2025-05-06T12:09:41+00:00 2024-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2023-07-01 370792770 HSHS Holy Family Hospital HSHS 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 62246 Mark Ennen Directory of Finance 2025-05-06 true Mallory Fairless P01321579 3128997000 2025-05-06 2023 2025-03-06 01:10:19Z Chris Klay 200 HEALTH CARE DRIVE GREENVILLE IL 62246 24323172 false 0928 X www.hshs.org/holy-family/ X 1956 IL TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. 8 7 133 86 0 0 355043 42348 24965924 22670299 -925689 13916 677395 1164333 25072673 23890896 0 0 8016829 7511126 0 0 19992728 18134050 28009557 25645176 -2936884 -1754280 21806401 24626908 52511968 58874997 -30705567 -34248089 X TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. false false 9094835 5905747 Emergency Services: HSHS Holy Family Hospital's Emergency Department is a continuous operation department that must be staffed and able to receive patients at all hours of the day. The department is comprised of specially trained nurses and physicians who are supported by departments representative of the gamut of our Ministry. This team can rapidly identify, treat, and/or stabilize emergency medical conditions in patients ranging in age from newborns to centenarians and sees an average of 600 patients per month in our recently renovated Emergency Department. As a community hospital, our Ministry has been able to provide lifesaving care to our community as well as serve as a local, and familiar, entry point into the juggernaut that is the healthcare system. Additionally, the department serves as a community resource for those struggling with substance use disorders, addiction related concerns, and acute mental health crisis through rapid identification of needs and provision of resources or transfer to specialty care facilities. 7227340 4826636 Outpatient services: HSHS Holy Family provides outpatient services for physical, occupational and speech therapy across all age populations. Services include therapy for orthopedic, neurologic, pediatric, and general medical care as some examples. We have specialty therapy services for those with Parkinson's disease, bladder care/pelvic pain, dry needling, sports therapy, vestibular rehab, concussion care, balance assessments, lymphedema care, hand therapy, voice therapy and modified barium swallow testing. We have one primary location on the hospital property that is open Monday through Friday. Visits seen in therapy for FY24 is 2,536. 3096091 10834469 General patient care: Holy Family Hospital is an acute care facility that provides high quality, cost-effective emergency, medical and surgical care, and skilled nursing services. The hospital serves patients of all ages. The hospital is licensed by the State of Illinois to provide quality health care to local residents as well as consumers in surrounding areas. The hospital is accredited by the Joint Commission. St. Joseph's Hospital employees over 100 colleagues and contracts with several services to provide a comprehensive panel of competent and mission-oriented colleagues. Fiscal year 2024 had a inpatient average daily census was 4.5 with 363 admissions, 39,475 outpatient visits, 6280 Emergency Room visits, and 507 surgical cases. 2055628 1658627 Surgical Services: HSHS Holy Family hospitals' surgery department has been enjoying its newly renovated space for over 2 years. With 9 pre/post bays, 3 surgical suites and a fully upgraded Central Sterile Processing department, we are well placed to accommodate growth. We are able to provide a wide range of surgical specialties including: general surgery, gastrointestinal, gynecology, podiatry, orthopedics and ophthalmology. We provide exceptional patient care in our department and have plans to increase our surgical volume significantly. In FY24, we performed 946 surgeries and are looking forward to growth. 2055628 1658627 21473894 true true 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 true false false false true X 1073 0 true 133 true false false false false false false false false false false false false X 8 7 false false false false true true true true true false false true true true true true true true true true true X Linda Dace 6182342120 3051 Hollis Drive Springfield IL 62704 BART CALDIERARO Chair 1.0 1.0 X X 0 0 0 CHRIS KLAY PRESIDENT/CEO 15.0 45.0 X X 0 494100 65738 Crystal Grove Vice Chair (Until 6/12/24) 1.0 1.0 X X 0 0 0 KELLY M SAGER President/CEO (Until 6/5/24) 59.0 1.0 X X 322147 0 35729 Suzanne Davis Secretary (Until 10/31/23) 1.0 1.0 X X 0 0 0 EUGENE DUNKLEY Board Member 1.0 1.0 X 0 0 0 JAMIE BAUM MD Board Member 1.0 1.0 X 0 0 0 Nick Suess Board Member 1.0 1.0 X 0 0 0 RANDY ALDERMAN Board Member 1.0 1.0 X 0 0 0 TRAVIS THACKER Board Member 1.0 1.0 X 0 0 0 WILLIAM WALKER Board Member 1.0 1.0 X 0 0 0 Michael Scialdone Treasurer / HSHS SVP & CFO (began 01/08/24) 0.3 59.7 X 0 0 0 Paige Toth Secretary (began 11/1/23) 4.2 55.8 X 0 306108 66169 PATRICIA ALLEN CFO - CARE DELIVERY 2.0 58.0 X 0 649506 123627 TODD Smart Treasurer (UNTIL 5/3/24) 0.3 59.7 X 0 315606 66527 CYNTHIA CROUCH Assistant Manager-Nursing 40.0 0 X 111901 0 25144 Kacie Ann Blaser Director-Nursing 40.0 0 X 111447 0 16772 KATLYN OBERMARK Clinical Pharmacist Specialist 40.0 0 X 136714 0 23265 KELLI CLUTTS Director - Nursing 40.0 0 X 138151 