2026-05-07T13:38:24+00:00 2025-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2024-07-01 370512290 HSHS Good Shepherd Hospital Inc HSHS 2177743961 200 South Cedar Street Shelbyville IL 62565 Brian Brennan President & CEO Market 2026-05-07 true Mallory Fairless P01321579 3128997000 2026-05-07 2024 2025-03-06 01:10:19Z Brian Brennan 200 South Cedar Street Shelbyville IL 62565 23840741 false 0928 X www.hshs.org/good-shepherd X 1916 IL TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTHCARE MINISTRY. 7 6 114 6 58113 0 16217 42140 18533289 22988621 299194 188823 90281 480355 18938981 23699939 2450 0 6798816 7388760 0 0 11143906 11056363 17942722 18447573 996259 5252366 22956969 25875332 8969223 6987879 13987746 18887453 X TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. false false 5755393 7712541 Emergency Services: The Emergency Department at HSHS Good Shepherd Hospital stands as a comprehensive treatment facility, ensuring continuous care with a dedicated team of specially trained physicians, nurses, and technicians available 24/7. Our commitment to quality patient care spans a broad spectrum of concerns. Leveraging advanced telemedicine, we have access to a diverse array of specialists who contribute to diagnosis and treatment for those in need of elevated care. Equipped with cutting-edge technology, we efficiently process x-rays, CT scans, and various diagnostic tests, facilitating swift and accurate diagnosis and treatment across a spectrum of medical areas, including: Stroke, Heart attack, Shortness of breath, Motor vehicle and other accidents, Broken bones, Abdominal pain, Lacerations, and Mental health issues. During FY25 the emergency department saw 4,782 patients of those 79% were admitted or placed in observation and 12% were transferred to a higher level of care. 4360808 2450 7920470 Other: Good Shepherd Hospital provides a comprehensive range of other specialized healthcare services. The facility excels in advanced imaging, incorporating 3D mammography, and focuses on inpatient care through its swing bed program. Equipped with a modern laboratory and dedicated rehabilitation programs in cardiac, pulmonary, and general therapy services, the hospital prioritizes high-quality patient care. Services also include a specialized sleep center. Furthermore, a specialty clinic convenes expert providers in podiatry, cardiac, general medicine, and orthopedics, fortifying local access to specialized healthcare. 3421201 4578675 Outpatient Lab All Other: Our team brings a high level of expertise, experience, and dedication to every patient interaction. We're committed to delivering a smooth, supportive experience while upholding the highest standards of safety and care. Our Laboratory Services are designed with your needs in mind-from flexible blood draw scheduling to clear, timely communication about your tests. We also prioritize fast and accurate result delivery to your referring provider, ensuring your care team has the essential information they need to guide your treatment plan effectively. 1230385 3244592 Outpatient Imaging: Good Shepherd Hospital Imaging is committed to delivering high-quality imaging services while ensuring patients experience comfort and convenience in a welcoming environment. We offer a range of procedures, including general radiography, 3D mammography, CT, MRI, ultrasound, and nuclear medicine. Our experienced, registered, and licensed technologists use the latest advanced technology to meet the imaging needs of our local community. 1230385 3244592 14767787 true true false false false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false true false false false false true X 1079 0 true 114 true true true false false false false false false false false false false false X 7 6 false false false false true true true true true false false false true true true true true true true true true true X Linda Dace 6182342120 3051 Hollis Drive Springfield IL 62704 Chad Markham President/CEO 2.0 58.0 X X 13946 404419 86867 DENISE BENCE Chair (until 10/31/24) 2.5 0 X X 0 0 0 JOSH SHALLENBERGER Vice Chair (until 10/31/24) 1.5 0 X X 0 0 0 KIM TURNER Board Member, Vice Chair (began 11/1/24) 1.5 0 X X 0 0 0 TRAVIS BANFIELD Board Member, Chair (began 11/1/24) 2.5 0 X X 0 0 0 Elliott Uphoff Board Member 1.0 0 X 0 0 0 ERIC FORLINES Board Member 1.0 0 X 0 0 0 PAUL KAY MD Board Member (until 10/31/24) 1.0 0 X 0 0 0 Shane Schuricht Board Member 1.0 0 X 0 0 0 Susan Koontz Board Member 1.0 0 X 0 0 0 Michael Scialdone Treasurer / HSHS SVP & CFO 0.3 59.8 X 0 780312 132635 Paige Toth Secretary 0.3 59.7 X 0 293537 75167 PATRICIA ALLEN CFO - CARE DELIVERY (until 4/30/25) 3.0 57.0 X 0 559236 89922 ANDREW CORZINE Pharmacist 60.0 0 X 153573 0 39435 Charli Haas Team Lead - Laboratory 60.0 0 X 115983 0 20406 KARLA DIXON Manager - Nursing 60.0 0 X 118744 0 42786 Shelle Sloan APRN 44.0 16.0 X 129597 47613 43100 Tina J Shutts House Supervisor 60.0 0 X 106770 0 26144 Aaron Puchbauer Former PRESIDENT/CEO 0.0 0.0 X 0 310093 30024 TODD Smart Former Treasurer 0.0 0.0 X 0 116976 15590 638613 2512186 602076 11 true true false EMERGENCY STAFFING SOLUTIONS INC 17304 Preston Road Dallas TX 78252 CONTRACT STAFFING 368581 BURDICK PLUMBING AND HEATING COMPANY PO BOX 496 DECATUR IL 62525 EQUIPMENT MAINTENANCE 