UnrelatedBusinessRevenue

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real142449Real
Personal10542Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real97133Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real45316Real
Personal10542Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column55858TotalRevenueColumn
Exclusion$55,858ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other38275Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other161565Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-123290Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-123290TotalRevenueColumn
Exclusion-$123,290ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events106188GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events71128CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses44614FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column61574TotalRevenueColumn
Exclusion$61,574ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming33350GrossIncomeGaming
Gaming Direct Expenses15365GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column17985TotalRevenueColumn
Exclusion$17,985ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory172957GrossSalesOfInventory
Cost Of Goods Sold140210CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column32747TotalRevenueColumn
Exclusion$32,747ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
INVESTMENT HFHS & DME44611040084911410493978$192,767
MISCELLANEOUS900003172739172739
FieldValueIRS element (for citing)
Total Other Revenue573588TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column133572374TotalRevenueColumn
Related Or Exempt Function Income131403818RelatedOrExemptFunctionIncome
Unrelated Business Revenue141272UnrelatedBusinessRevenue
Exclusion$270,799ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total46000Total
Program Services46000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3775808Total
Program Services1547076ProgramServices
Management And General2228732ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total60269750Total
Program Services55408087ProgramServices
Management And General4719341ManagementAndGeneral
Fundraising142322Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2114836Total
Program Services1986906ProgramServices
Management And General124012ManagementAndGeneral
Fundraising3918Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7892342Total
Program Services7112040ProgramServices
Management And General736941ManagementAndGeneral
Fundraising43361Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3547974Total
Program Services3181514ProgramServices
Management And General356917ManagementAndGeneral
Fundraising9543Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total166180Total
Management And General166180ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total99313Total
Management And General99313ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total490704Total
Program Services490704ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total463181Total
Program Services11352ProgramServices
Management And General451829ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total17979917Total
Program Services17331638ProgramServices
Management And General642082ManagementAndGeneral
Fundraising6197Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2739505Total
Program Services2739505ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3042343Total
Program Services3042343ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total272229Total
Program Services261908ProgramServices
Management And General8735ManagementAndGeneral
Fundraising1586Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total403739Total
Program Services195516ProgramServices
Management And General208223ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2678356Total
Program Services2678356ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total8963990Total
Program Services8963990ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1001043Total
Program Services1001043ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PURCHASED SERVICES47978953213251156953415110
STATE PROVIDER ASSESSME31948353194835
MAINTENANCE2679352263998839364
CONSULTING684405140478543927
INCOME TAX120171120171

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total127423868Total
Program Services115306701ProgramServices
Management And General11895130ManagementAndGeneral
Fundraising222037Fundraising
FieldValueIRS element (for citing)
Joint CostsXJointCosts

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2105044BOY
EOY6587436EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY11936228BOY
EOY3029507EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY42991BOY
EOY26036EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY17363972BOY
EOY18908121EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY4136BOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY600649BOY
EOY603714EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1540786BOY
EOY1992813EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3877458BOY
EOY5366828EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis169246577LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec96872086LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY73519444BOY
EOY72374491EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY23041128BOY
EOY34821666EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY16990354BOY
EOY17550008EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY3110773BOY
EOY3532874EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY303382BOY
EOY728652EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY154436345BOY
EOY165522146EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY10465927BOY
EOY13414930EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY102908BOY
EOY95678EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY59601068BOY
EOY57546774EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY303382BOY
EOY728652EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY325EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY70473285BOY
EOY71786359EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY82533665BOY
EOY92133119EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY282000BOY
EOY270462EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1147395BOY
EOY1332206EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY83963060BOY
EOY93735787EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY154436345BOY
EOY165522146EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses6148506ReconcilationRevenueExpenses
Reconcilation Other Changes3624221ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

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)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members1MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$11,328OtherActivitiesAmount
Total Lobbying Expenditures IIB11328TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES:PART I-A, LINE 1:HOLY FAMILY MEMORIAL EXECUTIVES MET WITH LOCAL LEGISLATORS TO DISCUSS THE EFFECTS OF PENDING LEGISLATION ON HEALTHCARE. A SMALL NUMBER OF HOLY FAMLY MEMORIAL EMPLOYEES WROTE LETTERS TO THEIR LEGISLATORS TO EXPRESS THEIR VIEWS ON HEALTHCARE RELATED ISSUES.
EXPLANATION OF OTHER LOBBYING ACTIVITIES:PART II-B, LINE 1I:HOLY FAMILY MEMORIAL BELONGS TO VARIOUS TRADE ASSOCIATIONS. A CERTAIN PERCENTAGE OF MEMBERSHIP DUES TO THE ASSOCIATIONS IS DETERMINED TO HAVE BEEN SPENT ON SPECIFIC LOBBYING PURPOSES.