0 4564 Rebecca L Martin Director-Operations 40.0 0 X 119182 0 11738 939542 1765320 439273 8 false true false HAROLD O'SHEA BUILDERS 1941 S 10 1/2 St Springfield IL 62703 Construction Contractor 2966816 APEXNETWORK PHYSICAL THERAPY 15 Apex Dr Highland IL 62249 Therapy Services 1919703 CEP AMERICA IL LLP 1601 Cummins Dr Suite D Modesto CA 953586411 Physician Services/Fees 1209012 CEP AMERICA ILLINOIS HOSPITALISTS 1601 Cummins Dr Suite D Modesto CA 953586411 Physician Services/Fees 943320 Berners Schober Associates Inc 310 Pine Street Green Bay WI 543015136 Construction 775026 11 30000 12348 42348 NET PATIENT REVENUES 621990 22551489 22551489 Affiliate Rental Revenue 531120 118810 118810 0 0 0 0 22670299 3924 3924 403760 432276 -28516 0 -28516 -28516 9992 9992 0 9992 9992 Gift Shop / Auxiliary 453220 637669 637669 Other Revenue 900099 441845 441845 Athletic Trainer 900099 113335 113335 0 0 0 0 1192849 23890896 23225479 0 623069 X 357876 343959 13917 5271084 5066106 204978 227060 218230 8830 1241041 1192780 48261 414065 397963 16102 1248 1248 2021 2021 5418952 5390201 28751 0 24359 24359 73851 60441 13410 64924 60980 3944 1530754 1436162 94592 43656 26897 16759 33346 515 32831 51454 51454 753008 700510 52498 532029 427308 104721 Purchased Services 5848073 2601165 3246908 Supplies 1550986 1545209 5777 Medicaid Assessment 1508279 1508279 Equipment Rental 313759 303680 10079 383351 193509 189842 0 25645176 21473894 4171282 0 1788533 297800 0 3141991 2041503 0 0 0 0 256424 254271 14628 67972 25098741 4925459 15185561 20173282 613665 642193 0 0 805599 1149887 21806401 24626908 4533266 4301109 2755202 1919834 0 0 44553925 52380598 669575 273456 52511968 58874997 X -30705567 -34248089 -30705567 -34248089 21806401 24626908 X -1754280 10044 -1798286 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1539949 1539949 13916658 3867028 10049630 2693521 1030655 1662866 6948613 27776 6920837 20173282 ASSET RETIREMENT OBLIGATION 194502 Accrued Benefit Liability Operating Lease Capital Lease & Internal Line of Credit 78954 273456 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. 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, 2024 and 2023 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, 2024 and 2023, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 13167 13167 0.0005 4172332 2048763 2123569 0.0828 12063 12063 0.0005 0 0 4197562 2048763 2148799 0.0838 2636 2636 0.0001 139161 139161 0.0054 101842 101842 0.0040 0 0.0 12117 12117 0.0005 0 0 255756 0 255756 0.0100 0 0 4453318 2048763 2404555 0.0938 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 6347876 12453397 -6105521 X true true 1 1 HSHS Holy Family Hospital 200 HEALTHCARE DRIVE GREENVILLE IL 62246 www.hshs.org/holy-family/ 0005355 X X X HSHS Holy Family Hospital 1 false false true X X X X X X X X X 23 true true true true X https://www.hshs.org/getmedia/6c487775-311a-44d7-98d6-a75a2517f868/CHNA_report_HFG_DY_2024_FINAL.pdf X true 24 true https://www.hshs.org/getmedia/d0d665e4-0f2c-4da3-931e-47461cc1716f/Implementation-Plan_HFG_2025-2027 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 Holy Family Hospital. Holy Family Hospital worked with core group partners to leverage existing relationships and provide diverse input for a comprehensive review and analysis of community health needs in Bond, Clinton and Madison counties Representation on the CAC was sought from health and social service organizations that: 1. Serve low-income populations 2. Serve at-risk populations 3. Serve minority members of the community 4. Represent the general community The following community stakeholders were invited to serve on the CAC: - Age Smart* - BCMW Community Services* - Birth to Five* - Bond County Community Unit School District 2 - Bond County Health Department* - Catholic Diocese of Belleville - Chestnut Health Systems* - City of Breese - City of Greenville - City of Highland - Greenville First Christian Church - HSHS Holy Family Hospital in Greenville* - HSHS St Joseph's Hospital Breese* - HSHS St Joseph's Hospital Highland* - Madison County Health Department* - MERS Goodwill* - Regional Office of Education #13 * Denotes groups representing medically underserved, low-income and minority populations Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - HSHS Holy Family Hospital. ST. JOSEPH'S HOSPITAL IN BREESE, AND ST. JOSEPH'S HOSPITAL IN HIGHLAND Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS Holy Family Hospital. Yes, the hospital conducted its FY2021 CHNA with: - Age Smart* - BCMW Community Services* - Birth to Five* - Bond County Community Unit School District 2 - Bond County Health Department* - Catholic Diocese of Belleville - Chestnut Health Systems* - City of Breese - City of Greenville - City of Highland - Greenville First Christian Church - HSHS Holy Family Hospital in Greenville* - HSHS St Joseph's Hospital Breese* - HSHS St Joseph's Hospital Highland* - Madison County Health Department* - MERS Goodwill* - Regional Office of Education #13 * Denotes groups representing medically underserved, low-income and minority populations Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS Holy Family Hospital. Fiscal year ending June 30, 2024 was the final year of the Implementation Strategy adopted in tax year 2022 for the CHNA that was conducted in 2021. Information provided below