2024-05-10T17:06:28+00:00 2023-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2022-07-01 370661236 St Francis Hospital Sisters of the Third Order of St Francis STFR 2173242191 1215 Franciscan Drive Litchfield IL 62056 Patricia Allen System CFO for Care Delivery 2024-05-10 true Patricia Allen 999009999 true Mallory Fairless P01321579 3128997000 2022 2023-04-26 12:10:37Z Matthew Fry 1215 Franciscan Drive Litchfield IL 62056 63636069 false 0928 X www.hshs.org/stfrancis X 1955 IL TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. 11 10 280 182 36896 20362 2688068 276531 58102384 62227122 2852368 708019 409925 411466 64052745 63623138 0 0 17544333 18877183 0 0 30203520 31448912 47747853 50326095 16304892 13297043 130230817 143816141 19644929 16163927 110585888 127652214 X TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. false false 13021239 32572307 OTHER - St. Francis Hospital provides comprehensive health care services with the latest technology to the Litchfield area 24 hours a day, 7 days a week. St. Francis Hospital offers a full range of services including heart care, orthopedics, radiology, rehabilitation, women and infant services all in one convenient location. Specialists work with health care professionals across our health system to ensure each patient has seamless access to care. 11949502 12951905 EMERGENCY SERVICES - St. Francis Hospital's ER has the latest technology which allows our nurses and doctors to provide excellent care. There are nine rooms including two trauma rooms and one safe room for behavioral health patients. Emergency services provide care to people suffering injuries ranging from a fractured bone to a heart attack or stroke. Our emergency department is staffed with board certified emergency medicine physicians, nurses, and other medical experts who handle a variety of conditions. Total patients served - 10.719 10306879 10778735 SURGERY - St. Francis hospital's surgery center has more than 16,000 square feet of space with a waiting/registration area; a private family consult room; four surgery suites and private pre- and post-operative patient rooms. Two operating rooms are used for ear/nose and throat procedures and general and orthopedic surgeries. The other operating rooms are used for endoscopy and urology procedures. The Ambulatory Surgery Unit within the Surgery Center has twelve private rooms for patients undergoing outpatient procedures. Total patients served - 1,914 8208275 5906328 INFUSION / ONCOLOGY - St. Francis Hospital's cancer care center offers a comfortable and healing environment for our patients and their families. Features include: two private patient exam rooms, two private infusion rooms and four semi-private infusion bays and comfortable reclining chairs and individual television monitors for use during treatment. Infusion Services - An intravenous (IV) infusion is the medical term for the administration of liquid substances/ medications into the bloodstream. In addition to chemotherapy, the Cancer Care Center offers a full continuum of outpatient infusion services including: blood transfusions, infusions and injections of supportive medications, immunotherapy treatments and port maintenance and flushing. Chemotherapy - A cancer treatment using drugs that are given intravenously through an injection or by mouth. These drugs destroy cancer cells by impeding their growth and reproduction. Total patients served - 2,758. 8208275 5906328 43485895 true true false true 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 true true false false false true X 1200 0 true 280 true true true false false false false false false false false false false false X 11 10 false false true false true true true true true false false true true true true true true true true true true IL X Linda Dace 6182342120 3051 Hollis Drive Springfield IL 62704 James Timpe President & CEO 60.0 0 X X 353251 0 68168 Jane Martin Vice Chair 1.0 0 X X 0 0 0 Marchelle Kassebaum Secretary 1.0 0 X X 0 0 0 Steve Bryant Chair 1.0 0 X X 0 0 0 Gerald Williams Board Member 1.0 0 X 0 0 0 JENNIFER REID BAUGHER Board Member 1.0 0 X 0 0 0 Jerome Epplin MD BOARD MEMBER 1.0 1.0 X 0 0 0 Kevin Niemann Board Member 1.0 0 X 0 0 0 SR RITAMARY BROWN BOARD MEMBER/HSHS SISTER 1.0 0 X 0 0 0 Thomas Baker Board Member 1.0 0 X 0 0 0 WILLIAM MONTGOMERY Board Member 1.0 0 X 0 0 0 PATRICIA ALLEN Interim CFO - Illinois 3.0 57.0 X 0 541100 154396 TODD Smart Treasurer 0.3 59.8 X 0 329569 81262 Brian Strader Director-Pharmacy 40.0 0 X 212585 0 15726 HEATHER SENALDI Director - Nursing 40.0 0 X 138141 0 13075 JILL MOUTRIA PHARMACIST 40.0 0 X 164705 0 17495 Susan Stromsland Laboratory Manager 40.0 0 X 147992 0 18795 Tammy Keiser-Donoho Registered Nurse - Critical Care 40.0 0 X 138847 0 52944 Aaron Puchbauer FORMER INTERIM CEO 0.0 60.0 X 0 332481 70274 EVERT J KUIPER Former Division CEO - Illinois (until Jan 2022) 0.0 0.0 X 0 526246 6227 PATRICIA FISCHER Former Chief Executive Officer 0.0 0.0 X 0 32914 70774 1155521 1762310 569135 22 true true false Infinity Healthcare Physicians 111 E Wisconsin Ave Ste 2100 Milwaukee WI 53202 Physicians Fees 1687561 Orthopedic Center IL 1301 S Koke Mill Rd Springfield IL 627119252 Physician Fees 1013599 Medical Solutions 1010 N 102nd Street Suite 300 Omaha NE 68114 Staffing Service 875470 Alton Physical Therapy PC 1719 Clawson St Alton IL 62002 PT/OT