2011-05-13T08:30:42-05:00 2010-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2009-07-01 370661236 ST FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE 3RD ORDER OF ST FRANCIS STFR 2173242191 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 daniel perryman 2173242191 2011-04-01 true KPMG LLP 6142492300 2009 2016-02-24 21:20:13Z Daniel Perryman 1215 Franciscan Drive Litchfield IL 62056 36796946 false 0928 X WWW.STFRANCIS-LITCHFIELD.ORG X 1875 IL St. Francis Hospital continues the healing ministry of Jesus Christ in the tradition of St. Francis by providing the highest quality healthcare with respect, care, competence and joy. 11 10 287 25 3504 -58 121905 106577 34654224 35153482 -983441 989076 382266 262235 34174954 36511370 4000 4000 0 0 14383820 15703259 0 0 0 16123530 17455421 30511350 33162680 3663604 3348690 41447467 44846973 22893782 27722267 18553685 17124706 St. Francis Hospital continues the healing ministry of Jesus Christ in the tradition of St. Francis by providing the highest quality healthcare with respect, care, competence and joy. false false 6313306 6163410 SEE SCHEDULE O PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS 680316 945029 Maternity/Gynecology Services 18880673 4000 28045043 Outpatient Acute Care 169094 Other Misc Expenses 169094 26043389 true true false true false false false false false true false true false false false false false false false false true false false true false false false false false false false false false false false false true true false false false true 0 0 287 true true true false false false false false false false false false false false 11 10 false false false false true true true true true false false true true true true true true true true false X DIANE LINDSAY 2173248368 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 CHRIS POIROT MD 2.0 X X 0 0 0 Dona McGraw 1.0 X 0 0 0 DANIEL PERRYMAN 40.0 X X 0 300493 71178 LONNIE BATHURST 2.0 X X 0 0 0 SISTER MARYBETH CULNAN OSF 1.0 X 0 0 0 SISTER MARGUERITE COOK OSF 1.0 X 0 0 0 Tom Franzen 1.0 X 0 0 0 JOHN FASSERO 2.0 X X 0 0 0 ROGER WUJEK MD 1.0 X 0 0 0 SISTER KENNETH WILDT OSF 1.0 X 0 0 0 Robert Ritz 40.0 X 698568 109286 Larry J Ragel 40.0 X 225663 0 52258 Ann Carr 1.0 X 0 153448 117382 CAROL JACO 40.0 X 131359 0 32074 DIANE LINDSAY 40.0 X 119398 0 66402 JILL MOUTRIA 40.0 X 122639 0 41055 AARON HUMPHREYS MD 40.0 X 432115 0 99292 1031174 1152509 588927 5 false true false Amsol Anesthetists of Litchfield I PO Box 6633 High Point NC 27262 CRNA Services 506026 Illinois Emergency Physicians PO Box 793 Traverse City MI 49685 ER Physician Service 1454066 2 63220 28068 15289 106577 NET PATIENT SERVICE REVENUE 900099 35153482 35153482 35153482 920387 920387 0 0 141248 285576 -144328 -144328 -144328 68689 68689 68689 68689 0 0 0 CAFETERIA/CAFE 722210 62470 62470 OTHER RELATED SERVICES 900099 337663 337663 LAB 621500 6430 3504 2926 406563 36511370 35153482 3504 1247807 0 4000 4000 0 0 284029 152915 131114 0 11057712 8284250 2773462 464487 340279 124208 3080656 2256859 823797 816375 598069 218306 0 194190 194190 62399 62399 15868 15868 0 0 1266205 955391 310814 37639 404 37235 125448 61526 63922 806004 604503 201501 0 0 18744 9582 9162 0 58643 18608 40035 25633 25633 0 1523636 1236110 287526 0 PROVISION FOR BAD DEBT 3203925 3203925 MEDICAL PROFESSIONAL FEES 2302189 2302189 SUPPLIES 3470138 3241915 228223 UTILITIES 771639 532203 239436 MAINTENANCE AND REPAIRS 784828 574253 210575 2788293 1624907 1163386 33162680 26043389 7119291 0 3600178 3042484 42 58 3991700 2806718 644512 880265 484334 458766 593302 479213 33429688 26312425 7684317 7117263 24098457 29281079 350625 781127 41447467 44846973 2861583 3097136 12716289 12601656 7315910 12023475 22893782 27722267 X 16818614 15309074 1112026 1192399 623045 623233 18553685 17124706 41447467 44846973 X false true true X true true X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 15868 15868 false DESCRIPTION OF OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II B, QUESTION 11 The 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 23.76% lobby expense, Catholic Health Association (CHA) at 5.46% lobby expense, Illinois Hospital Association (IHA) at 31% 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. 0 99383 99383 0 15959498 12383019 3576479 0 1059740 968944 90796 0 15958181 12960462 2997719 0 352886 352886 7117263 0 MALPRACTICE CLAIMS LIABILITY 1000901 WORKERS' COMP TRUST LIABILITY 750442 ACCRUED BENEFIT LIABILITY 8645519 RETIRE OBLIGATION - ASBESTOS 842122 SETTLEMENT VALUE OF INTEREST 784491 12023475 Explanation for adoption of ASC Subtopic 740-10 ASC Subtopic 740-10 ON JULY 1, 2007, HSHS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO.109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2010 AND 2009, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS. true true true X 125. true X true true true false true true 1194 601996 601996 0.02000 6912859 4460009 2452850 0.08190 138409 143641 -5232 0.00020 1194 7653264 4603650 3049614 0.10170 138004 138004 0.00460 144599 15289 129310 0.00430 282603 15289 267314 0.00890 1194 7935867 4618939 3316928 0.11060 13 152 1886 1886 0.00010 13 152 1886 1886 0.00010 true 1168151 79908 12070416 13644450 -1574034 X true true St Francis Hospital of the Hospital Sis