315923 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DR Dept D8126 CHICAGO IL 60693 HOUSEKEEPING SERVICES 308240 HEALTH CAROUSEL PO BOX 714216 CINCINNATI OH 452714216 CONTRACT STAFFING 265765 COMPASS ONE HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD AND NUTRITION SERVICES 234459 11 25648 16492 42140 Patient Service Revenue 622110 22927995 22927995 Affiliate Rental Revenue 531120 2513 2513 Reference Lab 621500 58113 58113 0 0 0 0 22988621 225282 225282 58928 104343 -45415 0 -45415 -45415 0 36459 -36459 0 -36459 -36459 Other Income 900099 368794 368794 Insurance Funds 900099 156976 156976 0 0 0 0 525770 23699939 23456278 58113 143408 X 2450 2450 16841 15487 1354 5585701 5136634 449067 254505 234044 20461 1126877 1036281 90596 404836 372289 32547 27513 27513 2513028 2264240 248788 0 4885 4885 30155 27042 3113 85292 63525 21767 324689 321940 2749 76268 64109 12159 13911 10966 2945 169655 169655 796714 793714 3000 408902 314497 94405 Shared Services 4582109 2207635 2374474 Medical Supplies 1139105 1138330 775 Medicaid Assessment 668424 668424 Equipment Rental 12284 12284 203429 83896 119533 0 18447573 14767787 3679786 0 132413 1201862 3518220 2737971 0 0 0 0 175055 181992 22330 151737 26873131 19062335 8093010 7810796 10767161 13585614 0 0 248780 205360 22956969 25875332 2846713 1782753 288674 12634 4991762 4692104 0 0 842074 500388 8969223 6987879 X 13987746 18887453 13987746 18887453 22956969 25875332 X 5252366 338708 -691367 X false true true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1299179 1299179 17844543 13612220 4232323 194613 166919 27694 5795385 3834593 1960792 1739411 1448603 290808 7810796 Federal Income Taxes Operating lease liabilities 388 Other Non-Current Liabilities 500000 500388 X 0 0 0 0 0 0 0 0 0 0 0 0 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely Kiara, Inc. will not realize most of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2025 and 2024 in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2025 and 2024, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 62639 62639 0.00340 3900881 3468349 432532 0.02345 0 0.0 0 0 3963520 3468349 495171 0.02684 98266 98266 0.00533 0 0.0 2683861 2223307 460554 0.02497 0 0.0 2450 2450 0.00013 0 0 2784577 2223307 561270 0.03043 0 0 6748097 5691656 1056441 0.05727 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 0 0 9479496 9638657 -159161 X true true 1 1 HSHS Good Shepherd Hospital 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 www.hshs.org/good-shepherd/ 0002154 X X X HSHS Good Shepherd Hospital 1 false false true X X X X X X X X X 24 true false true true X https://www.hshs.org/getmedia/599cc055-9325-495a-932b-d3fd679df862/CHNA_report_GSS_2025.pdf X true 22 true https://www.hshs.org/getmedia/13c9bb90-c55d-4f85-a563-5f4c86513472/CHIP-Implementation-Plan_GSS_2023 false true X 200.0 600.0 X X X X X X true true X X X true X https://www.hshs.org/patients/billing/financial-assistance X https://www.hshs.org/patients/billing/financial-assistance X HTTPS://WWW.HSHS.ORG/ABOUT-US/PATIENT-FINANCIAL-SERVICES/ILLINOIS-FINANCIAL-ASSISTANCE X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - HSHS GOOD SHEPHERD HOSPITAL. HSHS Good Shepherd Hospital conducted its FY2025 Community Health Needs Assessment (CHNA) for Shelby County during FY2025 (July 1, 2024 through June 30, 2025) through an eight-month planning and assessment process. Input from persons representing the broad interests of the community was obtained through multiple methods, including a Community Advisory Council (CAC), a virtual CAC meeting held on April 8, 2025, key stakeholder engagement, and a community survey. In May 2025, 136 individuals completed the survey, and results were analyzed and used to inform prioritization of community health needs. Representation on the CAC included organizations serving low-income, at-risk, and minority populations. The following community stakeholders were invited to participate in and provide input through the CAC: - DOVE, Inc.* - Shelby County Community Services* - Shelby County Health Department* - Shelby County Senior Services* - CEFS Community Action Agency* - Shelbyville C.U.S.D. #4* *Denotes organizations representing medically underserved, low-income, and minority populations. The CAC reviewed community data, identified community assets and gaps, and provided input on priority health needs. Governmental public health expertise was included through participation of Shelby County Health Department. No written comments were received regarding the prior FY2022 CHNA or the related implementation strategy. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS Good Shepherd Hospital. The CHNA was conducted in collaboration with the following organizations: - Shelby County Health Department This organization partnered with the hospital as part of the CHNA core group and collaborated in the planning, data collection, analysis, and prioritization of community health needs. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS GOOD SHEPHERD HOSPITAL. Fiscal year ending June 30, 2025, was the final year for the Implementation Strategy adopted in tax year 2022 for the CHNA that was conducted in 2021-2022. Information provided below relates to the activities that occurred during the three year CHNA cycle addressing the health needs identified in the 2022 CHNA. As part of the identification and prioritization of health needs, the internal Community Benefit Team considered the estimated feasibility and effectiveness of possible interventions by the hospital to impact health priorities. Prioritization was based on scope, severity and burden; health disparities associated with the need; the importance the community places on addressing the health need; the hospital and community assets and resources available to address the health need; and local expertise and input. Based on the CHNA planning and development process described, the following priority community health needs were identified in the 2022 CHNA: 1. Access to mental and behavioral health services 2. Chronic conditions 3. Workforce development Emergency department-based screening and referral to treatment and recovery. In FY2022, the substance, treatment and recovery program was fully deployed in HSHS Good Shepherd Hospital's emergency department. This collaborative program, in partnership with Gateway Foundation, focuses on warm handoff services for treatment and recovery of patients presenting with substance use disorder in the emergency department. This collaborative initiative has provided rehab services for more than 30 persons during the community health improvement plan (CHIP) cycle. The following colleagues work together to identify, screen, assess and transition patients from the emergency department directly to a treatment bed: - Engagement specialist: A certified addictions counselor who promotes substance use disorder treatment services and programs to engage potential clients, completes intake screenings and assessments, evaluates patients' needs, determines appropriate program placement, and completes related forms and records. They maintain collaborative working relationships and regular communication with referral sources to plan and coordinate services and resolve potential barriers to effective treatment. - Recovery coach: A staff person with lived experience who provides support and outreach to individuals in recovery or seeking recovery. They serve as a role model by exhibiting long-term stable personal recovery and use of appropriate coping skills. They maintain relationships with and knowledge of resources for clients, as well as consulting with other treatment team members and providing resources to assist with recovery and transition. - Clinical supervisor: A clinical leader who is responsible for providing direct supervision to team members delivering services. They oversee client services and ensure compliance with established program standards and service delivery objectives. Responsible for orienting and training staff, they serve as a resource to assigned staff in identifying and resolving complex case problems. They also interpret and enforce area policies and procedures, and initiate corrective actions. They assume client caseload in response to workload or staffing shortages, and also interface with key staff at assigned community resources to foster exceptional relationships. School-based behavioral telehealth. As a result of the FY2019 CHNA, the hospital focused its efforts on establishing partnerships between Shelby County and Shelbyville Public Schools. In FY2020, funding and equipment were secured for a behavioral telehealth program at Shelbyville High School. The equipment was set up and the program fully deployed in school year 2022-2023. The gap in time was a result of the COVID pandemic leading to remote learning. Since its launch, nearly 296 student referrals have been made to crisis care, psychiatric care and general counseling. This resource allows teachers to refer students with behavioral health issues directly to care. Chronic conditions: As a result of the last round of System CHNAs, HSHS undertook a three-year process to investigate a closed loop referral software program integrated within our electronic medical chart to assess, refer and track referral conversions for patients screening at risk for one of the social determinants of health. A contract was signed in September 2024, and FindHelp will be fully launched across Hospital Sisters Health System's 13 ministries in July 2025. This tool will allow us to integrate screening and direct referral into the hospital and HSHS affiliate physician practice workflow and connect patients to essential community resources. Good Shepherd Hospital has partnered with Shelbyville School District to participate in their annual back-to-school health fair. Each year, we meet with school families to better understand their primary and specialty care needs and help connect them with available providers in the community. Additionally, local hospital leadership has worked tirelessly with county officials and the HSHS system office to recruit needed care to the area: - Dr. Lisa Kowalski, general surgeon, joined Good Shepherd Hospital's medical staff - Macy Collins, APRN, specializing in behavioral health, joined the Rural Health Clinic (RHC) - The hospital expanded free fecal immunochemical test (FIT) testing program for the month of March for Colon Cancer Awareness Month - Caitlin Bird, APRN, family medicine, joined the RHC - Corrie Smith, APRN, family medicine, joined