Therapy Services 872526 Springfield Clinic LLP 1025 South 6th St PO Box 19248 Springfield IL 62794 Physician & Nurse Fees 282126 10 159223 117308 276531 NET PATIENT SERVICE REVENUE 621990 61575106 61575106 OTHER DEPARTMENTAL REVENUE 621990 615120 615120 REFERENCE LAB 621500 36896 36896 0 0 0 0 62227122 391407 391407 328579 328579 0 328579 328579 329543 12931 329543 -12931 316612 316612 AUXILIARY & GIFT SHOP 453220 63838 63838 PATIENT PROMPT PAYMENT FEES 900099 19049 19049 0 0 0 0 82887 63623138 62209275 36896 1100436 X 421419 395460 25959 13894957 13039032 855925 686873 644562 42311 2800735 2628210 172525 1073199 1007090 66109 1399 1399 18518 18518 5757019 5460421 296598 0 153137 415 152722 8994074 9040626 -46552 1692913 1649246 43667 1742412 1707043 35369 2094 2094 13390 8935 4455 442404 6 442398 2209029 2157179 51850 711867 577775 134092 Medicaid Tax Assessment 1743389 1743389 Equipment Rental 235459 209358 26101 Dues 84482 445 84037 Purchased Services 4555951 3671002 884949 3091375 -456393 3547768 0 50326095 43485895 6840200 0 -13104 82084 7532095 8327724 0 0 0 0 1038366 977810 361800 428287 55616333 29990606 26141710 25625727 94692775 106630208 0 0 477175 1744301 130230817 143816141 8287846 5491605 32589 8396609 8178091 0 0 2960474 2461642 19644929 16163927 110585888 127652214 110585888 127652214 130230817 143816141 X 13297043 2577394 1191889 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 26314 26314 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE HOSPITAL IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HOSPITAL ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 27.29% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.00% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 43.5% LOBBYING EXPENSE LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURE0S PAID. 462220 462220 39323525 19008516 20315009 1244575 760056 484519 14586013 10222034 4363979 0 0 25625727 SETTLEMENT VALUE OF INTEREST RATE SWAP PROGRAM 1164792 RETIRE OBLIGATION - ASBESTOS 1103348 ACCRUED BENEFIT LIABILITY Right of Use - Operating Lease Liability 193502 2461642 X 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. The net operating loss carryforwards result in a deferred tax asset of $3,382 and $3,548 at June 30, 2023 and 2022, respectively. 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, 2023 and 2022 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, 2023 and 2022, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 123276 123276 0.0024 11476466 12267587 0 0.0 0 0.0 0 0 11599742 12267587 123276 0.0024 200222 200222 0.0040 210816 210816 0.0042 0 0.0 0 0.0 23524 23524 0.0005 0 0 434562 0 434562 0.0086 0 0 12034304 12267587 557838 0.0111 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 24317709 24563343 -245634 X true true 1 1 St Francis Hospital 1215 Franciscan Drive Litchfield IL 62056 http://www.stfrancis-litchfield.org/ 2336 X X X X St Francis Hospital 1 false false true X X X X X X X X X 20 true true true true X https://www.hshs.org/st-francis/about-us/community-health-needs-assessment X true 21 true https://www.hshs.org/st-francis/about-us/community-health-needs-assessment false true X 200.0 600.0 X X X X X X true true X X X true X https://www.hshs.org/about-us/patient-financial-services X https://www.hshs.org/about-us/patient-financial-services/illinois-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 St. Francis Hospital. SFL, HAH and CAH&C are committed to address community health needs in collaboration with local organizations and other area health care institutions. The FY2021 assessment sought input from a broad section of community stakeholders. Input from Community Stakeholders The FY2021 assessment was designed to better document community inclusion. PSP created an electronic demographic survey for the community advisory council (CAC) and focus group participants to document these inclusion efforts. This survey documented basic information such as gender, age, and profession. In total, 33 individuals completed the survey. While the CAC was mostly male and the focus groups were majority female, the gender dispersion was nearly even (45.5% male; 54.5% female). No participants identified as transgender or nonconforming. The age range across all participants was from 15 years old to 71 years old, with an average age of 50.4 years old and a median age of 51 years old. Almost 67% of CAC members worked outside of health care (e.g., hospitals, clinics, public health departments) and 100% of the focus group participants worked outside of health care. In addition to the nine retirees, participants worked in ministry, law enforcement, public education, farm bureau, social work, public housing and economic development. This information demonstrates the majority of the stakeholders were not employed by the hospitals. Input from Members of Medically Underserved, Low Income and Minority Populations To best understand the reasons for and solutions to the greatest health priorities concerning the community, the hospitals invited a diverse group of individuals who would be directly impacted to be part of the CAC and focus groups. Youth were included for the first time in FY2021 to better learn about their health concerns first hand. Out of the 33 participants, 15.5% were youth. FY2021 was also the first year demographic data was collected from CAC and focus