1215 Franciscan Drive Litchfield IL 62056

X Not applicable as the organization does follow FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals. St Francis Hospital's community benefit report is available upon request at 1215 Franciscan Drive, Litchfield, IL 62056. Charity Care is calculated by determining the total amount from patient billing that is written off to charity care charge codes or allowances. This amount matches the number that is reported on our fiscal year ending 2010 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. The hospital does not have sufficient information at this time to determine if subsidized services exist based on the definition and calculations required by the IRS and is working to provide such information in next year's return. The percent of charity care and certain other benefits for the poor and the broader community at cost as a percent of total expenses less bad debt is 11.06%. The hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients that potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity due to missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital. The hospital computes the cost of bad debt by applying the ratio of patient care cost to charges to the total charges written off as bad debt expense. The bad debt attributable to patient accounts is $3,203,925. However, calculating the ratio of patient care cost to charges brings the estimated cost of bad debt to $1,168,151. 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. The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who 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 totaling $1,574,034. If an account that has been sent to a collection agency is determined by the agency to be uncollectible, attempts by the agency to collect payment on the account will cease and the account will be returned to the hospital. The hospital will then consider the account to be uncollectible St Francis Hospital does not have any healthcare facilities that are not registered as a healthcare facility under state law. St. Francis Hospital contracted with the Illinois Institute for Rural Affairs (IIRA) at Western Illinois University for a Community Health Mapping program. The program has provided 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, and help prioritize community healthcare needs. To assist with the assessment process, St. Francis organized a local health assessment steering committee, identified groups and local residents to participate in various stages of the process, helped with the organizing and scheduling of focus groups, and aided in the assembly of a local contact list of health and social service providers. The assessment was conducted using focus groups, telephone surveys of health and social service providers and interviews of key stakeholders. The IIRA analyzed existing and new data and provided the hospital with a written report of the findings. Several recommendations were made from the community needs assessment. First, provide the best possible service, including at points of initial contact. Second, make the necessary referrals and follow- up appointments with patients who need specialized care beyond the local community. Third, assist residents to reduce medical cost through wellness and preventative health programming, medication assistance, and follow-up care. Fourth, increase access to dental and mental health services. Fifth, address citizen's concerns and needs regarding diabetes care and cancer rates. Sixth, network and coordinate services with other health and social service programs to increase awareness and improve public health. In conclusion, St. Francis is uniquely positioned to be the leading healthcare facility in the area. The hospital is vital to the community and has a large physician network. Future opportunity will arise to work with healthcare providers more closely. The information from the community needs assessment provides the hospital leadership with an opportunity and a basis from which to develop a community benefit strategy. The St. Francis Hospital leadership has identified three community benefit initiatives: improve access to diabetes care, improve access to dental care and improve the