relates to the activities that occurred during the third year of this CHNA cycle addressing the health needs identified in the 2021 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: 1. Mental and behavioral health 2. Chronic conditions 3. Workforce development Implementation strategies established to address these needs through specific initiatives included: Mental and Behavioral Health Goal: Enhance access to comprehensive, high-quality mental and behavioral health services to improve community well-being and reduce health disparities. Strategy 1: Improve access to prevention and early intervention services. HSHS Holy Family Hospital partnered with the Gateway Foundation in FY2022 to enhance early intervention for substance use disorder cases in the emergency department (ED) By deploying an engagement specialist who collaborates with providers to screen and connect patients to appropriate treatment plans, the hospital ensures swift identification and early intervention Additionally, recovery coaches provide support for smooth reintegration into the community following residential treatment. Strategy 2: Improve access to care. The hospital offers 365-day psychiatric coverage in the ED as part of a comprehensive crisis screening plan started in January 2023 This initiative emerged from an 18-month collaboration with three other southern Illinois hospitals to address gaps in crisis screening, enhancing immediate access to mental health services Additionally, a determinants of health screening tool was introduced in FY2022 to identify and refer patients to social services based on their individual needs, with a goal to extend this screening to primary care settings. Strategy 3: Unified planning and policy efforts. In unifying efforts to improve mental and behavioral health, the hospital is actively engaging in the Illinois Human Trafficking Task Force and works closely with the Bond County Health Department to offer dental referrals as part of holistic care The hospital's strategy is also aligned with regional partners through participation in rural transportation grants to bolster access to medical appointments across counties ensuring comprehensive and seamless care coordination Chronic Disease Goal: Reduce the incidence and impact of chronic disease by enhancing preventive care, education, and access to effective management resources. Strategy 1: Improve access to prevention and early intervention services. In FY2023, Holy Family Hospital implemented a determinants of health screening tool for every patient entering the hospital, helping to identify social needs that could affect chronic condition management By making referrals to appropriate social service agencies, the hospital emphasizes early intervention and comprehensive prevention strategies. Strategy 2: Improve access to care. The hospital's commitment to better care accessibility is reflected in its continued engagement in delivering transportation services for individuals needing access assistance for medical and dental appointments Additionally, the determinants of health screening tool will be extended to primary care settings, further simplifying referrals to social services that address patient needs and improve overall care. Strategy 3: Unified planning and policy, and advocacy efforts. Holy Family Hospital actively collaborates with the Bond County Health Department to address oral health as part of the strategic plan for chronic condition management They also contribute to regional partnerships to secure grants that enhance rural transportation services Such unified efforts help reduce barriers and deliver a coordinated response to chronic health challenges. Workforce Development and Barriers Strategy 1: Integrated programs, long-term goals with workers at the center. In FY2022, Holy Family Hospital launched a diversity, equity, and inclusion (DEI) committee and participated in its workforce subcommittee This committee aimed to integrate programs addressing gaps in workforce readiness and success, both internally and externally The hospital maintained long-term goals with employees at the center, ensuring their development and addressing workforce barriers such as affordable housing and childcare. Strategy 2: Develop workforce plan and training programs. Holy Family Hospital demonstrated a strong commitment to developing a robust workforce plan and training program. By providing over $240,000 in mentoring and job shadowing opportunities, they successfully partnered with local educational institutions to mentor and train 57 interns in various health care fields, including nursing, pharmacy, rehab, radiology and senior care Strategy 3: Unified planning and policy, and advocacy efforts. Unified planning and policy efforts were achieved through the 18-month planning process that identified gaps in emergency department crisis screening Beginning in January 2023, the hospital, alongside others in southern Illinois, devised a plan for 365-day psychiatric coverage Additionally, they engaged with the Illinois Human Trafficking Task Force to raise awareness and respond to trafficking issues affecting workforce safety. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - HSHS Holy Family 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 2 EMERALD POINTE 105 HONEY LOCUST LANE GREENVILLE IL 62246 INDEPENDENT LIVING FACILITY CONVENIENT CARE 201 Health Care Drive GREENVILLE IL 62246 WALK IN CLINIC STAFFED BY A NURSE PRACTITIONER 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 2024 WAS $6,105,521. 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 - HSHS Holy Family Hospital: Line 16a URL: https://www.hshs.org/about-us/patient-financial-services; Schedule H, Part V, Section B, Line 16b FAP Application website - HSHS Holy Family 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 - HSHS Holy Family 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 Holy Family Hospital conducted a Community Health Needs Assessment inFY2024 (July 1, 2023 through June 30, 2024). 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 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 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 Holy Family Hospital's main service area is comprised of approximately 383 square miles in Bond County, Illinois, with a county population of approximately 16,725 residents. The hospital is in Greenville, which is the largest town in the service area, and is the location of the county's governance. The county is mostly rural and consists of eight smaller villages and communities comprising the service area and includes Donnellson, Keyesport, Mulberry Grove, Panama, Pierron, Pocahontas, Smithboro, and Sorento. Holy Family Hospital is the sole hospital provider in the county and does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. Based on the U.S. Census Bureau's information, the population of the entire county has declined by 0.5%. The median age is 41.5 years of age with 19.8% of the population over the age of 65 compared to 16.6% over the age of 65 in the state of Illinois. A higher percentage of residents in Bond County are disabled than compared to the state rate (17.9% vs. 11.6% respectively). Holy Family Hospital is one of the largest employers in Bond County. The current unemployment rate for the county is 2.3%. Median household income is $58,617 which is lower than the median household income for Illinois at $78,433. Persons living below the federal poverty level is 12.0% of the population. Per the most recent US Census information, 5.7% of Bond County residents under the age of 65 years are without health insurance. The percentage of the population that is food insecure in Bond County (10.7%) is nearly even with the state rate (9.5%). Bond County is in an area designed as a shortage area for primary care health professionals (HPSA). This designation is made by the U.S. Department of Health & Human Services. The designation is also in place for mental health professionals. 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), Holy Family Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1960, 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 Bond County 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 Holy Family Hospital is responding to community need. In addition, Holy Family Hospital receives community support and guidance through an Advisory Council and HSHS Holy Family Foundation Leadership Council. Both Councils meet quarterly and provide feedback from the community on additional services or improvements needed. Holy Family Hospital is blessed with a strong volunteer program. Volunteers are active in hospital departments and donate many more hours throughout the year to hospital-sponsored community programs. Consistent with its exempt purpose, Holy Family 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, Holy Family 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. Holy Family Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2024, Holy Family Hospital provided more than $2,404,555 million 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. Holy Family 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 Holy Family 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. In FY2024, HSHS collectively provided $259.6 million in Community Benefit (8.1% of total hospital expenses). Of the total Community Benefit provided, HSHS provided $2.8 million for Financial Assistance (aka Charity Care) and $191.3 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 $379.4 million. HSHS hospitals also recorded $72.8 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 false true false false false false false false false CHRIS KLAY PRESIDENT/CEO 0 379320 0 24696 0 90084 0 36236 0 29502 0 559838 0 30652 KELLY M SAGER President/CEO (Until 6/5/24) 259377 0 60908 0 1862 0 13034 0 22695 0 357876 0 0 0 PATRICIA ALLEN CFO - CARE DELIVERY 0 498772 0 53821 0 96913 0 99475 0 24152 0 773133 0 34179 TODD Smart Treasurer (UNTIL 5/3/24) 0 275819 0 37512 0 2275 0 46882 0 19645 0 382133 0 0 Paige Toth Secretary (began 11/1/23) 0 283016 0 23092 0 0 0 33609 0 32560 0 372277 0 0 KATLYN OBERMARK Clinical Pharmacist Specialist 136614 0 0 0 100 0 -5947 0 29212 0 159979 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 2023; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). CHRIS KLAY-- $40,910 TODD SMART -- $25,441 KELLY M. SAGER -- $32,807 PATRICIA ALLEN -- $44,695 PAIGE TOTH -- $14,542 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2023; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. PATRICIA ALLEN -- $34,179 CHRIS KLAY-- $30,652 Form 990, Part