group participants to capture how it provides a good representation of the population. All participants had voting power and time to discuss their thoughts and opinions on the priority areas and the data associated with it. Across adult and youth participants, both racial/ethnic minorities and sexual minorities were represented: 3.03% identified as Native American and 3.03% identified as African American/Black. Additionally, 9.10% reported being a member of the LGBTQ2+ community. A combined assessment of HSHS St. Francis, Hillsboro Area, and Carlinville Area Hospital Community Health Needs Assessment 12 All participants reported having medical insurance; however, there was also some differences in socioeconomic status as indicated by income, employment, and education. Among all participants, 18.20% reported a household income level less than $49,999, but only 3.03% reported their household income fell below the federal poverty line. Out of the adult participants, 10.71% reported their employment status as disabled. In addition, 7.14% indicated they were not homeowners. Finally, while adult education was higher on average than the general population, 7.14% of adult participants had completed some high school and 17.9% had completed some college, thus indicating that not all participants were from positions of power or privilege. Input from Communities on Past CHNAs No written comments were received regarding the SFL FY2021 CHNA, the HAH FY2021 or the CAH&C FY2021. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - HSHS St. Francis Hospital. Yes. Hillsboro Area Hospital and Carlinville Area Hospital and Clinics. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Francis Hospital. - Montgomery County Economic Development, - Locust Street Clinic, - Litchfield Chamber of Commerce, - Carlinville Catholic Charities, - Macoupin County Health Department, - Vine Street Clinic - Federally Qualified Health Clinic, - Litchfield Police Department, - CEFS Economic Opportunity Corporation, - Community Action Agency, - Farm Bureau, - City of Nokomis, - Hillsboro Sources of Strength - CUSD, - Village of Fillmore, - Hillsboro School District, - Montgomery County Health Department, - David A. Emler Youth Assessment Project, - Staunton Hospital, - Carlinville Area Hospital and Clinics, - Hillsboro Area Hospital, - Hillsboro Chamber of Commerce, - St. Francis Hospital. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS St. Francis Hospital. Based on the CHNA planning and development process described the following community health needs were identified: 1. Access to Mental and Behavioral Health Treatment 2. Workforce Development 3. Food Insecurity SFL continues to own and operate the St. Clare's Food Pantry. Montgomery County contains areas known as "food deserts," where residents do not have easy access to healthy food. In FY2023, SFL increased contribution by $60,000 for a total of $162,272 to the food pantry and served 5,737 Litchfield residents. This is nearly a 20% increase in participants over FY22. SFL has partnered with Carlinville Catholic Charities for 7-years to offer the Dental Voucher Program. We continue to provide vouchers for pain related dental disorders to connect uninsured residents with needed dental care. SFL gave $5,000 in free dental services in FY2023. For the third year, SFL has partnered with Gateway Foundation to provide emergency department-based screenings for persons presenting with substance use disorder. Through the use of Engagement Specialists and Peer Recovery Coaches, patients are screened and connected with residential, or outpatient rehab services based on need. This collaborative initiative provided rehab services for more than 60 persons in FY2023. As an outcome of the prioritization process, the following community health needs were also identified but will not be addressed directly by the hospital for the reasons indicated: * Access to Dental Care: There is an ongoing strategy in place in partnership with Catholic Charities which provides a dental voucher for patients experiencing dental pain. While it is not a final priority, SFL continues to be involved with that program through monetary support. * Access to Exercise: The hospital did not take the lead on this issue. It is addressed by groups including the local chamber and local businesses. * Affordable Health Care: While not selected as a final priority, SFL continuously works with the System and local providers to provide affordable care to all residents. * Child Abuse and Neglect: This issue is closely related to substance abuse and mental health and will be addressed as we work to address those needs * Cost Burdened Renters: This stems from the root cause of academic success and workforce development and will be addressed downstream as we work to address workforce development opportunities. * Diabetes and Obesity: This issue is currently being addressed through primary care provider based programming. * Unmanaged Chronic Conditions: This issue is currently being addressed through primary care provider based programming. * Future Water Issues in Rural Areas: SFL did not select this as a priority area due to the feasibility of what we can do as a hospital. Our leadership will attend stakeholder meetings to dialogue solutions if the opportunity presents. * Human Trafficking: SFL is part of the