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS0IncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1429395BeginningOfYearBalance
Contributions240013Contributions
Investment Earnings Or Losses162063InvestmentEarningsOrLosses
Grants Or Scholarships500GrantsOrScholarships
Other Expenditures228304OtherExpenditures
End Of Year Balance1602667EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1223863BeginningOfYearBalance
Contributions485645Contributions
Investment Earnings Or Losses-107593InvestmentEarningsOrLosses
Grants Or Scholarships500GrantsOrScholarships
Other Expenditures172020OtherExpenditures
End Of Year Balance1429395EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1372479BeginningOfYearBalance
Contributions316645Contributions
Investment Earnings Or Losses-303997InvestmentEarningsOrLosses
Grants Or Scholarships500GrantsOrScholarships
Other Expenditures160764OtherExpenditures
End Of Year Balance1223863EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.93000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.07000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis4629795OtherCostOrOtherBasis
Book Value4629795BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis103228546OtherCostOrOtherBasis
Depreciation53428696Depreciation
Book Value49799850BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3559183OtherCostOrOtherBasis
Depreciation2306380Depreciation
Book Value1252803BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis55979205OtherCostOrOtherBasis
Depreciation40555236Depreciation
Book Value15423969BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1849848InvestmentCostOrOtherBasis
Depreciation581774Depreciation
Book Value1268074BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings72374491TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value17550008BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities17550008TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionSECURITY DEPOSITDescription
Amount$325Amount
FieldValueIRS element (for citing)
Total Of Amounts325TotalOfAmounts
Total Revenue133572374TotalRevenue
Total Expenses127423868TotalExpenses
Excess Or Deficit For Year6148506ExcessOrDeficitForYear
Net Unrealized GL On Investments3450948NetUnrealizedGLOnInvestments
Other$173,273OtherAmount
Total Adjustments3624221TotalAdjustments
Excess Or Deficit Per FS9772727ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt141758192TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments3450948NetUnrealizedGainsInvestments
Other Revenues4734870OtherRevenues
Revenue Not Rptd F9908185818RevenueNotRptdF990
Revenue Subtotal133572374RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990133572374TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt132158740TotExpensesEtcAuditedFinclStmt
Other Expenses Included4734872OtherExpensesIncluded
Expenses Not Rptd F9904734872ExpensesNotRptdF990
Expenses Subtotal127423868ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990127423868TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:HOLY FAMILY MEMORIAL'S ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE FINANCIAL SUPPORT ON AN ONGOING BASIS TO MEET THE CURRENT AND FUTURE NEEDS OF HOLY FAMILY MEMORIAL AND THE PEOPLE IT SERVES. FUNDS ARE USED FOR CAPITAL EQUIPMENT PURCHASES, MAJOR BUILDING IMPROVEMENTS AND PROGRAM DEVELOPMENT. FUNDS MAY NOT BE USED FOR ONGOING, ROUTINE OPERATIONAL NEEDS, UNLESS DIRECTED BY THE DONOR IN THE CASE OF A DONOR OR NAMED ENDOWMENT FUND.
PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN RESTRICTED ASSETS: $173,273. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS: $4,851,832. PURCHASE DISCOUNTS: $3,209. TAXES: ($120,171). PART XIII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBTS: $4,851,832. PURCHASE DISCOUNTS: $3,209. TAXES: ($120,171). ROUNDING: $2.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1SPAGHETTI ITALIANameOfEvent1
Gross Receipts Event122750GrossReceiptsEvent1
Charitable Contributions Event19884CharitableContributionsEvent1
Gross Revenue Event112866GrossRevenueEvent1
Other Direct Expenses Event16372OtherDirectExpensesEvent1
Name Of Event2SAMARITAN DAYNameOfEvent2
Gross Receipts Event2111310GrossReceiptsEvent2
Charitable Contributions Event259079CharitableContributionsEvent2
Gross Revenue Event252231GrossRevenueEvent2
Other Direct Expenses Event234943OtherDirectExpensesEvent2
Total Number Of Other Events4TotalNumberOfOtherEvents
Gross Receipts Other Events43256GrossReceiptsOtherEvents
Charitable Contrib Other Events2165CharitableContribOtherEvents
Gross Revenue Other Events41091GrossRevenueOtherEvents
Other Direct Expenses Other Events3299OtherDirectExpensesOtherEvents
Gross Receipts Total177316GrossReceiptsTotal
Charitable Contributions Total71128CharitableContributionsTotal
Gross Revenue Total Events106188GrossRevenueTotalEvents
Other Direct Expenses Total Events44614OtherDirectExpensesTotalEvents
Direct Expense Summary Events44614DirectExpenseSummaryEvents
Net Income Summary61574NetIncomeSummary

Gaming Information GamingInformation

FieldValueIRS element (for citing)
Gross Revenue Other Gaming33350GrossRevenueOtherGaming
Cash Prizes Other Gaming15300CashPrizesOtherGaming
Other Direct Expenses Other Gaming65OtherDirectExpensesOtherGaming
Volunteer Labor Other Gaming1VolunteerLaborOtherGaming
Volunteer Labor Prcnt Other Gaming0.75000VolunteerLaborPrcntOtherGaming
Gross Revenue Total Gaming33350GrossRevenueTotalGaming
Cash Prizes Total Gaming15300CashPrizesTotalGaming
Other Direct Expenses Total Gaming65OtherDirectExpensesTotalGaming
Direct Expense Summary Gaming15365DirectExpenseSummaryGaming
Net Gaming Income Summary17985NetGamingIncomeSummary
FieldValueIRS element (for citing)
States Where Gaming ConductedWIStatesWhereGamingConducted
Licensed1Licensed
License Suspended Etc0LicenseSuspendedEtc
Gaming With Nonmembers1GamingWithNonmembers
Member Of Other Entity0MemberOfOtherEntity
Percentage Of Gaming Othr Facility1.00000PercentageOfGamingOthrFacility
Name Of Gaming Rec Keeper PersonERIK BARBERNameOfGamingRecKeeperPerson

Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1450AddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code542211450ZIPCode
FieldValueIRS element (for citing)
Contract With3rd Party For Gam Rev0ContractWith3rdPartyForGamRev
Charitable Distrib Required0CharitableDistribRequired

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served1647PersonsServed
Total Community Benefit Expense1747801TotalCommunityBenefitExpense
Net Community Benefit Expense1747801NetCommunityBenefitExpense
Percent Of Total Expense0.01440PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served50281PersonsServed
Total Community Benefit Expense12072687TotalCommunityBenefitExpense
Direct Offsetting Revenue5325044DirectOffsettingRevenue
Net Community Benefit Expense6747643NetCommunityBenefitExpense
Percent Of Total Expense0.05560PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served51928PersonsServed
Total Community Benefit Expense13820488TotalCommunityBenefitExpense
Direct Offsetting Revenue5325044DirectOffsettingRevenue
Net Community Benefit Expense8495444NetCommunityBenefitExpense
Percent Of Total Expense0.07000PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served12967PersonsServed
Total Community Benefit Expense220483TotalCommunityBenefitExpense
Net Community Benefit Expense220483NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served1064PersonsServed
Total Community Benefit Expense163166TotalCommunityBenefitExpense
Net Community Benefit Expense163166NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Persons Served85PersonsServed
Total Community Benefit Expense77963TotalCommunityBenefitExpense
Net Community Benefit Expense77963NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served333PersonsServed
Total Community Benefit Expense164270TotalCommunityBenefitExpense
Net Community Benefit Expense164270NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served14449PersonsServed
Total Community Benefit Expense625882TotalCommunityBenefitExpense
Net Community Benefit Expense625882NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served66377PersonsServed
Total Community Benefit Expense14446370TotalCommunityBenefitExpense
Direct Offsetting Revenue5325044DirectOffsettingRevenue
Net Community Benefit Expense9121326NetCommunityBenefitExpense
Percent Of Total Expense0.07510PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs10NumberOfActivitiesOrPrograms
Total Community Building Expense5000TotalCommunityBuildingExpense
Net Community Building Expense5000NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense32TotalCommunityBuildingExpense
Net Community Building Expense32NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense21064TotalCommunityBuildingExpense
Net Community Building Expense21064NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1221NumberOfActivitiesOrPrograms
Total Community Building Expense2100TotalCommunityBuildingExpense
Net Community Building Expense2100NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs1235NumberOfActivitiesOrPrograms
Total Community Building Expense28196TotalCommunityBuildingExpense
Net Community Building Expense28196NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,995,919BadDebtExpenseAmount
Amount Attributable To213385AmountAttributableTo
Amount Reimbursed By Medicare44763513AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare57908564CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-13145051MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 YORK STREET PROPERTIES LLC
REAL ESTATE0.360000.000000.00000
2 HOLY FAMILY MEMORIAL CANCER CENTER - ST VINCENT CANCER COLLABORATIVE
PROFESSIONAL CANCER CARE SERVICES0.500000.000000.00000
FieldValueIRS element (for citing)
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 Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code542211450ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained0EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis0ExplainsBasis
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures0IncludesPublicityMeasures
Actions On Nonpayment0ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
HOLY FAMILY HEALTH SERVICES INC
3310 CALUMET AVENUEMANITOWOCWI54220RETAIL PHARMACY
NORTH END HOME MEDICAL SERVICES LLC
3310 CALUMET AVENUEMANITOWOCWI54220DURABLE MEDICAL EQUIPMENT