III, Line 4d Description of other program services (Expenses $ 2,055,628 including grants of $)(Revenue $ 1,658,627) Surgical Services: HSHS Holy Family hospitals' surgery department has been enjoying its newly renovated space for over 2 years. With 9 pre/post bays, 3 surgical suites and a fully upgraded Central Sterile Processing department, we are well placed to accommodate growth. We are able to provide a wide range of surgical specialties including: general surgery, gastrointestinal, gynecology, podiatry, orthopedics and ophthalmology. We provide exceptional patient care in our department and have plans to increase our surgical volume significantly. In FY24, we performed 946 surgeries and are looking forward to growth. Form 990, Part IV, Line 24a Tax Exempt Bonds HSHS HOLY FAMILY GREENVILLE HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO. 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. Form 990, Part VI, Line 13 Whistle Blower 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 VENTURES HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING HSHS HOLY FAMILY 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. 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 Holy Family Hospital (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) 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 HSHS Holy Family 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 shall be subject in all respects to the Member's right to exercise the reserved powers set forth in this section (the "Reserved Powers") with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or controlling shareholder (the "Affiliates"). The Member shall have the exclusive right to exercise the Reserved Powers, and the Board of Directors of the Corporation shall have no power or authority over the Corporation which would in any way conflict with the Member's exclusive right to exercise the Reserved Powers. The Reserved Powers shall include all rights granted to the Member of a not-for-profit corporation 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 the Member; (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 any Affiliate from such budgets in an amount or percentage specified by the Member 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 the Member. 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. 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 Fees - Total Expense: 1926719, Program Service Expense: 1907082, Management and General Expenses: 19637, Fundraising Expenses: ; Contract Labor - Total Expense: 2005694, Program Service Expense: 2005694, Management and General Expenses: , Fundraising Expenses: ; Purchased Services - Outside - Total Expense: 1486539, Program Service Expense: 1477425, Management and General Expenses: 9114, Fundraising Expenses: ; Form 990, Part X, Line 11 POOLED INVESTMENT FUND THE ORGANIZATION'S 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 RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. 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 and 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 Net Transfers Between Affiliates - -1797100; Change in Pension Funded Status - -1186; HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) Type III-FI NA false HOSPITAL SISTERS OF ST FRANCIS FOUNDATION INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 7 HSHS true HOSPITAL SISTERS HEALTHCARE-WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) Type I 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 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 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 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 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 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 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 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 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 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 HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) Type III-FI HSHS 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 UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 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 ST CLARE MEMORIAL HOSPITAL INC 855 S MAIN STREET OCONTO FALLS WI 54154 390848401 HEALTHCARE WI 501(c)(3) 3 HSSI true UTLAUT MEMORIAL FOUNDATION 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(c)(3) Type II HSSI true HSHS GOOD SHEPHERD HOSPITAL INC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 370512290 HEALTHCARE IL 501(c)(3) 3 HSSI true HOSPITAL SISTERS MISSION OUTREACH CORPORATION 4849 LAVERNA ROAD SPRINGFIELD IL 62707 352271729 RECYCLING MEDICAL SUPPLIES IL 501(c)(3) HSHS true PRAIRIE CARDIOVASCULAR CONSULTANTS LTD 3051 HOLLIS DRIVE SPRINGFIELD IL 62704 371071858 HEALTHCARE IL 501(c)(3) 10 HSSI true PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261479945 MEDICAL IL HSHS Related 0 0 false true 1 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation 953484 19065022 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 -678213 23739679 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 204854765 1 true false false true false true false false false false false true false true true true true true true 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.