the RHC Workforce Development: Integrated programs, long-term goals with workers at the center. Develop workforce plan and training programs. Good Shepherd Hospital fulfilled these strategies with the launching of the System Diversity, Equity and Inclusion (DEI) committee in FY2022. By participating in the workforce subcommittee, Good Shepherd Hospital explored gaps in workforce readiness and success. Their commitment to the long-term inclusion of workers was demonstrated through $27,638 worth of mentoring and job-shadowing experiences. Good Shepherd Hospital collaborated with local schools and colleges to train interns, providing hands-on experience in their respective fields. Their partnership with these institutions fostered a training program that prepared individuals for health care careers, contributing to the community's workforce development. This comprehensive training ensured that future health care workers gained practical skills, enhancing their employability. The hospital invested 600 hours in the lives of two radiology interns. The CHNA identified several significant community health needs; however, not all were selected as priorities for the FY2025-FY2027 implementation cycle. The Hospital focused on needs determined to have the greatest impact based on community input, health disparities, feasibility, and available resources. Other identified needs were not addressed directly due to limited resources or alignment considerations but will continue to be monitored for future planning cycles. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - HSHS Good Shepherd Hospital. Presumptive eligibility under the Financial Assistance Program may be granted if evidence of a patient's inability to pay for medically necessary services is provided by the patient or through other sources available to HSHS. Once determined, due to the inherent nature of the presumptive circumstances, the only discount that can be granted is a 100% write-off of the account balance. Presumptive eligibility may be determined based on individual circumstances that may include: ALL HOSPITALS (HSHS) AND MEDICAL GROUP: i. Homelessness ii. Deceased with no estate iii. Mental incapacitation with no one to act on patient's behalf iv. Medicaid eligibility, but not on date of service or for non-covered services v. Incarceration in a penal institution vi. Enrollment in the following assistance programs for low-income individuals: - Temporary Assistance for Needy Families (TANF) - Illinois Housing Development Authority's Rental Housing Support Program - Wisconsin Department of Health Services Housing Assistance Program URBAN HOSPITALS - Additional Mandated Categories: Enrollment in one or more of the following programs with criteria at or below 200% of the current Federal Poverty Guidelines: i. Participation in Women, Infants and Children programs (WIC) ii. Supplemental Nutrition Assistance Program (SNAP) eligibility iii. Low Income Home Energy Assistance Program (LIHEAP) iv. Wisconsin Home Energy Assistance Program (WHEAP) v. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria vi. Receipt of grant assistance for medical services HSHS may use external programs to verification patients' ability to pay (e.g., Search America). If a patient is determined to be unable to pay for their medically necessary services via these external programs, the accounts will be adjusted off to charity. See "Presumptive Eligibility" (above). Patients who were determined to be eligible for the Financial Assistance Program retain eligibility for a period of up to six (6) months from the date of approval. At the end of six (6) months, the patient is responsible for reapplying for eligibility under the Financial Assistance Program. 2 SHELBY HOME EQUIPMENT 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 durable medical equipment shelby memorial home health 200 SOUTH CEDAR STREET shelbyville IL 62565 home health agency Schedule H, Part I, Line 7g Subsidized Health Services NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC ARE INCLUDED ON LINE 7G. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET 3 TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH PROGRAM, AND DONATIONS ARE STATED AT ACTUAL COST (WHEN APPLICABLE). THE COST OF THESE ITEMS ARE TRACKED THROUGH THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount FOR FINANCIAL STATEMENT PURPOSES, HOSPITAL SISTERS HEALTH SYSTEM HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The text of the footnote to the organization's financial statements that describes bad debt expense can be found on pages 16-19 in the HSHS Consolidated Audit Report. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs 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 leadership 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. The IRS does not classify this shortfall in Medicare payments as Community Benefit. However, we believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for financial assistance or other means-tested government programs. Further, by absorbing this shortfall and providing care below cost to these individuals, the Hospital is relieving the burden of the government. Accordingly, this shortfall restricts the Hospital's ability to make funds available to provide for financial assistance and other Community Benefit. The hospital's Medicare shortfall at cost for fiscal year 2025 was $159,161. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Every effort is made prior to, during and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and provide adequate documentation. If the patient qualified for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualified for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The Hospital will make reasonable efforts to determine whether a patient is eligible under the Financial Assistance Policy before engaging in any extraordinary collection action. Once a patient is determined to be eligible for financial assistance, HSHS will not pursue extraordinary collection actions and will take all reasonably available measures to reverse any extraordinary collection action taken to obtain payment for care covered under the Financial Assistance Policy. Any remaining balance will be handled in accordance with the Financial Assistance Policy and standard billing procedures. Certain collection safeguards apply to all patients, while additional protections apply specifically to patients known to qualify for financial assistance. Schedule H, Part V, Section B, Line 16a FAP website - HSHS Good Shepherd Hospital: Line 16a URL: https://www.hshs.org/patients/billing/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - HSHS Good Shepherd Hospital: Line 16b URL: https://www.hshs.org/patients/billing/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - HSHS Good Shepherd Hospital: Line 16c URL: HTTPS://WWW.HSHS.ORG/ABOUT-US/PATIENT-FINANCIAL-SERVICES/ILLINOIS-FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment As indicated in Part V, Section C, HSHS GOOD SHEPHERD HOSPITAL conducted a Community Health Needs Assessment in FY2025 (July 1, 2024 through June 30, 2025). In addition to the triennial CHNA process, the hospital continuously reviews updated local and state data, Illinois and Wisconsin Comp Data, patient surveys and feedback, and local needs assessments conducted by community groups. Additionally, the hospital receives input from public health officials, community groups and community boards on an ongoing basis. The information received and reviewed is used to inform ongoing strategic initiatives developed to meet CHNA health priorities; as well as new areas of need that are going unmet. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Patients may learn of Financial Assistance Policy (FAP) resources on-line. Materials are presented in English and Spanish, with translation services available in more than 25 languages. Information regarding the Financial Assistance Policy, including a plain language summary, application for financial assistance, and contact information, is available on the hospital's website and may also be requested by patients. Information regarding the availability of financial assistance is also made available to patients during the registration and discharge processes. Financial counselors discuss patients' financial circumstances to help determine eligibility for financial assistance under the hospital's Financial Assistance Policy and for applicable federal, state, or local government programs. The care management team also works with patients to confirm eligibility for financial assistance and applicable government programs and provides resources accordingly. Patients may also receive information regarding financial assistance through billing communications and through discussions with hospital staff, who are available to assist patients with the financial assistance application process and accessing available assistance programs. Schedule H, Part VI, Line 4 Community information HSHS Good Shepherd Hospital is a not-for-profit hospital located in the rural Shelby County, Illinois. The Hospital is located in the city of Shelbyville, Illinois, in Shelby County. Shelbyville is located along the Kaskaskia River and has a population of 4,540 people (2024). It is approximately 59 miles southeast of Springfield, Illinois. Shelbyville and the surrounding geographic area are not close to any major metropolitan area. It is accessible by a state highway and other secondary roads. Shelby County is considered 22.27 percent urban and 77.73 percent rural. Based on 2024 US Census Data Shelby County's population of 20,542 people is comprised of 97.5% Caucasians, 0.7% African-Americans, 0.3% American Indians/Alaska Natives, 0.4% Asians, and 1.3% Hispanic or Latino. 