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
PART I, LINE 7: COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE CARE AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT PROGRAMS INCLUDE SERVICES FOR THOSE WHO CAN NOT AFFORD HEALTH CARE AND INITIATIVES FOR IMPROVING HEALTH IN THE BROADER COMMUNITY. PROVIDING COMMUNITY BENEFITS DEMONSTRATES THAT HOLY FAMILY MEMORIAL IS FULFILLING ITS CHARITABLE MISSION AND DEMONSTRATING ITS PREFERENTIAL TAX STATUS IS DESERVED.
PERCENTAGE OF COMMUNITY BENEFIT EXPENSE TO OVERALL ENTITY'S EXPENSES.SCHEDULE H, PART 1, LINE 7, COLUMN F
PART II: COMMUNITY BUILDING ACTIVITIES INDICATED IN PART II PROMOTE THE HEALTH OF THE MANITOWOC COMMUNITY BY ACTIVELY ADDRESSING EXPRESSED AND REPORTED ISSUES. SPECIFICALLY, THROUGH THE PROGRAMS INDICATED, HOLY FAMILY MEMORIAL AND IN PARTNERSHIP WITH OTHERS, WORKS DILIGENTLY TO ACHIEVE AN OVERALL HEALTHIER COMMUNITY. MAJOR INITIATIVES WITH DISCERNABLE POSITIVE RESULTS INCLUDE: IMPROVED ACCESS TO HEALTH INFORMATION AND PROVIDER RESOURCES, REDUCTION IN COMMUNITY FALLS, REDUCTION IN ADULT SMOKING POPULATION RATES, REDUCTION IN TEENAGE PREGNANCY RATES AND REDUCTION IN TEENAGE AND ADULT DRINKING RATES.
PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE ORGANIZATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.
PART III, LINE 8: HOLY FAMILY MEMORIAL IS A LICENSED MEDICARE PROVIDER WITH APPROXIMATLEY 47.7 PERCENT OF ITS PATIENT BASE QUALIFYING FOR THIS PROGRAM. AT PRESENT, THE REIMBURSEMENT RATE FOR THE MEDICARE PROGRAM DOES NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THIS REPRESENTS THE ESTIMATED SHORTFALL CREATED WHEN HOLY FAMILY MEMORIAL RECEIVES PAYMENTS BELOW THE COSTS OF TREATING MEDICARE AND OTHER PUBLIC PROGRAM BENEFICIARIES.COST METHODOLOGY = COST TO CHARGE RATIO
PART III, LINE 9B: PAYMENT OPTIONS AS WELL AS COMMUNITY CARE ASSISTANCE IS NOTED ON ALL COLLECTION LETTERS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SDS, MRI, CT AND ER SERVICES. A PATIENT FINANCIAL ADVISOR SEES SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENT OF ANY PROGRAMS THEY MAY QUALIFY FOR INCLUDING, BUT NOT LIMITED TO MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY CARE PROGRAM. IF THEY MAY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE DIRECT THEM TO THE APPROPRIATE ORGANIZATION FOR APPLICATION AND ASSISTANCE. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CALL FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON WHERE TO GO TO APPLY FOR THOSE PROGRAMS.
PART VI, LINE 2: HOLY FAMILY MEMORIAL UTILIZES FOUR DISTINCT PROCESSES TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. FIRST, AS A PART OF THE ANNUAL STRATEGIC PLANNING PROCESS, AN ENVIRONMENTAL ASSESSMENT IS DONE. INCLUDED IN THAT REPORT AND ANALYSIS IS CURRENT POPULATION DATA INCLUDING DEMOGRAPHICS, UTILIZATION, MORTALITY INFORMATION, DEMAND FORECASTING, PREVALENT DISEASE STATES AND FEEDBACK FROM VARIOUS CONSTITUENCIES RELATIVE TO PERCEIVED MET AND UNMET COMMUNITY HEALTH NEEDS. SECOND, HOLY FAMILY MEMORIAL PARTICIPANTS IN A TRI-ANNUAL FULL COMMUNITY HEALTH ASSESSMENT PROCESS IN CONJUNCTION WITH HEALTHIEST MANITOWOC COUNTY 2020. THIS ASSESSMENT CONSISTS OF DIRECT FEEDBACK OBTAINED FROM HUNDREDS OF COMMUNITY RESIDENTS, INCLUDING ALL AGE GROUPS, BEGINNING FROM HIGH SCHOOL AGE. THE INFORMATION IS TABULATED, ANALYZED AND UTILIZED TO DETERMINE HEALTH NEEDS IN THE AREAS OF PHYSICAL, SOCIAL, ENVIRONMENTAL AND BEHAVIORAL HEALTH. HOLY FAMILY MEMORIAL USES THIS INFORMATION IN ITS ANNUAL STRATEGIC AND PROGRAMMATIC PLANNING. THIRD, HOLY FAMILY MEMORIAL CONDUCTS REGULAR INPUT SESSSIONS WITH LOCAL EMPLOYERS TO ASCERTAIN HEALTH NEEDS FROM AN OCCUPATIONAL HEALTH PERSPECTIVE. THIS INFORMATION IS THEN UTILIZED TO DEVELOP AND PROVIDE NEEDED EMPLOYER/EMPLOYEE HEALTH SERVICES THROUGHOUT THE BUSINESS COMMUNITY. LASTLY, HOLY FAMILY MEMORIAL UTILIZES A COMBINATION OF PATIENT FEEDBACK FROM ONGOING PATIENT SATISFACTION SURVEYS (CONDUCTED POST PROVISION OF SERVICES) AND COMMUNITY RESEARCH STUDIES COMMISSIONED BY HOLY FAMILY MEMORIAL, TO ASSESS PROGRAM AND SERVICE HEALTH CARE NEEDS OF THE COMMUNITY.
PART VI, LINE 3: PATIENT REGISTRATION AREAS/WEBSITE/BROCHURES/ADMISSIONS STAFF/COLLECTION CORRESPONDENTS AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SDS, MRI, CT SERVICES. A PATIENT FINANCIAL ADVISOR SEES/COMMUNICATES TO SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENT OF ANY PROGRAMS THEY MAY QUALIFY FOR INCLUDING, BUT NOT LIMITED TO MEDICAID, VETERANS ADMINISTRATION OR OUR OWN CHARITY PROGRAM. IF THEY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE ASSIST THEM TO THE APPROPRIATE ORGANIZATION FOR APPLICATION AND ASSISTANCE. FOR THE NETWORK CHARITIY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CALL FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON WHERE TO GO TO APPLY FOR THOSE PROGRAMS.
PART VI, LINE 4: THE COMMUNITY THAT HOLY FAMILY MEMORIAL SERVICES IS CONSIDERED TO BE LOCATED IN THE RURAL LAKESHORE REGION OF NORTHEAST WISCONSIN. THE PRIMARY SERVICE AREA IS MANITOWOC COUNTY WITH SECONDARY NEIGHBORING COUNTIES; BROWN, KEWAUNEE AND SHEBOYGAN. SPECIFICALLY, THE COMMUNITY SERVED IS AN OLDER POPULATION WITH 16% OF THE PEOPLE AGE 65 OR OLDER WITH AN MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $45,000. 13.5% OF OUR SERVICES ARE DEDICATED TO PROVIDING CARE TO MEDICAID AND SELF-PAY PATIENTS. THIS NUMBER IS 3% HIGHER THAN THE STATE AVERAGE AND 2-3% HIGHER THAN SURROUNDING COUNTIES. THE 2012 SERVICES AREA IS EXPECTED TO REMAIN AT 2009 LEVELS WITH A SLIGHT GROWTH TOWARD THE 65+ AGE AND RETRACTION OF THOSE 18-44. REFLECTIVE OF THIS NUMBER IS THAT OVER 47% OF OUR SERVICES ARE DEDICATED TO PROVIDING CARE TO MEDICARE PATIENTS. THE COMMUNITY IS MAINLY CAUCASIAN WITH SEVERAL OTHER NATIONALITIES INCLUDING AFRICAN AMERICAN, HMONG AND SPANISH. OTHER PROVIDERS IN THE AREA CONSIST OF THE AUORORA MEDICAL GROUP, MANITOWOC SURGERY CENTER, AND SEVERAL OTHER INDEPENDENT PROVIDERS.
PART VI, LINE 6: ALL OF HOLY FAMILY MEMORIAL'S BOARD MEMBERS RESIDE IN THE PRIMARY SERVICE AREA. THE BOARD CONSISTS OF COMMUNITY REPRESENTATIVES, PHYSICIANS AND REPRESENTATIVES OF THE SPONSOR ORGANIZATION. THE MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS WHO MEET THE REQUIREMENTS OF MEDICAL STAFF MEMBERSHIP. THE NETWORK OF PHYSICIANS IS COMMITTED TO PROVIDING EACH PATIENT WITH THE HIGHEST LEVEL OF PERSONAL CARE, RESPECT AND ATTENTION TO ENHANCE THE PATIENT'S QUALITY OF LIFE, INCLUDING PERSONALIZED SPIRITUAL CARE. ALL SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION TO PURCHASE NECESSARY MEDICAL EQUIPMENT, COMPENSATE EMPLOYEES, AND PLAN FOR FUTURE NEEDS. NONE OF THE SUPRLUS EARNINGS BENEFIT ANY INDIVIDUALS OR OTHER CORPORATE ENTITIES.
PART VI, LINE 7: THE HEALTH CARE NETWORK IS SPONSORED BY THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY, LOCATED AT HOLY FAMILY CONVENT, MANITOWOC, WISCONSIN. THE CONVENT, SITUATED ON SILVER LAKE, THREE MILES WEST OF LAKE MICHIGAN, IS HOME FOR OVER 350 CONGREGATION MEMBERS WHO SERVE THROUGHOUT THE UNITED STATES AND ARE PRIMARILY ENGAGED IN EDUCATION, PARISH AND HEALTH MINISTRIES. THE HEALTHCARE MINISTRY SPANS THREE STATES - WISCONSIN, NEBRASKA AND OHIO - AND HAS EXISTED FOR OVER 100 YEARS. THE MISSION OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY IS TO CARRY OUT THE COMMITMENT OF THE SPONSOR TO THE HEALING MISSION OF THE CATHOLIC CHURCH THROUGHOUT THE PROVISION OF QUALITY HEALTHCARE SERVICES.
WI,NEPART VI, LINE 7REPORTS FILED WITH STATES

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients14NumberOfRecipients
Amount Of Cash Grant46000AmountOfCashGrant
Method Of ValuationACTUAL TUITION COSTMethodOfValuation

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierOTHER INFORMATION:Identifier
Return ReferencePART IV:ReturnReference
ExplanationHOLY FAMILY MEMORIAL'S SCHOLARSHIP PROGRAM IS DESIGNED AS A RECRUITMENT TOOL FOR EMPLOYMENT OF CANDIDATES IN SPECIFIED POSITIONS, CONSIDERED DIFFICULT TO FILL AND TO ASSIST STUDENTS IN THEIR PURSUIT OF A HEALTH CARE RELATED DEGREE. AREAS OF STUDY INCLUDING NURSING, PHARMACY, PHYSICAL THERAPY, AND OTHERS. IN RETURN FOR THE SCHOLARSHIP, AN EMPLOYMENT SERVICE COMMITMENT IS MADE. IN ORDER TO BE ELIGIBLE: 1) STUDENTS MUST BE ACCEPTED INTO AN ACCREDITED PROGRAM 2) CANDIDATES MUST BE ATTENDING SCHOOL AS A FULL OR PART TIME STUDENT AND REMAIN IN THAT STATUS 3) STUDENTS MUST HAVE AND MAINTAIN A 3.0 CUMULATIVE GRADE POINT AVERAGE. SCHOLARSHIPS ARE AWARDED ON THE BASIS OF GRADE POINT AVERAGE, VERIFIED WITH OFFICIAL TRANSCRIPT OF GRADES, COMPLETION OF EMPLOYMENT APPLICATION AND PERSONAL INTERVIEW. THE SCHOLARSHIP IS TO BE USED FOR TUITION COST ONLY. THE SCHOLARSHIPS ARE GIVEN OUT EACH SEMESTER AND ARE PAID DIRECTLY TO THE SCHOOL THE STUDENT ATTENDS. APPLICANTS WHO ARE AWARDED THE SCHOLARSHIP MUST MAKE A SIX-MONTH COMMITMENT TO WORK AT HOLY FAMILY MEMORIAL FOR EACH SEMESTER THE SCHOLARSHIP IS AWARDED. THE SCHOLARSHIP RECIPIENT MUST REPAY THE FULL AMOUNT OF THE SCHOLARSHIP IF HE/SHE: 1) DROPS OUT OF SCHOOL 2) FALLS BELOW A 3.0 CUMULATIVE GRADE POINT AVERAGE 3) DOES NOT ACCEPT EMPLOYMENT 4) DOES NOT COMPLETE FULL LENGTH OF EMPLOYMENT COMMITMENT 5) DOES NOT OBTAIN WISCONSIN LICENSURE, AS REQUIRED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (18 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
PRADEEP GIRIYAPPA MD
197223074402071520195580194110317746000
MICHAEL B MCCORMICK MD
270005013350211350185960235670334638000
AMY L STOCKHAUSEN MD
137981054767056470161980201590234752000
GARY SCHMIDT MD
153360095000887109396040670185194000
MARY A GOVIER MD
1611690945006154097730209160207462000
EVELYN D SBAR MD
14575201178802048013387020160174991000
MARK P HERZOG
3994460952730116460831750230830612623000
PATRICIA HUETTL
214925000840165000211470252656000
STEVEN DRIGGERS MD
385539072204045580716980196780553677000
MARY MAURER
1860250351440295040949030760265489000
RYAN DOPIRAK MD
4673750116548004016601955902193101714511000
NANCY BUTLER MD
250016068382405725201955901035301021004000
JEFFREY JACOBY MD
474289079206803846201955902084301345221000
TRACY RUPKE MD
45000801671290433080195590218920701896000
KIRK DIMITRIS MD
4500080475073043308045830215990994571000
PATRICK BRANDEL
403220554930256304192043010106871000
JON RING
28140046166015127203742032190232539000
MARY DEBILZEN
9648407876057404480088940118308000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4AJON RING, FORMER VP-PHYSICAN SERVICES, RECEIVED SEVERANCE PAYMENTS TOTALING $139,879.
PART I, LINE 6AN AT-RISK COMPENSATION TEAM AWARD PROGRAM WHICH REWARDS EFFORTS AND ACCOMPLISHMENT OF HFM'S GOALS. GOALS ARE APPROVED BY THE HFM BOARD EXECUTIVE COMMITTEE AND ARE DEVELOPED IN THE FOLLOWING AREAS: WORKFORCE AND ORGANIZATIONAL DEVELOPMENT, STRATEGIC INFASTRUCTURE, IMPROVEMENT AND INNOVATION, AND CLINICAL AND SERVICE EXCELLENCE. IF THE NET EARNINGS BUDGET IS EXCEEDED, A LEVEL OF ACHIEVEMENT WILL BE CALCULATED. IN 2010, ALL REGULARLY SCHEDULED, NON-PHYSICIAN EMPLOYEES PARTICIPATED IN THE PROGRAM.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
WISCONSIN HEALTH AND EDUCATION FACILITIES
39133785597710VPE22003-09-0911293000SEE SCHEDULE K, PART V100
WISCONSIN HEALTH AND EDUCATION FACILITIES
39133785597710VPE22003-09-099922000SEE SCHEDULE K, PART V000
WISCONSIN HEALTH AND EDUCATION FACILITIES
39133785597710V2S62007-04-2645170000SEE SCHEDULE K, PART V000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Amount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
9571000112930008980001107000146000914200020061011
9922000244000967700020060011
45170000224700037448000485000499000020091111

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
000011
000011
000011

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
100001
110001
000001

Form990 Schedule K Part V Form990ScheduleKPartV (3 entries)