community presence of St. Francis Hospital. Based on the three community benefit initiatives, action plans were created to kick off this process. First, SIU School of Medicine's Endocrinology Department has been engaged to explore the possibility of satellite diabetes clinics/services. The possibility of providing certified diabetic education and dietician services on an out-patient basis is currently under consideration. Free diabetes screening and education is being planned for spring 2011 in conjunction with the Illinois Kidney Mobile. Community partners in this project include the Montgomery County Health Department and nursing students from Lewis & Clark Community College. Second, a free day of dental care for uninsured or underinsured residents is being planned with area dental offices. Lewis & Clark Community College has also been approached to provide free dental screenings. Third, community presence takes place with the St. Clare Food Pantry re-opening. The St. Clare Food Pantry has recently relocated and reopened within the St. Clare Center, a facility which also has a room for community outreach activities. Several free Community Outreach Health Education programs are currently scheduled. Patients are notified of the organization's charity care policy and other available financial assistance through signage in the registration areas, text on the billing statements 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. More than 94% of the inpatients treated at St. Francis Hospital reside in Montgomery and Macoupin Counties. 58% of the inpatients live in Montgomery County and 36% live in the neighboring Macoupin County. Both of the counties are located in central Illinois, between the cities of Springfield, Illinois and St. Louis, Missouri. Combined population is 77,796 and 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 16.8% in Montgomery County and the current unemployment rate is 10.3% and 12.8%, respectively. Persons eligible for Medicare account for 46% of the patient revenue generated at the hospital and Medicaid-eligible patients generate 22%. Only 27% of the revenue is derived from patients who have 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 73% of the Maternity unit patients are 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 2010, over $939,000 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. St. Francis Hospital works with the Regional Cancer Partnership of Illinois to provide education and increase awareness of cancer-related illnesses and health issues, along with access to cancer screenings. The hospital also works with the Macoupin County Health Department to decrease domestic violence through the Safe Communities Coalition and an educational seminar for healthcare providers is planned for spring 2011. St. Francis Hospital also collaborated with the Montgomery County Health Department, the Hillsboro Hospital, the Montgomery County Extension office, and local produce growers to provide fresh produce to low income families. Nutrition information and recipes were also provided. St. Francis Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Francis is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 135 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. 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 not 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 item# 2 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. 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 2010, St. Francis provided over $3 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 over $1.1 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance and over $1.5 million (at cost) in excess of medicare payment for health care services. Exemplifying community benefits provided by the hospital are two programs serving the families of our area: 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 free health screenings for body mass index, head and neck cancer, colorectal cancer, cholesterol and blood pressure. Health fairs promoted men's heart health awareness and the importance of regular exercise. Over 1,500 persons took part in 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 250 families from throughout the community. Employees donated over $15,000 towards that cause during the past fiscal year. Over $129,000 was contributed from hospital operations to support the purchase of food and other needed items. St Francis Hospital of the Hospital Sisters of the 3rd Order of St Francis is an affiliate of Hospital Sisters Health System. The foundational mission principles of Hospital Sisters Health System (HSHS) embody the belief that every life is a sacred gift and every human being is a unity of body, mind and spirit. Our health