Central Illinois Human Trafficking Taskforce through work being done at the System Level. * Student Mobility: Local schools are addressing this Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Francis Hospital. Presumptive eligibility is presumed under certain circumstances for uninsured patients based on their enrollment in other means-tested programs or other sources of information, not provided directly by the patient. Once determined, presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 6c. Wisconsin Department of Health Services Housing Assistance Program 7. Participation in Women, Infants and Children programs (WIC); 8. Supplemental Nutrition Assistance Program (SNAP) eligibility; 9. Low Income Home Energy Assistance Program (LIHEAP); 10. Wisconsin Home Energy Assistance Program (WHEAP); 11. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 12. Receipt of grant assistance for medical services 0 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 2023 was $245,633. 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 it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care. Schedule H, Part V, Section B, Line 16a FAP website - St. Francis Hospital: Line 16a URL: https://www.hshs.org/about-us/patient-financial-services; Schedule H, Part V, Section B, Line 16b FAP Application website - St. Francis Hospital: Line 16b URL: https://www.hshs.org/about-us/patient-financial-services/illinois-financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - St. Francis 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 St. Francis Hospital conducted a Community Health Needs Assessment in FY2021 (July 1, 2020 through June 30, 2021). Throughout the three-year CHNA cycle, the hospital continuously reviews updated local and state data, Illinois Comp Data, patient surveys and feedback, and local needs assessments conducted by community groups. Additionally, the hospital received 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 and new areas of need that are going unmet. Sources of data included the U.S. Census and subsequent updates and estimates from the U.S. Census Bureau, the Illinois Behavioral Risk Factor Surveillance System (IBRFSS), official websites of the City of Litchfield and Macoupin and Montgomery counties health departments, and a statewide report on poverty in Illinois. County Health Rankings obtained from the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute were utilized as well as information from Community Commons, the Illinois Department of Employment Security, and the National Cancer Institute. Other data sources include the U.S. Health Resources and Services Administration data, the Illinois State Board of Education, and the U.S. Department of Agriculture. The hospital's awareness of the health care needs of our community continues through phone calls, inquiries, and requests received by the Community Outreach Facilitator from the community for health-related services. Program evaluations of community outreach programs also provide a mechanism for feedback from the community regarding health care and health related education needs. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Patients may learn of FAP resources online. Materials are presented in English and Spanish with translation services available in more than 25-languages. At the time of registration, patients are provided with information on financial assistance. Then again during discharge, the care management team works with patients to confirm eligibility for financial assistance and provide resources accordingly. Financial Counselors are also available to assist self-pay patients with Medicaid eligibility. Schedule H, Part VI, Line 4 Community information Combined population is 74,291 and the median household income is around $53,953 per year. The percentage of people living below the poverty level averages 13% in Macoupin County and 15.4% in Montgomery County and the current unemployment rate is 5.7% and 6.7% respectively. Based on the 2018 population estimates derived from the 2010 census data, 98% of Macoupin County and 89% of Montgomery County is Caucasian. Two percent of the population in Macoupin County is African Americans, Native American, Asian and Hispanic or Latino. In Montgomery County, 8% of the residents are African American. Less than 3% are Native American, Asian and Hispanic or Latino. The female population in Macoupin County is 22,543 and the male population is 22,939. The female population in Montgomery County is 13,993 while 15,308 males live in the county. The age of individuals living in Macoupin County under five years is 2,846; under 18 years, 10,071 and 65 years and over is 8,127. The age range for Montgomery County is: under five years: 1,461; under 18 years: 5,785 and 65 years and over: 5,435. Persons eligible for Medicare account for 49% of the patient revenue generated at the hospital and Medicaid-eligible patients generate 18%. Likewise, 29% of the revenue is derived from patients who have managed care/commercial insurance coverage. The remaining 3% of patient revenue comes from patients with no insurance. Most of the Medicaid revenue originates in the Maternity unit. More than 67.0% of the Maternity unit revenue was from treating patients eligible for Medicaid. Provision of maternity services is a financial burden for the hospital, 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, since a CAH is allowed only 25 inpatients at a time, including maternity patients. 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 St. Francis Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1857, 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 Macoupin and Montgomery County, IL and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Francis Hospital is responding to community need. Consistent with its exempt purpose, HSHS St. Francis 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, HSHS St. Francis Hospital 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 St. Francis Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2023, HSHS St. Francis Hospital provided $1,399,320 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 St. Francis 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 HSHS St. Francis 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 15 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 140 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. The COVID-19 pandemic caused an unprecedented disruption in healthcare services across the United States. HSHS responded with services that benefited our communities, including free telehealth screenings, free testing, and coordination with other healthcare providers in the communities we serve to best ensure access to needed care. In FY2023, HSHS collectively provided $222.3 million in Community Benefit (8.2% of total hospital expenses). Of the total Community Benefit provided, HSHS spent $5.8 million provided for Financial Assistance (aka Charity Care) and $146.3 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 $304.5 million. HSHS hospitals also recorded $74.3 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 false true false false false false false false false EVERT J KUIPER Former Division CEO - Illinois (until Jan 2022) 0 51437 0 0 0 474809 0 3413 0 2814 0 532473 0 196540 James Timpe President & CEO 245613 0 68927 0 38711 0 36448 0 31720 0 421419 0 0 0 PATRICIA FISCHER Former Chief Executive Officer 0 0 0 0 0 32914 0 70774 0 0 0 103688 0 32914 Aaron Puchbauer FORMER INTERIM CEO 0 211993 0 31750 0 88738 0 29558 0 40716 0 402755 0 0 TODD Smart Treasurer 0 267686 0 38335 0 23548 0 45254 0 36008 0 410831 0 0 PATRICIA ALLEN Interim CFO - Illinois 0 414598 0 44684 0 81818 0 126563 0 27833 0 695496 0 0 Tammy Keiser-Donoho Registered Nurse - Critical Care 136847 0 1610 0 390 0 17572 0 35372 0 191791 0 0 0 JILL MOUTRIA PHARMACIST 159353 0 3099 0 2253 0 5371 0 12124 0 182200 0 0 0 HEATHER SENALDI Director - Nursing 109299 0 0 0 28842 0 1141 0 11934 0 151216 0 0 0 Brian Strader Director-Pharmacy 175053 0 0 0 37532 0 2464 0 13262 0 228311 0 0 0 Susan Stromsland Laboratory Manager 146092 0 0 0 1900 0 3606 0 15189 0 166787 0 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 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 2022 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Patricia Allen -- $37,240 John Ludwig -- $35,698 AARON PUCHBAUER -- $25,396 Todd Smart -- $25,135 James Timpe -- $32,382 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Patricia Fischer -- $32,914 EVERT KUIPER -- $196,540 John Ludwig -- $86,566 Form 990, Part III, Line 4d Description of other program services (Expenses $ 8,208,275 including grants of $)(Revenue $ 5,906,328) INFUSION / ONCOLOGY - St. Francis Hospital's cancer care center offers a comfortable and healing environment for our patients and their families. Features include: two private patient exam rooms, two private infusion rooms and four semi-private infusion bays and comfortable reclining chairs and individual television monitors for use during treatment. Infusion Services - An intravenous (IV) infusion is the medical term for the administration of liquid substances/ medications into the bloodstream. In addition to chemotherapy, the Cancer Care Center offers a full continuum of outpatient infusion services including: blood transfusions, infusions and injections of supportive medications, immunotherapy treatments and port maintenance and flushing. Chemotherapy - A cancer treatment using drugs that are given intravenously through an injection or by mouth. These drugs destroy cancer cells by impeding their growth and reproduction. Total patients served - 2,758. 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 IV, Line 24a Tax Exempt Bonds St. Francis Hospital HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE COROPORATE 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. 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. 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 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 THREE 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 4 Significant changes to organizational documents THE BYLAWS WERE AMENDED WITH THE FOLLOWING SIGNIFICANT CHANGES: 1. THE MEMBER GAINED ONE ADDITIONAL RESERVED POWER TO APPROVE MATERIAL ACTIONS WITH RESPECT TO EMPLOYEE RETIREMENT PLANS SPONSORED BY THE CORPORATION OR ANY AFFILIATE. 2. THE MEMBER ONLY FILLS PRESIDENT VACANCIES, REMOVING THE ABILITY TO FILL SECRETARY AND TREASURER VACANCIES. 3. THE DIVISION PRESIDENT NO LONGER SERVES ON THE BOARD OF DIRECTORS. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE CORPORATE MEMBER OF ST. FRANCIS 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. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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 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 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 DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY THE MEMBER; (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 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 ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS, AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION, OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY, AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. 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, (the top management official, other officers and key employees). 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 Medical Physician Fees - Total Expense: 5308714, Program Service Expense: 5308326, Management and General Expenses: 388, Fundraising Expenses: ; Pathologist Fees - Total Expense: 55000, Program Service Expense: 55000, Management and General Expenses: , Fundraising Expenses: ; Consulting - Total Expense: 71456, Program Service Expense: 32288, Management and General Expenses: 39168, Fundraising Expenses: ; Physician Recruitment - Total Expense: 249510, Program Service Expense: , Management and General Expenses: 249510, Fundraising Expenses: ; Other Professional Fees - Total Expense: 8212, Program Service Expense: 680, Management and General Expenses: 7532, Fundraising Expenses: ; Management & Contracted Service Fees - Total Expense: -243, Program Service Expense: -243, Management and General Expenses: , Fundraising Expenses: ; Medical Director Fees - Total Expense: 64370, Program Service Expense: 64370, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT ST. FRANCIS HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, AND EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS," INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in Net Pension Periodic Costs - net of service costs - 1333366; Change in FV of Interest Rate Swaps - 287130; Transfers to Affiliates - -428607; 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, INCLUDING ST. FRANCIS HOSPITAL. 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. KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -105950 447864 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 554315 15980466 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL 1805698 3189003 KCIN 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 4936 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 GOOD SHEPHERD HOSPITAL INC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 370512290 HEALTHCARE IL 501(c)(3) 3 HSSI true HSHS HOLY FAMILY HOSPITAL 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 E 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 990 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 HSSI true SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371778753 TRUST IL 501(a) HSSI true SOUTHERN ILLINOIS CARDIOVASCULAR SERVICE INC ONE ST ELIZABETHS BLVD OFALLON IL 62269 371276333 HEALTHCARE IL 501(c)(3) 3 ST ELIZABETH'S HOSPITAL false 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 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 JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC IS 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 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 12866 TROXLER AVENUE HIGHLAND IL 62249 370663568 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 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 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 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 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 UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 10 HSSI true UTLAUT MEMORIAL FOUNDATION INC 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(c)(3) Type II HSSI true SPRINGFIELD URGENT CARE REAL ESTATE LLC PO BOX 19456 SPRINGFIELD IL 627949456 030413258 RENTAL REAL ESTATE IL LASANTE INC N/A 0 PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261479945 MEDICAL IL HSHS Related -7032 12572 false true 1 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 823633320 REAL ESTATE IL St John's Related -126650 1434911 false false 0.5 REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC 9001 Liberty Parkway Birmingham AL 35242 871489748 Medical DE HSHS Related -80505 4187830 false false 0.5 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation 601904 18670450 1 true LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 391572196 HEALTHCARE IL KIARA INC C Corporation true LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163400 HEALTHCARE IL KIARA INC C Corporation true PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY WI 54304 391839351 HEALTHCARE WI HSSI C Corporation -1641640 24425128 0.5 true PREVEA CLINIC INC 2710 EXECUTVE DRIVE GREEN BAY WI 54304 391839349 HEALTHCARE WI PHSI C Corporation true RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY11102 980669953 INSURANCE CJ HSSI C Corporation 0 156895227 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false false false false false false false false false false false false false false true true true true false 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 organizations 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.