IdentifierIdentifierExplanationExplanation
PART 1, LINE A,COLUMN F:THE PURPOSE OF THE BOND ISSUE WAS A PROJECT CONSISTING OF THE CONSTRUCTION, RENOVATION, AND EQUIPPING OF AMBULATORY CARE, DIAGNOSTIC IMAGING, REHABILITATION, OCCUPATIONAL MEDICINE, PRIMARY CARE AND ORTHOPEDIC FACILITIES AT CERTAIN HOLY FAMILY HEALTH FACILITIES.
PART 1, LINE B,COLUMN F:THE PURPOSE OF THE BOND ISSUE WAS A PROJECT CONSISTING OF THE CONSTRUCTION, RENOVATION, AND EQUIPPING OF AMBULATORY CARE, DIAGNOSTIC IMAGING, REHABILITATION, OCCUPATIONAL MEDICINE, PRIMARY CARE AND ORTHOPEDIC FACILITIES AT CERTAIN HOLY FAMILY HEALTH FACILITIES.
SCHEDULE K, PART 1, LINE C, COLUMN F:THE PURPOSE OF THE BOND ISSUE WERE 1)THE ACQUISITION, CONSTRUCTION, RENOVATION, REMODELING AND EQUIPPING OF CERTAIN HOSPITAL AND OTHER HEALTHCARE FACILITIES AS IDENTIFIED IN A NOTICE OF PUBLIC HEARING PUBLISHED IN CONNECTION WTIH THE ISSUANCE OF THE BONDS, INCLUDING THE ACQUISITION OF TELEMETRY MONITORS AND AN MRI SYSTEM 2) THE CURRENT REFUNDING OF ALL OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE (WHEFA) BONDS, SERIES 1995, 3) THE ADVANCE REFUNDING OF ALL THE WHEFA BONDS, SERIES 1998A AND 4) THE ADVANCE REFUNDING OF A PORTION OF THE WHEFA BONDS, SERIES 2003A.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
LINDA BRANDEL
SPOUSE OF FORMER CFO22370WAGES0
ALAN SBAR MD
SPOUSE OF M.D., COUNCIL CO-CHAIR264233WAGES0
NORTH END HOME MED SCS LLC
OFFICERS OF HFM208082100% OWNED LLC0
HOLY FAMILY HEALTH SERVICES
SERVE AS DIRECTORS ON BOTH ORGANIZATIONS192766100% OWNED FOR PROFIT0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6HOLY FAMILY MEMORIAL IS SPONSORED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTH CARE MINISTRY INC., WHICH IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AHOLY FAMILY MEMORIAL OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PRIMARILY TO THE RESIDENTS OF MANITOWOC COUNTY, WISCONSIN. HOLY FAMILY MEMORIAL IS OPERATED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTH CARE MINISTRY INC., WHICH IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTH CARE MINISTRY INC. IS A NOT-FOR-PROFIT HEALTHCARE HOLDING COMPANY INCORPORATED TO MONITOR AND MANAGE HEALTHCARE OPERATIONS. THE BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN EIGHTEEN INDIVIDUALS. THE PRESIDENT OF THE CORPORATION AND CHAIR OF THE PHYSICIAN COUNCIL SHALL BE EX-OFFICIO MEMBERS WITH FULL VOTING PRIVILEGES. IN ADDITION TO THE EX-OFFICIO BOARD POSITIONS, THE BOARD OF DIRECTORS SHALL INCLUDE FOUR MEMBERS OF FRANCISCAN SISTERS OF CHRISTIAN CHARITY AND AT LEAST FOUR PHYSICIANS.
FORM 990, PART VI, SECTION A, LINE 7BSOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER AS OUTLINED IN THE CORPORATE BYLAWS. FOR EXAMPLE, THE GOVERNING BOARD SUBMITS NAMES OF NEW BOARD MEMBERS TO THE MEMBER AND THE MEMBER APPOINTS THEM. APPROVAL OF THE PHILOSOPHY, MISSION & VISION STATEMENTS MUST BE APPROVED BY THE MEMBER. A CERTIFIED AUDIT OF CORPORATE FUNDS OR THE ANNUAL FISCAL AUDITOR MUST BE APPROVED BY THE MEMBER, ETC.
FORM 990, PART VI, SECTION B, LINE 11THE CHAIR OF THE GOVERNING BOARD REVIEWS THE 990 PRIOR TO FILING. AN OVERVIEW OF THE 990 ALONG WITH SPECIFIC SECTIONS ON GOVERNANCE, COMMUNITY BENEFITS, CONFLICT OF INTEREST, AND COMPENSATION IS PRESENTED TO THE BOARD. THE COMPENSATION EVALUATION SUBCOMMITTEE REVIEWS THE 990 SECTIONS RELATED TO COMPENSATION PRIOR TO FILING. COPIES ARE AVAILABLE TO ALL BOARD MEMBERS.
EACH FEBRUARY, ALL GOVERNING BOARD MEMBERS ARE GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY TO REVIEW AND A COPY OF THE CERTIFICATION ON WHICH TO DISCLOSE ANY CONFLICTS AND SIGN. AT THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING WHERE THERE WILL BE A VOTE, THE CHAIRPERSON ASKS IF THERE ARE ANY CONFLICTS TO THE PARTICULAR ISSUE. IF THERE IS A CONFLICT, THAT PERSON ABSTAINS FROM DISCUSSION & VOTING. ALL PHYSICIANS, NETWORK LEADERS, AND KEY EMPLOYEES ARE GIVEN THE SAME AT THE TIME OF THEIR CONTRACT RENEWAL OR PERFORMANCE APPRAISAL AND IS MONITORED THROUGH HOLY FAMILY MEMORIAL'S COMPLIANCE DEPARTMENT. PROVIDERS COMPLETE A CONFLICT OF INTEREST ACKNOWLEDGEMENT AS PART OF THE APPROVAL PROCESS FOR THE PURCHASE OF NEW PRODUCTS OR EQUIPMENT THAT THEY ARE DIRECTLY ASSOCIATED WITH.FORM 990, PART VI, SECTION B, LINE 12C