care ministry calls on us to foster healing, serve with compassion, and promote wellness for all persons, with special attention to our neighbors who are sick, poor, underserved, and most vulnerable. These principles have made it possible for HSHS to provide high quality, cost-effective and compassionate health care for millions of people in Illinois and Wisconsin. Our health care ministry consists of 13 hospitals and numerous physician partners committed to continuing the healing ministry of Jesus Christ. Beyond functioning as a primary source for health care in the 12 primary communities we serve, HSHS also provides a wide array of Community Benefits that expand residents' access to health care, enhance their overall health status, and further medical education. In the Fiscal Year that ended June 30, 2010, HSHS hospitals provided $152.2 million in Community Benefits (or 8.5% of total expenses), an increase of $28 million from FY 2009. Of this amount, $32.3 million was provided for charity care and $89.2 million was the amount of unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals provided $159.3 million in health care services primarily to the elderly beneficiaries of the Medicare program in excess of governmental and managed care contract payments. HSHS hospitals also recorded $95 million in uncollectible accounts. HSHS is committed to sustaining and strengthening 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 ongoing enhancements ensure that our hospitals can continue to provide high quality, compassionate care to our patients. During Fiscal Year 2010, HSHS continued to pursue a Care Integration strategy designed to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by the system investments in information technology, this 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. The Care Integration strategy includes, among other efforts, three "Medical Home" pilot projects, the coordination of care for cardiac patients living in rural communities through the use of telemedicine, and development of a "clinical integration network" that will help independent physicians improve quality and the patient experience by benchmarking their care against best practices. HSHS also placed a special emphasis on investing in interoperable health information technologies and robust health information exchanges. We recognize that our investments in information technology will have a positive impact on the quality, safety and efficiency of health care. These investments also ensure that the patient is at the center of a high quality, highly integrated, compassionate health care delivery system. Expanding access to health care At the heart of our health care ministry is the commitment to care for every patient who seeks our help. Because not all patients have health insurance, HSHS hospitals have generous Charity Care program guidelines that cover 100% of hospital charges for individuals and families who earn less than 250% of the federal poverty level. Under these guidelines a family of four without health insurance that has an annual household income of $55,125 or less is eligible for a 100% discount on their hospital bill. HSHS Charity Care programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Hospitals have created a simple two page form 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. The gratitude of the people who have benefitted from our Charity Care program (sometimes referred to as Christian Care) is reflected in some of the thank you letters sent to St. Anthony's Memorial Hospital in Effingham, IL. Comments included: "When I opened your letter today and read that you gave me a 100% Christian Care adjustment, I gasped and started crying. I am so grateful. I count this as an unexpected miracle from God working through people willing to show his love to others." - D.K. The King will reply, "I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me." - Matthew 25:40. "We just want to take a moment to express our deepest gratitude! Your generosity has eased our minds, hearts & pocket book!! Thank you, Thank you, Thank you! God Bless You All! I pray someday I will be able to help someone in such a generous way! You have no idea what a relief this is for us! Thank You seems too simple of words!" - S.L. and C.S. "I want to say at all those who have made it possible to help us pay my hospital bills - Thank You! I don't have words to thank you for all the worry that you have taken away. A thousand "thanks." May God bless you." - L.B. (translated by N.R. and W.R.) "My husband K. and I would like to express our deepest gratitude for your assistance with his medical bill from the hospital. We cannot thank you enough for the help and how this eased a financial burden