94.5 percent of Shelby County's residents have a high school diploma, 17.6% have a Bachelor's Degree. The current unemployment rate of Shelby County is 4.1% (November 2025), according to the US Bureau of Labor Statistics, and the median household income is $68,457 (2023). Within the report area 10.6 (2023)% of individuals are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, nutritional food and other necessities that contribute to poor health status. No other hospitals are located within Shelby County; however, Pana Community Hospital is located in the neighboring county. Schedule H, Part VI, Line 5 Promotion of community health As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), HSHS Good Shepherd Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Shelby Memorial Hospital was founded in 1916 and affiliated with HSHS in 2017. The hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Shelbyville and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS Good Shepherd Hospital is responding to community need. In FY2021, for example, the board reviewed and approved the Community Health Improvement Plan which is an accompaniment to the FY2022 Community Health Needs Assessment. Also consistent with its exempt purpose, HSHS Good Shepherd Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, Good Shepherd Hospital (GSS) reinvests surplus funds to support the mission of the organization and promote the health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS Good Shepherd Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2025, Good Shepherd provided $1,056,441 in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. HSHS Good Shepherd Hospital provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by Good Shepherd Hospital, and they often relieve a burden that would otherwise be carried by government. Schedule H, Part VI, Line 6 Affiliated health care system HEADQUARTERED IN SPRINGFIELD, ILLINOIS, HOSPITAL SISTERS HEALTH SYSTEM (HSHS) IS A HIGHLY INTEGRATED, MULTI-INSTITUTIONAL HEALTH CARE SYSTEM COMPRISED OF 13 HOSPITALS AND MORE THAN 200 PHYSICIAN PRACTICE SITES IN ILLINOIS AND WISCONSIN. HSHS IS SPONSORED BY HOSPITAL SISTERS MINISTRIES (HSM), WHICH IS A PUBLIC JURIDIC PERSON OF THE ROMAN CATHOLIC CHURCH. HSHS CONTINUES THE HEALTH CARE MINISTRIES BEGUN BY ITS FOUNDERS, THE HOSPITAL SISTERS OF ST. FRANCIS, MORE THAN 150 YEARS AGO, IN RURAL AND MIDSIZED COMMUNITIES THROUGHOUT ILLINOIS AND WISCONSIN. HSHS PROVIDES COMPASSIONATE, HOLISTIC, HIGH QUALITY, AND COST-EFFECTIVE HEALTH CARE THROUGH ITS ACUTE CARE HOSPITALS, PHYSICIAN PRACTICES, HOME HEALTH PROGRAMS, PALLIATIVE AND HOSPICE PROGRAMS, AND COMMUNITY OUTREACH SERVICES. IN ADDITION, HSHS AFFILIATED HOSPITALS INCLUDE CRITICAL ACCESS FACILITIES THAT OFFER ESSENTIAL HEALTH SERVICES THAT OTHERWISE WOULD NOT BE AVAILABLE IN MANY COMMUNITIES. OUR MISSION CALLS US TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE, AND WE EXTEND OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY BEYOND THE WALLS OF OUR HOSPITALS BY PROVIDING COMMUNITY HEALTH IMPROVEMENT SERVICES WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN ADDITION TO PROVIDING COMMUNITY HEALTH IMPROVEMENT SERVICES TO THE BROADER COMMUNITY, HSHS CARES FOR EVERYONE WHO COMES TO ITS FACILITIES, REGARDLESS OF THEIR ABILITY TO PAY. IN TANDEM WITH A VARIETY OF CROSS SECTOR COMMUNITY PARTNERS, HSHS'S COMMUNITY BENEFIT INITIATIVES ARE STRATEGICALLY PLANNED AND PROFESSIONALLY IMPLEMENTED TO IMPROVE ACCESS TO HEALTH CARE SERVICES; ENHANCE THE HEALTH OF THE COMMUNITY; ADVANCE MEDICAL OR GENERAL HEALTH CARE KNOWLEDGE; AND RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT TO IMPROVE HEALTH. IN FY2025, HSHS COLLECTIVELY PROVIDED $211.9 MILLION IN COMMUNITY BENEFIT (8.39% OF TOTAL HOSPITAL EXPENSES). OF THE TOTAL COMMUNITY BENEFIT PROVIDED, HSHS PROVIDED $4.4 MILLION FOR FINANCIAL ASSISTANCE (AKA CHARITY CARE) AND $119.2 MILLION FOR UNREIMBURSED CARE PROVIDED AS PART OF THE MEDICAID PROGRAM. IN ADDITION, HSHS HOSPITALS COMMITTED SIGNIFICANT RESOURCES TO TREAT MEDICARE PATIENTS. THE COST OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM - IN EXCESS OF GOVERNMENTAL AND MANAGED CARE CONTRACT PAYMENTS - WAS $294.9 MILLION. HSHS HOSPITALS ALSO RECORDED $90.8 MILLION IN UNCOLLECTIBLE ACCOUNTS. WHILE HSHS DOES NOT COUNT THE LATTER TWO AMOUNTS AS COMMUNITY BENEFIT, THEY NONETHELESS REFLECT OUR COMMITMENT TO SERVING ALL PERSONS IN NEED OF CARE. IN ADDITION TO THE DOLLARS INVESTED IN OUR COMMUNITY BENEFIT PROGRAMS, HSHS CONTINUES TO REINVEST ANY SURPLUS REVENUE FROM OPERATIONS AND INVESTMENTS INTO NEW MEDICAL TECHNOLOGY, FACILITY INFRASTRUCTURE AND HEALTH CARE SERVICES IN OUR COMMUNITIES. BY DOING SO, WE ENSURE OUR ABILITY TO MEET THE ONGOING DEMAND FOR HIGH QUALITY, EFFICIENT AND EASILY ACCESSIBLE HEALTH CARE. Schedule H, Part VI, Line 7 State filing of community benefit report IL X X X X X true true false false false false false false false Chad Markham President/CEO 13091 383887 309 7424 546 13108 1913 55480 982 28492 16841 488391 0 0 Aaron Puchbauer Former PRESIDENT/CEO 0 110293 0 3685 0 196115 0 0 0 30024 0 340117 0 42518 TODD Smart Former Treasurer 0 106706 0 9754 0 516 0 0 0 15590 0 132566 0 0 PATRICIA ALLEN CFO - CARE DELIVERY (until 4/30/25) 0 531646 0 4240 0 23350 0 63815 0 26107 0 649158 0 21130 Michael Scialdone Treasurer / HSHS SVP & CFO 0 727132 0 5000 0 48180 0 112411 0 20224 0 912947 0 0 Paige Toth Secretary 0 290612 0 2380 0 545 0 42494 0 32673 0 368704 0 0 ANDREW CORZINE Pharmacist 149147 0 1422 0 3004 0 9150 0 30285 0 193008 0 0 0 KARLA DIXON Manager - Nursing 118210 0 509 0 25 0 10453 0 32333 0 161530 0 0 0 Shelle Sloan APRN 121514 39613 8083 8000 0 0 12739 0 22187 8174 164523 55787 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. Schedule J, Part I, Line 4a Severance or change-of-control payment ORGANIZATION: ST. JOSEPH'S HOSPITAL EIN: 37-1208459 INTERESTED PERSON: AARON PUCHBAUER AMOUNT: 139,181 TERMS: COMPENSATION PAID AS A RESULT OF A SEVERANCE Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2024. THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). PATRICIA ALLEN - $43,115 CHAD MARKHAM - $40,142 MICHAEL SCIALDONE - $87,924 PAIGE TOTH - $24,201 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2024. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. PATRICIA ALLEN - $21,130 AARON PUCHBAUER - $42,518 Form 990, Part III, Line 4a-4c Description of program services (Expenses $ 1,230,385 including grants of $)(Revenue $ 3,244,592) Outpatient Imaging: Good Shepherd Hospital Imaging is committed to delivering high-quality imaging services while ensuring patients experience comfort and convenience in a welcoming environment. We offer a range of procedures, including general radiography, 3D mammography, CT, MRI, ultrasound, and nuclear medicine. Our experienced, registered, and licensed technologists use the latest advanced technology to meet the imaging needs of our local community. Form 990, Part IV, Line 24a Tax Exempt Bonds HSHS GOOD SHEPHERD 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 AND NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. Form 990, Part IV, Line 10 Endowment Funds The organization maintains net assets with donor restrictions and without donor restrictions on its balance sheet. Such funds are held by Hospital Sisters of St. Francis Foundation, Inc., a related tax-exempt organization. While these funds are held to further one or more exempt purposes of the filing organization, they are not maintained exclusively for the filing organization. The board of directors of Hospital Sisters of St. Francis Foundation, Inc. maintains ownership and ultimately authority and discretion over the use of these funds. Based on the above, the related amounts have not been reported as endowment funds on Part V of Schedule D. Form 990, Part V, Line 1a NUMBER REPORTED IN BOX 3 OF FORM 1096 THE FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURN IS FILED BY THE ORGANIZATION'S PARENT, HOSPITAL SISTERS HEALTH SYSTEM (HSHS) ON THE ORGANIZATION'S BEHALF TO TRANSMIT TO THE IRS FORMS 1099, 1098, 5498, AND W-2G. THE ORGANIZATION IS UNABLE TO DETERMINE THE NUMBER OF FORMS 1099, 1098, 5498 AND W-2G FILED BY HSHS, ON THEIR BEHALF. HOWEVER, AS THE PARENT ORGANIZATION, HSHS ENSURES THAT THE FILING ORGANIZATION COMPLIES WITH ALL INFORMATION RETURN REPORTING REQUIREMENTS AND BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND REPORTABLE GAMING WINNINGS TO PRIZE WINNERS, AS APPLICABLE. ACCORDINGLY, THE NUMBER REPORTED ON FORM 990, PART V, LINE 1A REFLECTS THE NUMBER REPORTED IN BOX 3, OF FORM 1096 FOR HSHS, THE PARENT ORGANIZATION. Form 990, Part VI, Line 13 Whistleblower Policy PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. Form 990, Part VI, Line 16b Joint Venture Policy HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ALL HSHS HOSPITALS TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD THE ORGANIZATION'S TAX-EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. Form 990, Part VI, Line 1a Delegate broad authority to a committee PER ARTICLE 5.5 OF THE ORGANIZATION'S BY-LAWS, THE GOVERNING BODY DELEGATES BROAD AUTHORITY TO AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH AND MAY IN ITS DISCRETION EXERCISE THE FULL POWERS, DUTIES, RESPONSIBILITIES, AND AUTHORITY OF THE BOARD EXCEPT WHERE PROHIBITED BY LAW AND SUBJECT TO ANY LIMITATIONS IMPOSED BY THE BYLAWS OR THE BOARD OF DIRECTORS. AS PROVIDED IN THE BY-LAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF FOUR TO SIX MEMBERS, INCLUDING THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON, THE PRESIDENT AND OTHER MEMBERS SELECTED FROM AMONG THE DIRECTORS BY THE BOARD. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE CORPORATE MEMBER OF HSHS Good SHEPHERD Hospital (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF HSHS Good SHEPHERD Hospital (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE 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 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, AND THE 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 DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (H) 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; (I) APPROVE THE STRATEGIC PLAN AND ANNUAL GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) 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; (O) APPROVE MATERIAL ACTIONS WITH RESPECT TO EMPLOYEE RETIREMENT PLANS SPONSORED BY THE CORPORATION OR ANY AFFILIATE; AND (P) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. Form 990, Part VI, Line 11b Review of form 990 by governing body THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP 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. Form 990, Part VI, Line 12c Conflict of interest policy 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 ORGANIZATION'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. Form 990, Part VI, Line 15a Process to establish compensation of top management official 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 HSHS EXECUTIVES. SULLIVAN COTTER, 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 HSHS EXECUTIVES. SULLIVAN COTTER 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. 