LINES 15 A & B - HOLY FAMILY MEMORIAL HAS A SENIOR LEADER COMPENSATION POLICY. THE PROCESS OF DETERMINING THESE SALARIES ARE GOVERNED BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD. THE POLICY COVERS THE FOLLOWING POSITIONS: PRESIDENT AND CEO, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER, CHIEF NURSING OFFICER AND CHIEF INNOVATION OFFICER. ANNUALLY (LAST DONE 6/21/10) EXECUTIVE SALARY SURVEY DATA IS EVALUATED USING TWO MAIN SOURCES: HAY GROUP ANNUAL EXECUTIVE COMPENSATION SURVEY AND MSA/CLARK CONSULTING - HEALTHCARE GROUP NATIONAL HEALTHCARE LEADERSHIP COMPENSATION SURVEY. TOTAL COMPENSATION FOR EACH SENIOR LEADER (SALARY, BENEFITS AND INCENTIVE) IS TARGETED TO THE 65TH PERCENTILE OF COMPENSATION FOR COMPARABLE POSITIONS. ALSO CONSIDERED ARE CURRENT MARKET CONDITIONS, INDEPENDENT CONSULTANT INPUT AND MARKET COMPETITIVENESS. AN EXTERNAL REVIEW BY AN EXECUTIVE COMPENSATION FIRM IS ALSO DONE EVERY THREE YEARS (LAST DONE IN 2008).FORM 990, PART VI, SECTION B, LINE 15
HOLY FAMILY MEMORIAL'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE FROM THE WI DEPARTMENT OF FINANCIAL INSTITUTIONS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE DACBOND.COM WEBSITE AND WE SUBMIT FINANCIAL INFORMATION TO THE STATE OF WI ANNUALLY. OUR FORM 990 IS AVAILABLE UPON REQUEST AND CAN BE SEEN ON THE GUIDESTAR WEBSITE. AFTER THE AUDIT, THE AUDITORS PRESENT THE AUDIT REPORT TO THE FINANCE COMMITTEE OF THE BOARD. THE FINANCE COMMITTE THEN MAKES A MOTION TO THE BOARD OF DIRECTORS TO ACCEPT THE AUDIT. THE BOARD THEN ACTS ON THE RECOMMENDATION FROM THE FINANCE COMMITTEE.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 3,450,948. CHANGE IN RESTRICTED ASSETS 173,273. TOTAL TO FORM 990, PART XI, LINE 5: 3,624,221.FORM 990, PART XI, LINE 5:
THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE THE TAX PROCESS.FORM 990,PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1NORTH END HOME MED SCS LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code54220ZIPCode
FieldValueIRS element (for citing)
EIN391868808EIN
Primary ActivitiesMEDICAL EQUIPMENTPrimaryActivities
Legal Domicile StateWILegalDomicileState
Total Income208082TotalIncome
EOY Assets1861730EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
FRANCISCAN SISTERS OF CHRISTIAN CHARITY
1415 SOUTH RAPIDS ROADMANITOWOCWI54220391530622HEALTHCAREWI501(C)(3)LINE 1N/A0
ST PAUL ELDER SERVICES INC
316 EAST 14TH STREETKAUKAUNAWI54130391029149ELDER CAREWI501(C)(3)LINE 5N/A0
GOOD SAMARITAN MEDICAL CENTER
800 FOREST AVENUEZANESVILLEOH43701314379479HOLDING CO.OH501(C)(3)LINE 7N/A0
FRANCISCAN CARE SERVICES INC
430 N MONITOR STWEST POINTNE68788470486026HEALTHCARENE501(C)(3)LINE 7N/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY HEALTH SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1
CityMANITOWOCCity
StateWIState
ZIP Code54220ZIPCode
FieldValueIRS element (for citing)
EIN391572253EIN
Primary ActivityPHARMACYPrimaryActivity
Legal Domicile StateWILegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income192766ShareOfTotalIncome
Share Of EOY Assets1367152ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HOLY FAMILY HEALTH SERVICES - INTEREST ON LOAN
A32496ACTUAL EXPENSE
HOLY FAMILY HEALTH SERVICES - LOAN TO HOLY FAMILY HEALTH SERVICES
D500000LOAN BALANCE
HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSUPPLIESRENT
O1458677ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT
A49625ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES
O76462ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES
O688000ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC
O1616314ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS
O9645000ACTUAL EXPENSE

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