that we faced. Keeping this gift in mind, we will strive to help others who are in need in whatever way we can to 'Pay it forward.' Thank you and bless you all!" - K.S. and L.S. Our Charity Care programs are only one aspect of our commitment to increasing access to health care services in Illinois and Wisconsin. In many of our communities, HSHS collaborates with Federally Qualified Health Centers (FQHCs) to provide greater access to health care services for low-income residents. For example, St. Elizabeth's Hospital in Belleville, IL hosts a FQHC primary care clinic adjacent to its Emergency Department and St. John's Hospital in Springfield, IL coordinates specialty physician referrals with the local FQHC and provides free health care to its clients. HSHS hospitals work collaboratively in their communities to support the various social services that together make up the fabric of the health care safety net. Sacred Heart Hospital in Eau Claire, WI provides leadership, staff support and laboratory and radiology services for the Chippewa Valley Free Clinic. During FY2010 Sacred Heart's Lab performed 676 tests for patients from the clinic St. Mary's Hospital Medical Center in Green Bay, WI supports a Women's Place, which provides health care services and referrals for men and women in the Latino community. "Because of language barriers, erratic work schedules and the lack of insurance and transportation, many in the Latino community aren't able to access our health system," explains Program Director Carol Ponce. "I feel it is important to overcome those barriers and build bridges for people in the Latino community to access health care and other services that contribute to their well-being. Our programs not only bring health care to the Latino community but joy and connection to other people from Mexico, Honduras, Nicaragua, Peru and Puerto Rico." In rural Illinois, Prairie Heart Institute of Illinois (PHII), a physician group affiliated with HSHS, is bringing a higher level of cardiovascular care to patients in their communities through extensive collaboration with local hospitals and physicians. Through regularly scheduled clinics and sharing of protocols and best practices, rural hospitals across central and southern Illinois can more rapidly and accurately identify heart attack patients and speed treatment to minimize damage to the heart muscle. Meanwhile, access to clinical trials provides opportunities for patients in rural areas to have access to drugs and treatments available only through PHII. "The result of this unique commitment is that regardless of where a patient lives, they will have access to care designed to detect heart disease earlier. We can also offer previously unavailable life-saving techniques and drugs and ensure a return to a quality of life," explains Jim Zito, PHII CEO. The benefits of this type of collaboration are many, including the standardization of quality assurance measures, the sharing of successful patient safety strategies, the addition of clinical research, workforce development and internal benchmarking. Enhancing the health status of the community A spirit IL X X X X X X false false false false false false false false false DANIEL PERRYMAN 0 242613 0 51039 0 6841 0 53076 0 19250 0 372819 0 23140 Robert Ritz 527628 82918 88022 91184 21282 811034 48202 Larry J Ragel 225663 0 0 0 0 0 34156 0 18102 0 277921 0 0 0 Ann Carr 0 131424 0 0 0 22024 0 104209 0 13649 0 271306 0 0 CAROL JACO 131359 0 0 0 0 24199 0 7875 0 163433 0 0 0 DIANE LINDSAY 119398 0 0 0 0 52296 0 14106 0 185800 0 0 0 JILL MOUTRIA 122639 0 0 0 0 0 33370 0 7685 0 163694 0 0 0 AARON HUMPHREYS MD 432115 0 0 0 0 99292 0 0 0 531407 0 0 0 STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PAGE 2, PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS The community benefit contribution of St. Francis Hospital includes programs and activities that improve access to health care and improve health in our communities. In order to portray the full breadth of our contribution, our community benefit information is described below: SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT: During the fiscal year ended June 30, 2010 St. Francis Hospital operated as a Critical Access Hospital. The Hospital provided 5,051 adult, pediatric and skilled nursing days of care and accommodated 52,314 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 local school children on heart health, choices for living, strong bones/body, smoking cessation, poison prevention, asthma program and bicycle safety; * Prenatal and postnatal programs, including Lamaze, breast feeding, baby care and sibling classes; * Assistance with community blood drives; * 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 diabetes, cardiac rehabilitation, congestive heart failure, weight loss, and other current health issues; * Screenings for colorectal cancer, head and neck cancers, hypertension 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 $1.5 million for the year ended June 30, 2010. 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 and 2009. 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 2010 assessment and reimbursement included in the Hospital's 2010 statement of operations is $2 million. Tax Exempt Bonds Form 990, Part IV, Line 4 Hospital Sisters Healthcare-West, Inc. holds a liability on its books for tax-exempt bonds, which is an allocation from its sole corporate member, hospital sisters services, inc. as a result, this question was answered no, and schedule k will be completed on the Hospital Sisters Services, Inc. form 990. RIGHTS OF MEMBERS TO ELECT GOVERNING BODY FORM 990, PART VI, LINE 6 & 7A THE SENIOR GOVERNING BODY OF ST. FRANCIS HOSPITAL (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT. MEMBER RESERVED POWERS FORM 990, PART VI, LINE 7B Responsibility for the policy and operations of St. Francis Hospital (the "Corporation") is vested in its Board of Directors, except with respect to specific powers reserved in the Corporation's Bylaws to the Corporation's Member, Hospital Sisters Health Services, Inc. ("HSSI") , an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The member of HSSI is Hospital Sisters Health System ("HSHS"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The members of HSHS are the individual sisters who from time to time are the duly elected Provincial Superior and Provincial Councilors, respectively of the American Province of the Hospital Sisters of St. Francis ("American Province"). The American Province is the United States organization of the Congregation of the Hospital Sisters of the Third Order Regular of St. Francis, a religious institute of the Roman Catholic Church. The governance and operations of the Corporation are subject to HSSI's right to exercise these reserved powers with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or a controlling shareholder ("Affiliates"). HSSI's right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS and HSHS' members. The reserved powers include all rights granted to HSSI by law and the right to: (a) Adopt, approve amendments to, or amend any statement of philosophy, mission, mission integration or values or any name, logo, or mark of the Corporation or of any Affiliate; (b) Adopt, approve amendments to, or amend the Articles of Incorporation of the Corporation or of any Affiliate; (c) Adopt, approve amendments to, or amend the Bylaws of the Corporation or of any Affiliate; (d) Appoint and remove the Board of Directors, any one or more of the Directors of the Corporation or of any Affiliate, and the Chairperson and President of the Corporation or of any Affiliate; (e) Approve the recommendation of the Board of Directors to appoint or remove the Board of Directors, any one or more Directors of the Corporation or of any Affiliate, or the Chairperson and President of the Corporation or of any Affiliate. (f) With respect to the Corporation or any Affiliate, approve the purchase, sale, alienation, exchange, lease or encumbrance of any real property of the Corporation or of any Affiliate, which property has a value in excess of limits set from time to time by HSSI; (g) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSSI from time to time; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI. FORM 990, REVIEW PROCESS FORM 990, PART VI, LINE 11a The hospital employs KPMG to assist in the overall review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS. CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C The organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP OR ACTIVITY CONTEMPLATED, ENTERED INTO OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, 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 ANSWERS ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. WHISTLEBLOWER POLICY FORM 990, PART VI, LINE 13 PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. COMPENSATION PROCESS FORM 990, PART VI, LINE 15 THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES (IHS), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time. POOLED INVESTMENT ACCOUNT FORM 990, PART X, LINE 11 INVESTMENTS IN SECURITIES AND RELATED INVESTMENT INCOME THE 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 HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, 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 INDIVIDUAL HOSPITAL PARTICIPANTS. TRANSACTIONS WITH RELATED ENTITIES SCHEDULE R, PART V, LINE 2 The transactions reported in question 1 are between related 501(C) (3) public charities and are not reported in this section. Springfield Health Partners LLC 4936 Laverna Road springfield IL 62707 371364419 healthcare IL hshs mg Hospital Sisters Health System 4936 laverna Road SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) 11a N/A Hospital Sisters Services Inc 4936 laverna Road SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) 11a N/A Hospital Sisters of St Francis Fdtn 4936 laverna Road SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 11a N/A HSHS Self Insurance Trust Fund 4936 laverna Road SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(c)(3) 11a N/A HSHS Health Care Plan Trust Fund 4936 laverna Road SPRINGFIELD IL 62707 371137724 HEALTHCARE IL 501(c)(9) N/A Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY I CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) 11a N/A Sacred Heart Hospital 900 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 N/A St Anthony's Hospital 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 N/A St Elizabeth's Hospital 211 SOUTH THIRD STREET BELLEVILLE IL 62220 370663567 HEALTHCARE IL 501(c)(3) 3 N/A St Nicholas Hospital 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(c)(3) 3 N/A St John's Hospital 500 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 N/A St Joseph's Hospital 9515 Holy Cross Lane PO Box 99 BREESE IL 62230 371208459 HEALTHCARE IL 501(c)(3) 3 N/A St Joseph's Hospital 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 N/A St Mary's Hospital 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 N/A St Mary's Hospital 111 SPRING STREET STREATOR IL 61364 362169181 HEALTHCARE IL 501(c)(3) 3 N/A St Mary's Medical Center 1726 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 N/A St Vincent Hospital 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 501(c)(3) 3 N/A St Joseph's Hospital 1515 MAIN STREET HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 N/A HSHS MEDICAL GROUP INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 263956318 HEALTHCARE IL 501(c)(3) 11a NA HSHS WISCONSIN MEDICAL GROUP INC 8040 Excelsior Drive STE 200 MADISON WI 53717 264515959 HEALTHCARE WI 501(c)(3) 11A NA Orange Cross Ambulance Inc 919 Ashland Ave Sheboygan WI 53081 391860942 Healthcare WI 501(c)(3) 9 St Nicholas Wisconsin Upper Pen Ocn Mngmt Services 835 S Van Buren Green Bay WI 54301 391677100 healthcare WI 501(c)(3) 3 St Vincents Unity Limited Partnership 2366 Oak Ridge Circle De Pere WI 54115 391750729 Healthcare WI 501(c)(3) 9 HSSI Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea IL 62226 371312961 HealthCare IL St Elizabeth's Related false false Health Ventures Of So Illinois LLC 2810 Frank Scott Pkwy W STE 700 Belleville IL 62223 371334060 HealthCare IL St Elizabeth's Related false false Prairie Heart Insutute - Carbondale LLC 800 East Carpenter Street Springfield IL 62769 371321197 HealthCare IL St John's Related false false Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay WI 543079047 263749065 HealthCare WI St Vincent's Related false false Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield WI 53221 263155343 HealthCare WI St Vincent's Related false false Surgery Center of Sheboygan LLC 3141 Saemann Ave Sheboygan WI 53081 260822209 HealthCare WI St Nicholas Related false false Prevea Ventures LLC 2710 EXECUTIVE DR Green Bay WI 54304 203775127 HealthCare WI HSSI Related false false Kiara Clinical Integration Network LLC 4936 Laverna Rd Springfield IL 62707 261417684 HealthCare IL Kiara Inc Related false false Carpenter Street Hotel LLC 525 North Sixth Street springfield IL 62702 364128127 hotel IL lasante inc related false false Springfield Urgent Care Real Estate LLC PO Box 19456 springfield IL 627949456 030413258 rent. real estate IL lasante inc related false false Kiara Inc 4936 Laverna Rd Springfield IL 62707 371163401 HealthCare IL HSHS C Corp LaSante Wisconsin Inc 4936 Laverna Rd Springfield IL 62707 391572196 HealthCare IL Kiara Inc C Corp LaSante Inc 4936 Laverna Rd Springfield IL 62707 371163400 HealthCare IL Kiara Inc C Corp Prairie Cardiovascular 619 East Mason STE 4P57 Springfield IL 62701 371071858 HealthCare IL Kiara Inc C Corp Prevea Health Services 2710 EXECUTIVE DR Green Bay WI 54304 391839351 HealthCare WI HSSI C Corp Prevea Clinic Inc 2710 EXECUTIVE DR Green Bay WI 54304 391839349 HealthCare WI HSSI C Corp Prevea Health Network 2710 EXECUTIVE DR Green Bay WI 54304 392000537 HealthCare WI HSSI C Corp Prevea Regional Services 2710 EXECUTIVE DR Green Bay WI 54304 391909993 HealthCare WI HSSI C Corp Renaissance Quality Insurance PO Box 1159 KY-1102 Grand Caymans CJ KY1-1102 980669953 insurance CJ HSSI c corp false false true false false false false false false false false false false true true true false false