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. Form 990, Part VI, Line 15b Process to establish compensation of other employees PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public 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. Form 990, Part IX, Line 11g Other Fees Professional Services - Total Expense: 262336, Program Service Expense: 86549, Management and General Expenses: 175787, Fundraising Expenses: ; Contract Labor - Total Expense: 325394, Program Service Expense: 325394, Management and General Expenses: , Fundraising Expenses: ; Purchased Services - Total Expense: 1925298, Program Service Expense: 1852297, Management and General Expenses: 73001, Fundraising Expenses: ; Form 990, Part X, Line 11 Pooled Investments HSHS Good SHEPHERD HOSPITAL CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM (HSHS). PARTICIPATION IN THE POOLED INVESTMENT FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS (SFAS) NO. 124, "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers to Affiliates - -619215; Pension expense - Mark to Market Adjustment - 11608; Change in Fair Value of Interest Rate Swap - -83760; Total - -691367; HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) Type III-FI NA false HOSPITAL SISTERS HEALTHCARE-WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) Type I HSSI true HOSPITAL SISTERS MISSION OUTREACH CORPORATION 4849 LAVERNA ROAD SPRINGFIELD IL 62707 352271729 RECYCLING MEDICAL SUPPLIES IL 501(c)(3) HSHS true HOSPITAL SISTERS OF ST FRANCIS FOUNDATION INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 7 HSHS true HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) Type III-FI HSHS true HSHS HOLY FAMILY HOSPITAL INC 200 HEALTHCARE DRIVE GREENVILLE IL 62246 370792770 HEALTHCARE IL 501(c)(3) 3 HSSI true HSHS MEDICAL GROUP INC 3051 HOLLIS DRIVE SPRINGFIELD IL 62704 263956318 HEALTHCARE IL 501(c)(3) Type III-FI HSSI true HSHS WISCONSIN MEDICAL GROUP INC 3051 HOLLIS DRIVE SPRINGFIELD IL 62704 264515959 HEALTHCARE WI 501(c)(3) Type III-FI HSSI true ORANGE CROSS AMBULANCE INC 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 10 ST NICHOLAS true PRAIRIE CARDIOVASCULAR CONSULTANTS LTD 3051 HOLLIS DRIVE SPRINGFIELD IL 62704 371071858 HEALTHCARE IL 501(c)(3) 10 HSSI true PRAIRIE EDUCATION & RESEARCH COOPERATIVE 800 EAST CARPENTER STREET 62 SPRINGFIELD IL 62769 371157915 HEALTHCARE IL 501(c)(3) 4 HSSI true SACRED HEART HOSPITAL OF HOSPITAL SISTERS OF THIRD ORDER OF ST FRANCIS 4936 LAVERNA ROAD SPRINGFIELD IL 62707 390807060 HEALTHCARE WI 501(c)(3) 3 HSSI true ST ANTHONY'S MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER O F ST FRANCIS 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 HSSI true ST CLARE MEMORIAL HOSPITAL INC 855 S MAIN STREET OCONTO FALLS WI 54154 390848401 HEALTHCARE WI 501(c)(3) 3 HSSI true ST ELIZABETH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FR ANCIS ONE ST ELIZABETHS BLVD OFALLON IL 62269 370663567 HEALTHCARE IL 501(c)(3) 3 HSSI true ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOHN'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC IS 12866 TROXLER AVENUE HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC IS 4936 LAVERNA ROAD SPRINGFIELD IL 62707 390810545 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC IS 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC - HOSPITAL SISTERS 1762 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 HSSI true ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC IS 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(c)(3) 3 HSSI true ST VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCI S 835 S VAN BUREN GREEN BAY WI 51301 390817529 HEALTHCARE WI 501(c)(3) 3 HSSI true UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 10 HSSI true SPRINGFIELD URGENT CARE REAL ESTATE LLC PO BOX 19456 SPRINGFIELD IL 62794 030413258 RENTAL REAL ESTATE IL LASANTE INC N/A 0 0.83 REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC 9001 LIBERTY PARKWAY BIRMINGHAM AL 35242 871489748 MEDICAL DE SACRED HEART HOSPITAL Related 0 0 0 false 0.5 HOSPITAL SISTERS SURGERY CENTER O'FALLON llc ONE ST ELIZABETHS BLVD OFALLON IL 62269 341446171 MEDICAL IL ST ELIZABETH'S HOSPITAL N/A 0 0.51 KIARA LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation 12978117 19279759 1 true LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 391572196 HEALTHCARE IL KIARA LLC C Corporation true LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163400 HEALTHCARE IL KIARA LLC C Corporation true RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY11102 980669953 INSURANCE CJ HSSI C Corporation 0 227389871 1 true false false true false false false false false false false false false false true true true true false true Schedule R, Part VII Related Organizations Due to the increasingly complex organization structure of Hospital Sisters Health System and Affiliates, the filing organization has elected to report all tax-exempt organizations, partnerships, and corporations within Hospital Sisters Health System as related, regardless of ownership interest or "control" as defined by the instructions to Schedule R. The intent of this reporting is to promote transparency and increase consistency across the numerous Form 990 submissions by Hospital Sisters Health System and Affiliates. Schedule R, Part V, Line 2 Transactions with related entities ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION.