TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) THERESE PANDL PRESIDENT/CEO	20.0	X	X			0	575,727	192,393
(2) JUDY NAGEL DIRECTOR	1.0	X				0	0	0
(3) SISTER BERNADINE GUTOWSKI OSF DIRECTOR	1.0	X				0	0	0
(4) ROBERT BURNS director	1.0	X				0	0	0
(5) JOHN HAGER SECRETARY	1.0	X	X			0	0	0
(6) KENNETH JOHNSON MD DIRECTOR	1.0	X				0	0	0
(7) DJ LONG CHAIR PERSON	1.0	X				0	0	0
(8) Daniel J Platkowski DIRECTOR	1.0	X				0	0	0
(9) FRANK MIKELL DIRECTOR	40.0	X				0	718,147	119,424
(10) DR KEN HUJET DIRECTOR	1.0	X				0	0	0
(11) BETSY MITCHELL DIRECTOR	1.0	X				0	0	0
(12) ANN M CARR TREASURER	.25		X			0	225,812	215,561
(13) LAWRENCE J CONNORS COO	40.0		X			188,584	0	140,707
(14) greg simia division cfo	20.0		X			0	216,664	12,262
(15) AMY J UNRATH DIVISION ADMINISTRATOR	40.0			X		231,875	0	243,698
(16) JOHN DAUL CRNA	40.0				X	181,757	0	103,159
(17) MARY ALICE JOHNSON CRNA	40.0				X	181,661	0	180,345

(A) Name and business address	(B) Description of services	(C) Compensation
ST VINCENT HOSPITAL 835 S VAN BUREN STREET GREEN BAY,WI54303	SHARED SERVICES	21,895,736
CARDINAL HEALTH PO BOX 70539 CHICAGO,IL60673	MEDICAL SUPPLIES	5,243,851
PREVEA CLINIC PO BOX 19070 GREEN BAY,WI54307	SHARED LABOR	3,483,277
SIEMENS MEDICAL SOLUTIONS 51 VALLEY STREAM PARKWAY MALVERN,PA19355	MEDICAL SUPPLIES	2,448,378
ZIMMER US INC W165 N5815 RIDGEWOOD DR MENOMONEE FALLS,WI53051	MEDICAL SUPPLIES	2,012,301
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 56

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	35,148,302	31,770,527	3,377,775	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,283,067	2,063,208	219,859	0
9	Other employee benefits .......	7,672,957	6,934,051	738,906	0
10	Payroll taxes ...........	2,247,719	2,031,264	216,455	0
11	Fees for services (non-employees):
a	Management ......	5,860,260	0	5,860,260	0
b	Legal .........	352,044	0	352,044	0
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	8,487,956	6,260,341	2,227,615	0
12	Advertising and promotion ....	757,156	251	756,905	0
13	Office expenses .......	260,509	240,659	19,850	0
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	3,528,409	3,426,287	102,122	0
17	Travel ............	38,659	28,537	10,122	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	42,086	39,383	2,703	0
20	Interest ...........	1,076,179	0	1,076,179	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	4,897,058	4,215,560	681,498	0
23	Insurance ..............	319,041	85,085	233,956	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	SUPPLIES - MED/SURG/O2/DRUGS	16,174,214	16,174,214
b	PREVEA INVESTMENT AND LEASE	10,564,743	10,564,743
c	BAD DEBT EXPENSE	5,129,876	5,129,876
d	MEDICAID TAX ASSESSMENT	3,415,106		3,415,106
e
f	All other expenses	2,470,991	1,785,723	685,268
25	Total functional expenses. Add lines 1 through 24f	110,726,332	90,749,709	19,976,623	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	2,584	1	2,579
2	Savings and temporary cash investments .......	5,222,105	2	6,691,890
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	13,730,953	4	12,784,813
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	250,000	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	476,737	7	465,724
8	Inventories for sale or use ..............	2,477,670	8	2,479,268
9	Prepaid expenses and deferred charges ............	442,018	9	421,457
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	156,799,798
b	Less: accumulated depreciation. .....	10b	79,261,559	75,424,932	10c	77,538,239
11	Investments—publicly traded securities ..........	49,928,874	11	51,620,725
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	8,627,051	13	9,578,157
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	1,731,209	15	1,616,335
16	Total assets. Add lines 1 through 15 (must equal line 34)...	158,314,133	16	163,199,187
	17	Accounts payable and accrued expenses .	15,576,505	17	17,161,138
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	33,637,883	20	32,993,547
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	16,925,311	25	26,120,699
26	Total liabilities. Add lines 17 through 25.....	66,139,699	26	76,275,384
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	84,324,387	27	79,921,595
28	Temporarily restricted net assets .....	5,552,567	28	4,704,337
29	Permanently restricted net assets .....	2,297,480	29	2,297,871
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	92,174,434	33	86,923,803
34	Total liabilities and net assets/fund balances .....	158,314,133	34	163,199,187

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC - HOSPITAL SISTERS
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC - HOSPITAL SISTERS
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
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Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
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Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

9,868

Total. Add lines 1c through 1i ...............................

9,868

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Description of other lobbying activities	schedule C, Part II-B, Question 1I	ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH 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 ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	0	2,276,732		2,276,732
b	Buildings ................	0	63,134,444	23,816,744	39,317,700
c	Leasehold improvements ............	0	645,540	275,756	369,784
d	Equipment ................	0	38,556,462	25,114,753	13,441,709
e	Other .................	0	52,186,620	30,054,306	22,132,314
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					77,538,239

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) INVESTMENT IN PREVEA	6,439,267	C
(2) INV. - COMMUNITY MEMORIAL HOSP	1,435,363	C
(3) INVESTMENT IN UNITY	1,288,747	C
(4) INV. IN ONCOLOGY JOINT VENTURE	389,323	C
(5) INV. IN CATHOLIC FOUNDATION	25,457	F




Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	9,578,157

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
ACCRUED PENSION LIABILITY		25,426,099
SETTLEMENT VALUE OF CONSTR RET		357,572
RETIRE OBLIGATION ASBESTOS		223,885
ESTIMATED SELF-INSURANCE		113,143





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		26,120,699
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ASC SUBTOPIC 740-10		ON JULY 1, 2007, HSHS ADOPTED ASC SUBTOPIC 740-10,ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO.109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2012 AND 2011, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 225 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	1	2,160	2,653,308	0	2,653,308	2.510 %
b Medicaid (from Worksheet 3, column a) .....	1	20,290	15,931,970	11,331,027	4,600,943	4.360 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .	2	574	29,280	0	29,280	0.030 %
dTotal Financial Assistance and Means-Tested Government Programs .....	4	23,024	18,614,558	11,331,027	7,283,531	6.900 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	57	8,600	215,475	11,522	203,953	0.190 %
f Health professions education (from Worksheet 5) ..	8	97	32,328	0	32,328	0.030 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	7	360	1,507,486	565,822	941,664	0.890 %
jTotal Other Benefits ...	72	9,057	1,755,289	577,344	1,177,945	1.110 %
kTotal. Add lines 7d and 7j. ..	76	32,081	20,369,847	11,908,371	8,461,476	8.010 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	2	21	226	0	226	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	32	222	0	222	0 %
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	3	53	448	0	448	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

1,951,245

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

839,947

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

31,667,296

Enter Medicare allowable costs of care relating to payments on line 5.....

44,744,642

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-13,077,346

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1Prevea Clinic - PHS	HEALTHCARE	25.000 %	0 %	50.000 %
2Prevea Health Ntwrk	healthcare	25.000 %	0 %	50.000 %
3Prevea Ventures	healthcare	25.000 %	0 %	50.000 %
4Prevea health srvcs	healthcare	25.000 %	0 %	50.000 %
5unity limited pship	healthcare	10.000 %	0 %	0 %
6NE WI RAD THERAPY	healthcare	25.000 %	0 %	50.000 %
7community mem hospit	healthcare	7.200 %	0 %	0 %
8
9
10
11
12
13

Schedule H (Form 990) 2011

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	ST MARY'S HOSPITAL MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY,WI54303	X	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

ST MARY'S HOSPITAL MEDICAL CENTER

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1	Yes
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20 11
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3	Yes
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4	Yes
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5	Yes
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7		No
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 225.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
SCHEDULE H, PART I, LINE 3C		NOT APPLICABLE AS THE ORGANIZATION DOES FOLLOW FPG TO DETERMINE ELIGIBILITY FOR PROVIDING CHARITY AND DISCOUNTED CARE TO LOW-INCOME, UNINSURED, AND UNDERINSURED INDIVIDUALS.
SCHEDULE H, PART I, LINE 6A		ST. MARY'S COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST AT WWW.STMGB.ORG.
SCHEDULE H, PART I, LINE 7G		THE HOSPITAL DOES NOT HAVE SUFFICIENT INFORMATION AT THIS TIME TO DETERMINE IF SUBSIDIZED SERVICES EXIST BASED ON THE DEFINITION AND CALCULATIONS REQUIRED BY THE IRS AND WILL CONTINUE TO WORK AND PROVIDE SUCH INFORMATION IN NEXT YEAR'S RETURN.
SCHEDULE H, PART I, LINE 7, COLUMN (F)		THE PERCENT OF CHARITY CARE AND CERTAIN OTHER BENEFITS AT COST AS A PERCENT OF TOTAL EXPENSES LESS BAD DEBT IS 8.01%. THE AMOUNT OF BAD DEBT EXPENSE REMOVED WHEN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F WAS $5,129,875.
SCHEDULE H, PART I, LINE 7		CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FISCAL YEAR ENDING 2012 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H - WORKSHEET J.
SCHEDULE H, PART II		THE COMMUNITY BUILDING ACTIVITIES THAT WE HAVE TRACKED AND REPORTED IN OUR COMMUNITY BENEFIT REPORT ARE A MINOR POTION OF OUR TOTAL COMMUNITY BENEFIT EFFORTS. THEY CONSIST PRIMARILY OF ACTIVELY PARTICIPATING IN AND SUPPORTING THE WORK OF COMMUNITY GROUPS TO ADVANCE COMMUNITY AWARENESS ABOUT HEALTH ISSUES.
SCHEDULE H, PART III, LINE 4		THE HOSPITAL STRONGLY BELIEVES THAT ITS CHARITY CARE, AND THE RELATED COMMUNITY BENEFIT OBTAINED FROM SUCH CARE, IS UNDERSTATED BECAUSE OF THOSE PATIENTS THAT POTENTIALLY QUALIFY FOR CHARITY CARE BUT DO NOT WISH TO APPLY FOR IT. IN ADDITION, SOME CARE IS NOT CLASSIFIED AS CHARITY DUE TO MISSING DOCUMENTATION ON PATIENT RESOURCES. THUS, THE HOSPITAL'S BAD DEBT MAY INCLUDE A PORTION THAT COULD BE CLASSIFIED AS CHARITY CARE IF APPLICATION FOR SUCH CARE WAS SOUGHT AND/OR COMPLETED. CURRENTLY, THE HOSPITAL IS IMPLEMENTING PROCESSES, PROCEDURES, AND SYSTEMS TO MORE EFFECTIVELY DETERMINE CHARITY CARE THAT WILL REDUCE A PATIENT'S DOCUMENTATION REQUIREMENTS AND EASE THE PATIENT'S EMOTIONAL BURDEN IN APPLYING FOR CHARITY CARE. THIS WILL PROVIDE A MORE ACCURATE REPORTING OF CHARITY CARE SERVICES PROVIDED BY THE HOSPITAL. THE HOSPITAL COMPUTES THE COST OF BAD DEBT BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE TOTAL CHARGES WRITTEN OFF AS BAD DEBT EXPENSE. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY THE BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES, AND COMMUNITY BENEFIT EXPENSE. THE ADJUSTED OPERATING COST IS THEN DIVIDED BY THE TOTAL GROSS PATIENT CHARGES TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES.
SCHEDULE H, PART III, LINE 8		THE HOSPITAL CONTINUALLY STRIVES TO PROVIDE EXCELLENT PATIENT CARE IN THE MOST COST EFFECTIVE FASHION. NONETHELESS, THE MEDICARE PROGRAM, IN MANY CASES, DOES NOT PROVIDE PAYMENT THAT COVERS THE FULL COST OF THE CARE PROVIDED. SINCE IT IS THE MISSION OF THE HOSPITAL TO RESPOND TO COMMUNITY NEED, HOSPITAL MANAGEMENT CONTINUALLY ADVOCATES FOR IMPROVED MEDICARE PAYMENT SO THAT THE COST OF QUALITY CARE TO THOSE PATIENTS THAT ARE NOT ABLE TO AFFORD IT IS NOT COMPROMISED AND IS FAIRLY SUBSIDIZED BY ALL PAYERS. WHILE THIS SHORTFALL IN MEDICARE PAYMENTS IS NOT CLASSIFIED AS COMMUNITY BENEFIT BY THE IRS, WE NONETHELESS BELIEVE IT IS AN IMPORTANT CONTRIBUTION MADE BY THE HOSPITAL TO THE HEALTH AND WELL-BEING OF THE COMMUNITY. OUR MISSION CALLS US TO SERVE ALL PATIENTS WITH THE HIGHEST POSSIBLE QUALITY AND EFFICIENCY, EVEN IF WE ARE NOT PAID FULLY FOR DOING SO. THE HOSPITAL COMPUTES THE UNPAID COSTS OF PROVIDING CARE TO MEDICARE PATIENTS BY COMPARING THE COST OF THE SERVICES TO THE REIMBURSEMENT RECEIVED FROM MEDICARE DURING THE YEAR. THE COST OF MEDICARE SERVICES IS CALCULATED BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE ANNUAL MEDICARE CHARGES. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES, AND COMMUNITY BENEFIT EXPENSE. THE DIFFERENCE BETWEEN THE REIMBURSEMENT RECEIVED AND THE CALCULATED COST OF THE SERVICES IS REPORTED AS THE MEDICARE SHORTFALL.
SCHEDULE H, PART III, LINE 9B		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 PROVIDING ADEQUATE DOCUMENTATION. IF THE PATIENT QUALIFIES 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 QUALIFIES 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 PAYOR 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. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO QUESTION VI, 3.
Part V, Section B, Line 3		THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS TRULY A COLLABORATIVE EFFORT. IN WISCONSIN, PUBLIC HEALTH DEPARTMENTS CONDUCT COMMUNITY HEALTH NEEDS ASSESSMENTS EVERY FIVE YEARS. THE BROWN COUNTY AND CITY OF DEPERE PUBLIC HEALTH DEPARTMENTS COLLABORATE ON THE ONE FOR BROWN COUNTY, THE COUNTY IN WHICH GREEN BAY IS LOCATED. WHEN A LEADER FROM ST. MARY'S APPROACHED THE HEALTH DEPARTMENTS ABOUT POSSIBLE OPPORTUNITIES TO COLLABORATE, THEY NOT ONLY WILLINGLY AGREED TO FIND WAYS TO DO SO, THEY ALSO AGREED TO MODIFY THEIR EVERY-FIVE-YEAR PROCESS TO MEET THE HOSPITALS' EVERY- THREE-YEAR TIME FRAME AND TO BEGIN TO CONDUCT THE LOCAL NEEDS ASSESSMENT IMMEDIATELY. IN THE PAST, THE BROWN COUNTY/CITY OF DEPERE HEALTH DEPARTMENTS WOULD THEMSELVES CONVENE THE COMMUNITY WIDE PLANNING TEAM AND THE SUBSEQUENT ACTION PLANNING TEAMS. ONCE CONTACTED ABOUT OPPORTUNITIES TO COLLABORATE, THEY INSTEAD CONVENED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT INCLUDED REPRESENTATIVES OF ST. MARY'S AND ITS SISTER HOSPITAL ST. VINCENT, THE LOCAL UNITED WAY, THE OTHER NOT FOR PROFIT HOSPITAL IN GREEN BAY, AND REPRESENTATIVES OF THE REGIONAL OFFICE OF WISCONSIN'S DEPARTMENT OF HEALTH. THIS STEERING COMMITTEE THEN WORKED TO IDENTIFY REPRESENTATIVES WHO COULD BROADLY REPRESENT THE COMMUNITY IN ACTUALLY CONDUCTING THE NEEDS ASSESSMENT AND SETTING PRIORITIES. THESE INDIVIDUALS WERE REFERRED TO AS OUR COMMUNITY "PARTNERS". ALL STEERING COMMITTEE MEMBERS WERE ASSIGNED PEOPLE TO CONTACT TO INVITE THEM INTO THE PROCESS AS PARTNERS. THIS RESULTED IN A COMMUNITY PARTNER GROUP THAT WAS BROADLY REPRESENTATIVE OF THE COMMUNITY: MANY COMMUNITY SERVICE AGENCIES, EDUCATIONAL INSTITUTIONS, GOVERNMENT, HEALTH CARE, LOW INCOME AND MINORITY POPULATION REPRESENTATIVES, PUBLIC HEALTH EXPERTS, AND OTHERS (SEE PARTNER LISTING AT THE END OF THIS REPORT). THE STEERING COMMITTEE ALSO DECIDED THE FORMAT FOR EACH MEETING, EVALUATED THE EFFECTIVENESS OF EACH MEETING AFTER IT OCCURRED, DEVELOPED THE PRIORITIZATION PROCESS, AND EVALUATED THE EFFECTIVENESS OF THE ENTIRE PROCESS. STEERING COMMITTEE MEMBERS ALL ASSUMED RESPONSIBILITIES FOR TASKS RELATED TO THE PROCESS DURING THE COURSE OF THE NEEDS ASSESSMENT. THE REPORT ENTITLED HEALTHY WISCONSIN 2020 AND THE HEALTH FOCUS AREAS CONTAINED WITHIN SERVED AS THE BASIS FOR THE HEALTH NEEDS ASSESSMENT. AN EPIDEMIOLOGIST FROM THE WISCONSIN DEPARTMENT OF HEALTH GATHERED DATA FROM SECONDARY SOURCES (SUCH AS PUBLIC HEALTH STATISTICS) ON HOW BROWN COUNTY AND THE CITY OF DEPERE COMPARES WITH THE STATE-WIDE DATA. ST. MARY'S HOSPITAL ALSO PROVIDED ADDITIONAL DATA WHEN AVAILABLE. MEETINGS OF ALL THE PARTNERS WERE HELD ONCE A MONTH FOR OVER SIX MONTHS. A PROFILE OF EACH HEALTH NEEDS AREA WAS DEVELOPED, AND THE "PARTNERS" REVIEWED THE DATA AT THESE MEETING WHERE THE INFORMATION WAS PRESENTED. THEY DISCUSSED KEY DATA POINTS AND ASSESSED WHAT IS CURRENTLY BEING DONE. BEFORE THE MEETING CONCLUDED, THEY THEN RATED THE HEALTH FOCUS AREA ON 3 CRITERIA --MAGNITUDE (NUMBER OF PEOPLE IMPACTED), SERIOUSNESS (LEVEL OF IMPACT OF THE PROBLEM), AND FEASIBILITY (WHETHER THERE ARE KNOWN INTERVENTIONS TO ADDRESS THE PROBLEM). THESE RATINGS WERE COMBINED, AND BASED ON THIS THE HEALTH FOCUS AREAS WERE NARROWED TO THE TOP EIGHT. AT A FINAL MEETING OF THE PARTNERS GROUP, A MULTI-VOTE APPROACH WAS USED TO NARROW THE TOP EIGHT TO THE TOP THREE. THE TOP THREE NEEDS WERE: ORAL HEALTH ADEQUATE AND APPROPRIATE FOOD AND NUTRITION, AND ALCOHOL AND OTHER DRUG ABUSE (AODA) THROUGHOUT THIS PROCESS, ST. MARY'S LEADERSHIP WAS ACTIVELY ENGAGED. THE PROGRESS OF THE NEEDS ASSESSMENT WAS REGULARLY REVIEWED BY AN INTERNAL COMMUNITY BENEFIT COMMITTEE. THE FINDINGS OF THE NEEDS ASSESSMENT WERE ALSO SHARED WITH OUR HOSPITAL'S COMMUNITY ADVISORY COMMITTEE FOR THEIR REACTION AND COMMENT. THE COMMUNITY ADVISORY COMMITTEE IS A GROUP OF OVER 25 COMMUNITY MEMBERS REPRESENTING BUSINESS, EDUCATION, NOT FOR PROFIT AGENCIES, LOW INCOME AND MINORITY POPULATIONS, CLERGY, AND OTHERS WHO SERVE AS ADVISORS TO THE HOSPITAL. THE INTERNAL COMMUNITY BENEFIT COMMITTEE AND THE COMMUNITY ADVISORY COMMITTEE SERVE BOTH ST. MARY'S AND ST. VINCENT BECAUSE THE TWO HOSPITALS PROVIDE COORDINATED SERVICES TO THE GREEN BAY AREA AS PART OF THE HOSPITAL SISTERS HEALTH SYSTEM EASTERN WISCONSIN DIVISION. BROWN COMMUNITY HEALTH NEEDS ASSESSMENT PARTNER LISTING: - AGING & DISABILITY RESOURCE CENTER, SUNNY ARCHAMBAULT - AURORA HEALTH SYSTEM, JULIE POMASL - BAY AREA COMMUNITY COUNCIL, PAT FINDER-STONE - BELLIN COLLEGE, KATHIE DEMUTH - BELLIN HEALTH, JODY WILMET - BELLIN HEALTH, LINDA ROETHLE - BOYS & GIRLS CLUB, JOHN BENBERG - BROWN COUNTY BOARD , MIKE FLECK - BROWN COUNTY BOARD OF HEALTH (BOARD MEMBER), AUDREY MURPHY - BROWN COUNTY COMMUNITY TREATMENT CENTER, MARY JOHNSON - BROWN COUNTY COOPERATIVE EXTENSION, JUDY KNUDSEN - BROWN COUNTY HEALTH DEPARTMENT, JUDY FRIEDERICHS (DIRECTOR, BROWN COUNTY HEALTH DEPARTMENT) - BROWN COUNTY HUMAN SERVICES, KEVIN LUNOG - BROWN COUNTY PLANNING, CHUCK LAMINE - BROWN COUNTY UNITED WAY, STEPHANIE FOLEY - CENTER FOR CHILDHOOD SAFETY/ SAFE KIDS GREATER GREEN BAY, JUSTINE LODL - CITY OF DE PERE BOARD OF HEALTH (BOARD MEMBER), PAT FINDER-STONE - CITY OF DE PERE HEALTH DEPARTMENT, MARY DORN, HEALTH DIRECTOR - DE PERE AREA CHAMBER OF COMMERCE, CHERYL DETRICK - DIVISION OF PUBLIC HEALTH NORTHEAST REGIONAL OFFICE, REBECCA HOVARTER, REGIONAL PUBLIC HEALTH NURSING CONSULTANT - DIVISION OF PUBLIC HEALTH NORTHEAST REGIONAL OFFICE, LYNN HRABIK, EPIDEMIOLOGIST - FAMILY SERVICES-CRISIS CENTER, TANA KOSS - GREATER GREEN BAY COMMUNITY FOUNDATION, MARTHA AHRENDT - GREATER GREEN BAY YMCA, SANDY ATKINS - GREEN BAY CHAMBER OF COMMERCE, NAN NELSON, CCE - HOMELESS POPULATION REPRESENTATIVE, SETH MOORE - N.E.W. COMMUNITY CLINIC, BONNIE KUHR - NWTC HEALTH SCIENCE, KAY TUPALA, DEAN - ONEIDA TRIBE OF INDIANS, MICHELLE MYERS - PARISH NURSE, KATIE DYKES - BROWN COUNTY SHERIFF REPRESENTATION --CHIEF'S GROUP, RANDY SCHULTZ - PREVEA HEALTH, DR. ASHOK RAI - ST. MARY'S HOSPITAL MEDICAL CENTER, HEIDI SELBERG - ST VINCENT HOSPITAL, HEIDI SELBERG - ST WILLEBROAD CATHOLIC PARISH, MARIA PLASCENCIA - SCHOOL REPRESENTATION --SUPERINTENDENT'S GROUP, BARB NATELLE - THE SALVATION ARMY, REBECCA LESPERANCE - UNITED HMONG AND ASIAN AMERICAN COMMUNITY CENTER, STARYOUNG THAO - UWGB-ENVIRONMENTAL SCIENCES, THOMAS ERDMAN - UW-GREEN BAY NURSING PROGRAM, CHRIS VANDENHOUTEN - WOMEN, INFANT AND CHILDREN (WIC), BONNIE KUHR
Part V, Section B, Line 4		Bellin Health was actively involved in the community health needs assessment.
Part V, Section B, Line 7		The board of directors approved the implementation strategy associated with the community health needs assessment in May, 2012. Thus, many of the activities identified in the implementation plan did not begin until after the end of the tax year. That said, some work on the oral health issue began in tax year 2012 through the formation of the community wide task force. They began their work by reviewing various models for addressing oral health issues in adults during tax year 2012, and began formulating action plans in the subsequent tax year. Our hospital actively supported the efforts of the NEW Community Clinic to apply for FQHC (federally qualified health center) status, which would allow them to provide dental services more easily and effectively than is currently the case; they were awarded this status at the end of June 2012. Our support of NEW Clinics application included donations to the current clinic location that were cited as part of the required matching funds and providing grant writing expertise and access to data to support the application. In addition, some work began with the alcohol and other drug needs issue through initiating discussions with local agencies on how medical clearance for alcohol intoxication is currently working. An issue that emerged during the course of the year was the influx of the Somali population to the Green Bay area. This first came to our attention by one of our community advisory committee members who shared some of the migration patterns that were emerging. We reviewed our experience and identified that we were, in fact, seeing a greater incidence of Somalis, and then acted to provide staff training on culturally appropriate responses. We also met with other community agencies to determine what services were being accessed by Somalis locally and if there were gaps that better coordination could address. This turned out to be a fairly intense but short term community need, as in a matter of months the migration continued and many Somalis left the Green Bay area for locations with better job prospects.
Part V, Section B, Line 13G		Our hospital posts our charity care policy and application on our website. In addition, charity care applications are available and prominently displayed in our waiting and registration areas. Our financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. Our collectors are trained to provide this assistance as well. Last but not least, we have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits.
Part V, Section B, Line 19D		The hospital sets the rate for billing individuals without insurance covering emergency or other medically necessary care at the hospitals lowest commercial rate.
Needs assessment		The FY 2012 Community Health Needs and associated implementation strategy will be used to guide our efforts in FY2013. For prior years, we employed a number of methods to assess health care needs: 1) We have a community advisory committee broadly representative of the community. This committee meets regularly to discuss hospital services and advise us on how well we are meeting community needs. As terms expire, committee members assist in identifying new members who can continue to assist us in this way. We include representatives from the neighboring communities we serve, as well as some potentially underserved groups such as Hmong or Native American leaders. 2) Hospital leadership meets with each committee member individually each year to learn more about their opinions about community needs. 3)we examine the reasons that self-pay and medical assistance patients come to our emergency department for care. 4) Hospital leadership serve on local social service agency boards, such as NEW Community Clinic. 5) Our Hispanic health educator/cultural liaisons assist using identifying needs of special subgroups of patients. THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED AT: http://www.stmgb.org/Scripts/pageview.asp?id=325
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE		OUR HOSPITAL POSTS OUR CHARITY CARE POLICY AND APPLICATION ON OUR WEBSITE. IN ADDITION, CHARITY CARE APPLICATIONS ARE AVAILABLE AND PROMINENTLY DISPLAYED IN OUR REGISTRATION AREAS. OUR FINANCIAL COUNSELORS ARE AVAILABLE TO MEET WITH PATIENTS ON SITE BEFORE, OR AT, THE TIME OF SERVICE TO ASSIST THEM IN IDENTIFYING WHETHER THEY ARE ELIGIBLE FOR GOVERNMENT AID OR FINANCIAL ASSISTANCE, AND TO ASSIST THEM IN APPLYING FOR PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE. AFTER PATIENTS RECEIVE SERVICE, OUR CUSTOMER SERVICE REPRESENTATIVES ARE ALSO TRAINED TO ASSIST THEM TO APPLY FOR VARIOUS GOVERNMENT PROGRAMS OR FOR OUR CHARITY CARE PROGRAM. OUR COLLECTORS ARE TRAINED TO PROVIDE THIS ASSISTANCE AS WELL. LAST BUT NOT LEAST, WE HAVE CONTRACTED WITH AN OUTSIDE FIRM TO DO ACTIVE OUTREACH WITH PATIENTS WHO MAY NEED ADDITIONAL ASSISTANCE OR ADVOCACY TO APPLY FOR BENEFITS, APPEAL DENIALS, OR WHO NEED TRANSPORTATION TO GOVERNMENT AGENCIES TO APPLY FOR BENEFITS.
Community Information		Brown County, Wisconsin is a primarily urban county, one of 72 Wisconsin counties located in the northeastern part of the state. Brown Countys population is primarily Caucasian, but there is a notable Native American population, as well as a growing Asian and Hispanic population. There are approximately 250,000 residents, of which about 42,000 are covered by Medicaid/Badger Care Plus. About 9% of Brown County Residents live at or below the federal poverty level, and 17% have incomes less than 200% percent of poverty (Source: WI DHS Public Health Profiles, Family Health Survey). Since most of the population resides in the Green Bay metro area, plans and services focus on this area.
PROMOTION OF COMMUNITY HEALTH		St. Marys Hospital Medical Center offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Marys is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 100 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospitals purpose and tradition, it is organized to promote the health of Brown County, Wisconsin, and surrounding areas. The hospital is governed by a Board of Directors, the majority of which is comprised of persons who reside in the organizations primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Marys is responding to community need. During the last year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. In addition our hospital Advisory Council, Friends of St. Marys Foundation and volunteers who assist in many areas of the hospital, provide the hospital with additional connections to and insights into the larger community and its health care needs. Also consistent with its exempt purpose, St. Marys has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Marys reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, St. Marys is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this careintegration strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. For example, the new Epic electronic medical record system enables providers to connect with their patients medical record from wherever they are as well as allows emergency physicians access to patient medical records from any facility that has Epic. This reduces duplicate testing, puts critical health information at providers fingertips, helps better manage chronic conditions, and improves patient safety. A Heart Failure Clinic has been established to assist heart failure patients with maintaining good health and staying out of the hospital incorporating diet, exercise and other wellness information into the longterm care plan. This growing program has shown success in reducing readmissions, something that is also especially helpful for those with limited financial resources. St. Marys Hospital Medical Center provides significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, St. Marys provided over $8.5million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. During this period, St. Marys provided $13.1 million (at cost) in excess of Medicare payment for health care services. Responding to Community Need The range of benefits provided by St. Marys flows from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Marys, and they often relieve a burden that would otherwise be carried by government. An example of our community benefit initiatives is the support we provide to patients that pass each year through the doors of the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St Marys provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinics care prevented a trip to the emergency department. A Woman's Place at St. Mary's Hospital Medical Center has been a valued and trusted outreach center for women and their families throughout our area. Through A Woman's Place we reach our Hispanic neighbors to provide health and wellness education, health screenings, resources and referral services, facilitated by the role of a Hispanic Health Educator. Last year A Woman's Place touched the lives of more than 7,000 women through its Resource Center and consumer lending library, screenings for cardiovascular disease, osteoporosis and reproductive cancer; educational events and classes on a variety of health topics. An additional 65,000 women were touched through its quarterly health newsletter. St. Mary's sponsors a walking club at the local mall. More than 490 active members participate in a variety of health-related screenings and informational sessions throughout the season which runs from September through May each year. In addition to using the mall as a venue for walking, the program has been extended to include routes throughout the city. Routes and incentives for walking are posted on our website to encourage people of all ages to lead an active lifestyle. Hospital employees provide information at educational and public forums, such as the YMCA Healthyn Kids Day, A Day Just for Women, Brown County Aging Resource Center, the Big Event for Little Kids, a series of events during National Womens Health Week and the Einstein Project. Many underserved and uninsured of our community attend these events. The American Cancer Society Loan Closet - located at A Woman's Place - provides wigs, scarves, turbans, hats and breast prostheses for women living with the side effects of cancer treatments. Additionally, the Look Good, Feel Better program offers information and guidance to cancer patients looking to enhance their appearance. This gives patients a sense of control over physical changes they may experience. St. Mary's Hospital along with St. Vincent Hospital and Bellin Health supports Unity Hospice, a provider of appropriate and compassionate care for the terminally ill. These various efforts to serve the needs of our community result in real benefits for the people of Green Bay.
Affiliated health care system		ST. MARY'S HOSPITAL MEDICAL CENTER - GREEN BAY is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and more than 2,000 physician partners across Illinois and Wisconsin. The Mission of HSHS is to reveal and embody Christs healing love for all people through our high quality Franciscan health care ministry. We live our Mission by healing those who seek our care, as well as through our Community Benefit initiatives. Working collaboratively with others in the 12 communities we serve, our Community Benefit efforts are successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. Across HSHS, we collectively provided $174.2 million in Community Benefits (or 9.7% of total hospital expenses) in FY2012. Included in this amount was $43.1 million provided for Charity Care and $97.9 million for unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources to care for 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 $168.4 million. HSHS hospitals also recorded $106.6 million in uncollectible accounts. Beyond the dollars invested in our Community Benefit programs, HSHS also 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 do, we ensure we are able to meet the ongoing demand for high quality, efficient and easily accessible health care. Recognizing that the health care delivery model in the U.S. is evolving, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care around the needs of each patient. During FY2012, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for the individual. Our efforts to ensure residents in the communities we serve receive the right care at the right time often involve partnering with others to achieve this goal. Across our two-state system, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. In western Wisconsin, St. Josephs Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,216 patient visits, a 25% increase from the prior year. With more than 150 individuals volunteering, the clinic provided over 6,500 hours (including 700 physician hours and 1,500 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In northeastern Wisconsin, St. Vincent Hospital in Green Bay supports patient care for the uninsured at the NEW Community Clinic by paying a nurses salary and offering free and discounted laboratory and radiology services. More than 70% of patients who use the clinic report the care they received helped keep them out of the Emergency Department. St. Nicholas Hospital in Sheboygan proactively reaches out to local Hmong and Hispanic organizations to ensure these populations can participate in free screenings and health education programs. Through this ongoing outreach initiative, St. Nicholas engaged more than 350 people last year, and in many cases was able to identify critical health conditions early and provide appropriate follow-up care. A Woman's Place at St. Mary's Hospital Medical Center in Green Bay reaches out to Hispanic neighbors to provide health and wellness education, health screenings, resources and referral services. Last year A Woman's Place touched the lives of more than 7,000 women through health screenings, educational events, classes and its resource center. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthonys Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthonys helped underwrite the cost of prescription medications for more than 430 residents. In southwest Illinois, St. Joseph's Hospital in Highland recognized many rural residents did not have a reliable means of transportation and partnered with generous individuals in the community to offer a free transportation service. The Friends Van, fully supported by the Friends of St. Joseph's Hospital, provides free rides to medical, dental and other personal appointments within a 20-mile radius of Highland. In FY2012, the Friends Van transported 2,050 individuals for a total of 12,561 miles. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Charity Care program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Charity Care programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our charity care policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our mission to embody Christs healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services.HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. To address metabolic disease management, St. Francis Hospital in Litchfield, Illinois, partners with Montgomery County Health Department to provide screening for diabetes and renal disease. ST. FRANCIS HOSPITAL teams up with Macoupin County Health Department to provide Diabetes Self-Management classes. St. Josephs Hospital in Breese, Illinois coordinates several community education seminars and health fairs on cardiovascular disease and healthy eating each year. Over 3,000 residents participated in these health events last year. Recognizing the importance of proper food and nutrition to overall health, St. Johns Hospital in Springfield initiated the Destination Dinner program which teaches families how to cook healthy, from-scratch meals, and eat together as a family. Families meet quarterly to learn new cooking skills. They also learn how to prepare a meal for a family of four on a budget of $8.00. In addition to raising awareness about how to eat healthy on a limited budget, the program brings families together around the dinner table, which research shows promotes healthy relationships, increased academic performance and decreased risk for substance abuse and risky sexual behavior. Sacred Heart Hospital in Eau Claire, Wisconsin addressed the need for access to mental health services for children and adolescents by opening an outpatient behavioral health clinic. Sacred Heart has also adopted screening tools for behavioral and mental health risk factors for use at affiliated clinics. The goal is to better identify mental health issues and provide earlier intervention. Sacred Heart Hospital is also working with the Chippewa Valley Free Clinic (CVFC) to develop expanded provider coverage for CVFC patients who require mental health services
STATE FILING OF COMMUNITY BENEFIT REPORT		WI

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) THERESE PANDL	(i) (ii)	0 559,242	0 0	0 16,485	0 169,750	0 27,306	0 772,783	0 58,540
(2) ANN M CARR	(i) (ii)	0 180,382	0 0	0 45,430	0 197,622	0 18,652	0 442,086	0 15,440
(3) LAWRENCE J CONNORS	(i) (ii)	188,584 0	0 0	0 0	117,182 0	24,315 0	330,081 0	0 0
(4) AMY J UNRATH	(i) (ii)	231,875 0	0 0	0 0	234,896 0	9,534 0	476,305 0	0 0
(5) DONNA A HUTCHINSON	(i) (ii)	73,160 0	0 0	0 0	197,001 0	1,291 0	271,452 0	0 0
(6) JOHN DAUL	(i) (ii)	181,757 0	0 0	0 0	82,029 0	21,903 0	285,689 0	0 0
(7) MARY ALICE JOHNSON	(i) (ii)	181,661 0	0 0	0 0	157,125 0	23,993 0	362,779 0	0 0
(8) CRAIG BABIARZ	(i) (ii)	186,399 0	0 0	0 0	34,905 0	8,195 0	229,499 0	0 0
(9) STEPHEN KORDIYAK	(i) (ii)	179,758 0	0 0	0 0	61,367 0	21,986 0	263,111 0	0 0
(10) GABRIEL LEIS	(i) (ii)	198,553 0	0 0	0 0	16,534 0	22,603 0	237,690 0	0 0
(11) greg simia	(i) (ii)	0 166,664	0 50,000	0 0	0 0	0 12,262	0 228,926	0 0
(12) FRANK MIKELL	(i) (ii)	0 604,272	0 0	0 113,875	0 101,313	0 18,171	0 837,631	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
THERESE PANDL	SCHEDULE J, PART I, LINE 4B	THERESE PANDL PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $56,375.
ANN M. CARR	SCHEDULE J, PART I, LINE 4B	ANN M. CARR PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $33,655.
FRANK MIKELL	SCHEDULE J, PART I, LINE 4B	FRANK MIKELL PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $111,653.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No
(1) THERESE PANDL MORTGAGE EXTENSION		X	250,000	274,484		No	Yes		Yes
(2) THERESE PANDL STOCK PURCHASE		X	4,125	4,125		No	Yes		Yes




Total ............... $				278,609

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) PREVEA CLINIC	OFFICER	3,483,277	PHYSICIAN SERVICES		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
LOANS TO/FROM INTERESTED PERSONS	SCHEDULE L, PART II	ALL TRANSACTIONS INVOLVING INTERESTED PERSONS ARE DETERMINED TO BE CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE APPROVED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING.
BUSINESS TRANSACTIONS WITH INTERESTED PERSONS	SCHEDULE L, PART IV	ALL TRANSACTIONS INVOLVING INTERESTED PERSONS ARE DETERMINED TO BE CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE APPROVED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING.

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Identifier	Return Reference	Explanation
ORGANIZATION'S MISSION	FORM 990 PART III, LINE 1	TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS. PROGRAM SERVICE REVENUE - SURGERY FORM 990 PART III, LINE 4A SURGERY St. Mary's Hospital Medical Center Surgical Services Surgical Services at St. Mary's Hospital Medical Center are comprised of Central Processing, Anesthesia, Surgery and Recovery. This includes eight OR Suites, a C-Section Room and two minor treatment rooms, Services are available 24/7 and include both inpatient and outpatient procedures. In fiscal year 2011-2012, over 5,100 surgical procedures were performed. Surgical procedures include General, Orthopedic, Urology, Gynecology, Oral - Maxillofacial, and Organ procurement. Anesthesia and Central Processing also provide Hospital-wide services to Inpatient Nursing, Labor and Delivery and the Emergency Department. The Anesthesia department is comprised of nine employed Nurse Anesthetists and three Anesthesiologists on campus daily.
PROGRAM SERVICE REVENUE - RADIOLOGY SERVICES	FORM 990, PART III, LINE 4B	RADIOLOGY St. Mary's Hospital Medical Center Imaging Services: The Imaging services department at St. Mary's Hospital Medical Center provides Inpatient, Outpatient, and Emergency care. Overall, the department performs more than 50,000 inpatient and outpatient exams and procedures annually. Patients have access to the latest technology in Digital Mammography, Computed Tomography, MRI, Nuclear Medicine, and Ultrasound. Four Interventional Radiologists provide minimally invasive procedures using image guidance. The staff consists of Board Certified radiologists as well as licensed and certified technologists, nurses, and sonographers. The modalities are accredited and utilize state-of-the-art equipment to afford the radiologists optimal images for interpretation. The department and hospital are accredited by the Joint Commission. During FY2012 the department began using a new state of the art MRI wide bore scanner.
PROGRAM SERVICE REVENUE - HEART & VASCULAR CENTER	FORM 990, PART III, LINE 4C	HEART & VASCULAR CENTER St. Mary's Hospital Medical Center Cath Lab: The Cath Lab offers a complete array of catheterization laboratory procedures and noninvasive cardiovascular diagnostic procedures, doing over 1,000 cardiac catheterizations in FY2012. If needed, a state-of-the-art Cardiovascular operating center (CVOR) is available nearby at our sister facility, St. Vincent Hospital, for cutting-edge open heart procedures by our highly-skilled cardiothoracic surgeons. CVICU suites are also offered there. For those patients who need follow-up, a Cardio-Pulmonary Rehabilitation Program is offered on site at St. Mary's. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES St. Mary's Hospital Medical Center Other Program Services at St. Mary's Hospital Medical Center is comprised of Family Birthing Center, Intensive Care, Emergency, Center for Digestive Health, Pharmacy, Laboratory, Respiratory Therapy, Rehabilitation Services and other services. In FY2012 the hospital had over 105,000 outpatient registrations, over 4,400 admissions, 15,440 patient days, 659 births and over 33,100 emergency room visits.
TAX EXEMPT BONDS	FORM 990, PART IV, LINE 24	ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODY	FORM 990, PART VI, LINE 6 & 7A	THE SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH 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. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD, AND PRESIDENT.
MEMBER RESERVED POWERS	FORM 990, PART VI, LINE 7B	RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC. (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 MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO, FROM TIME TO TIME, ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI.
FORM 990 REVIEW PROCESS	FORM 990, PART VI, LINE 11B	THE HOSPITAL EMPLOYS KPMG TO ASSIST IN THE OVERALL PREPARATION, REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. KPMG PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION, AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS.
CONFLICT OF INTEREST POLICY	FORM 990, PART VI, LINE 12C	THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, 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.
WHISTLEBLOWER POLICY	FORM 990, PART VI, LINE 13	PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
COMPENSATION PROCESS	FORM 990, PART VI, LINE 15a and 15b	THE COMPENSATION COMMITTEE ("COMMITTEE") IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES, AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING.
DOCUMENTS AVAILABLE TO THE PUBLIC	FORM 990, PART VI, LINE 19	BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME.
POOLED INVESTMENT ACCOUNT	FORM 990, PART X, LINE 11	THE HOSPITALS CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS ("SFAS") NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS.
Other Changes in net assets or fund balances	Form 990, Part XI, Line 5	UNREALIZED GAIN $(2,192,015) TEMPORARILY RESTRICTED INCOME IN FOUNDATION (848,230) PERMANENTLY RESTRICTED INCOME IN FOUNDATION 390 RECOGNITION OF CHANGES IN PENSION FUNDED STATUS (8,964,000) TRANSFER TO AFFILIATES (1,263,000) ROUNDING (12,705) ------------ TOTAL OTHER CHANGE IN NET ASSETS OR FUND BALANCES (13,279,560) ============
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:FRANK MIKELL TITLE:DIRECTOR HOURS:59
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ANN M. CARR TITLE:TREASURER HOURS:60

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL MEDICAL CENTER OF
GREEN BAY INC - HOSPITAL SISTERS

Employer identification number

39-0818682

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 26-1417684	HEALTHCARE	IL	0	0	HSSI
(2) PHYSICIAN CLINICAL INTEGRATION NTWRK LLC 4936 Laverna ROAd Springfield,IL62707 37-1668647	HealthCare	IL	0	0	KCIN
(3) SPRINGFIELD HEALTH PARTNERS LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1364419	HEALTHCARE	IL	0	0	HSHS MG

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1058692	HEALTHCARE	IL	501(c)(3)	11A	NA		No
(2) HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1163402	HEALTHCARE	IL	501(c)(3)	11A	NA		No
(3) HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1186514	HEALTHCARE	IL	501(C)(3)	11A	NA		No
(4) HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1120626	INSURANCE	IL	501(c)(3)	11A	NA		No
(5) HSHS HEALTH CARE PLAN TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1137724	HEALTHCARE	IL	501(C)(3)	N/A	NA		No
(6) HOSPITAL SISTERS HEALTHCARE WEST INC 2661 COUNTY HIGHWAY I CHIPPEWA FALLS,WI54729 51-0157933	HEALTHCARE	WI	501(C)(3)	11A	NA		No
(7) SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVENUE EAU CLAIRE,WI54701 39-0807060	HEALTHCARE	WI	501(C)(3)	3	NA		No
(8) ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM,IL62401 37-0661233	HEALTCARE	IL	501(C)(3)	3	NA		No
(9) ST ELIZABETH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILE,IL62220 37-0663567	HEALTHCARE	IL	501(C)(3)	3	NA		No
(10) ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN,WI53081 39-0808480	HEALTHCARE	WI	501(C)(3)	3	NA		No
(11) ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-0661238	HEALTHCARE	IL	501(C)(3)	3	NA		No
(12) ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE PO BOX 9 BREESE,IL62230 37-1208459	HEALTHCARE	IL	501(C)(3)	3	NA		No
(13) ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS,WI54729 39-0810545	healthcare	WI	501(c)(3)	3	NA		No
(14) ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR,IL62521 37-0661244	HEALTHCARE	IL	501(C)(3)	3	NA		No
(15) ST MARY'S HOSPITAL 111 SPRING STREET STREATOR,IL61364 36-2169181	HEALTHCARE	IL	501(C)(3)	3	NA		No
(16) STFRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD,IL62056 37-0661236	HEALTHCARE	IL	501(C)(3)	3	NA		No
(17) ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY,WI54301 39-0817529	HEALTHCARE	WI	501(C)(3)	3	NA		No
(18) ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND,IL62249 37-0663568	HEALTHCARE	IL	501(C)(3)	3	NA		No
(19) HSHS MEDICAL GROUP INC 3215 Executive Park Drive SPRINGFIELD,IL62703 26-3956318	HEALTHCARE	IL	501(C)(3)	11A	NA		No
(20) HSHS WISCONSIN MEDICAL GROUP INC 3215 Executive Park Drive Springfield,IL62703 26-4515959	HEALTHCARE	WI	501(C)(3)	11A	NA		No
(21) ORANGE CROSS AMBULANCE INC 919 ASHLAND AVE SHEBOYGAN,WI53081 39-1860942	HEALTHCARE	WI	501(C)(3)	9	STNICHOLAS		No
(22) WISCONSIN UPPER PEN OCN MNGMT SERVICES 835 S VAN BUREN GREEN BAY,WI54301 39-1677100	HEALTHCARE	WI	501(C)(3)	3	ST VINCENT		No
(23) UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE,WI54115 39-1750729	HEALTHCARE	WI	501(C)(3)	11A	HSSI		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CARPENTER STREET HOTEL LLC 525 NORTH SIXTH STREET HOTEL SPRINGFIELD,IL62707	Hotel	IL	LASANTE INC	RELATED	-30,639	1,191,792		No	0		No	50.500 %
(2) NORTHEAST WISCONSIN RADIATION 1821 S WEBSTER AVENUE STE 30 GREEN BAY,WI54301	HEALTHCARE	WI	HSSI	RELATED	438,615	3,757,018		No	0		No	50.000 %
(3) PRAIRIE HEART INSTITUTE - CARB 800 EAST CARPENTER STREET SPRINGFIELD,IL62769	HEALTHCARE	IL	ST JOHN'S	Related	-8,272	20,364		No	0		No	50.000 %
(4) MEMORIAL AND ST ELIZABETH'S HOSPITAL 400 NORTH ILLINOIS STREET SWANSEA,IL62226	HEALTHCARE	IL	ST ELIZABETH'S	RELATED	2,200,182	8,475,835		No	0		No	50.000 %
(5) PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD STE 300 MILWAUKEE,WI53221	HEALTHCARE	WI	ST VINCENT	RELATED	3,153,762	3,085,388		No	0		No	50.000 %
(6) SURGERY CENTER OF SHEBOYGAN 3141 SAEMANN AVE SHEBOYGAN,WI53081	HEALTHCARE	WI	ST NICHOLAS	RELATED	661,480	1,585,809		No	0		No	50.000 %
(7) PREVEA VENTURES LLC 2710 EXECUTIVE DR GREEN BAY,WI54304 20-3775127	HEALTHCARE	WI	HSSI	RELATED	0	0		No	0		No
(8) SPRINGFIELD URGENT CARE REAL ESTATE PO BOX 19456 SPRINGFIELD,IL62794	RENT. REAL ESTATE	IL	LASANTE INC	RELATED	35,277	1,168,057		No	0		No	51.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) Kiara Inc 4936 Laverna ROAd Springfield,IL62707 37-1163401	HealthCare	IL	HSHS	C Corp	-2,076,455	9,647,670	100.000 %
(2) LASANTE INC 4936 Laverna ROAd Springfield,IL62707 37-1163400	HEALTHCARE	IL	Kiara Inc	C Corp	-30,056	577,154	100.000 %
(3) LaSante Wisconsin INC 4936 Laverna ROAd Springfield,IL62707 39-1572196	HealthCare	IL	Kiara Inc	C Corp	509,460	9,832,286	100.000 %
(4) Prairie Cardiovascular 619 East Mason STE 4P57 Springfield,IL62701 37-1071858	HealthCare	IL	Kiara Inc	C Corp	-20,534,879	15,963,339	100.000 %
(5) PREVEA HEALTH SERVICES 2710 EXECUTIVE DR GREEN BAY,WI54304 39-1839351	HEALTHCARE	WI	HSSI	C CORP	0	0
(6) PREVEA CLINIC INC 2710 EXECUTIVE DR GREEN BAY,WI54304 39-1839349	HEALTHCARE	WI	HSSI	C CORP	0	0
(7) PREVEA HEALTH NETWORK 2710 EXECUTIVE DR GREEN BAY,WI54304 39-2000537	HEALTHCARE	WI	HSSI	C CORP	0	0
(8) RENAISSANCE QUALITY INSURANCE 98-0669953	INSURANCE	CA	HSSI	C CORP	0	0

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation
TRANSACTIONS WITH RELATED ORGANIZATIONS	SCHEDULE R, PART V, LINE 2	ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	7
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	837
6	Total number of volunteers (estimate if necessary) ....	6	100
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	929,417
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-1,407,112

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	315,925	969,249
9	Program service revenue (Part VIII, line 2g) .........	113,895,764	115,430,881
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,340,201	774,768
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	773,655	1,580,363
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	118,325,545	118,755,261
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	47,558,268	47,352,045
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	64,383,917	63,374,287
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	111,942,185	110,726,332
19	Revenue less expenses. Subtract line 18 from line 12.......	6,383,360	8,028,929
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	158,314,133	163,199,187
21	Total liabilities (Part X, line 26).............	66,139,699	76,275,384
22	Net assets or fund balances. Subtract line 21 from line 20.....	92,174,434	86,923,803

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 14,122,298 including grants of $ ) (Revenue $ 35,247,491 )
	SURGERY - see schedule O

4b	(Code: ) (Expenses $ 5,989,580 including grants of $ ) (Revenue $ 26,338,793 )
	RADIOLOGY SERVICES - see schedule O

4c	(Code: ) (Expenses $ 4,346,438 including grants of $ ) (Revenue $ 17,239,755 )
	HEART & VASCULAR CENTER - see schedule O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 66,291,393 including grants of $ ) (Revenue $ 35,110,063 )
4e	Total program service expenses$ 90,749,709

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,421,747	1,736,350	1,568,962

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) CRAIG BABIARZ CRNA	40.0	X		186,399	0	42,379
(19) STEPHEN KORDIYAK CRNA	40.0	X		179,758	0	82,579
(20) GABRIEL LEIS CRNA	40.0	X		198,553	0	38,364
(21) DONNA A HUTCHINSON CFO/ASSISTANT ADMINISTRATOR	0.0		X	73,160	0	198,091

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		969,249
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			969,249
			Business Code
2a	PATIENT SERVICES		900,099	113,936,103	113,936,103
b	LABORATORY SERVICES		621,500	651,361		651,361
c	PREVEA INVESTMENT GAIN/LOSS		900,099	843,417	843,417
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			115,430,881
3	Investment income (including dividends, interest
	and other similar amounts).....			-1,199,256			-1,199,256
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	2,991,571
b	Less: rental expenses	3,010,425
c	Rental income or (loss)	-18,854
d	Net rental income or (loss).......			-18,854			-18,854
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	2,002,912
b	Less: cost or other basis and sales expenses		28,888
c	Gain or (loss)	2,002,912	-28,888
d	Net gain or (loss)..........			1,974,024			1,974,024
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	OTHER REVENUE		900,099	861,750			861,750
b	CHILDCARE REVENUE		624,410	737,467	459,411	278,056
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,599,217
12	Total revenue. See Instructions....			118,755,261	115,238,931	929,417	1,617,664


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			2,584	1	2,579
2	Savings and temporary cash investments .......			5,222,105	2	6,691,890
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			13,730,953	4	12,784,813
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			250,000	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			476,737	7	465,724
8	Inventories for sale or use ..............			2,477,670	8	2,479,268
9	Prepaid expenses and deferred charges ............			442,018	9	421,457
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	156,799,798
b	Less: accumulated depreciation. .....	10b	79,261,559	75,424,932	10c	77,538,239
11	Investments—publicly traded securities ..........			49,928,874	11	51,620,725
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			8,627,051	13	9,578,157
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			1,731,209	15	1,616,335
16	Total assets. Add lines 1 through 15 (must equal line 34)...			158,314,133	16	163,199,187
17	Accounts payable and accrued expenses .			15,576,505	17	17,161,138
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			33,637,883	20	32,993,547
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			16,925,311	25	26,120,699
26	Total liabilities. Add lines 17 through 25.....			66,139,699	26	76,275,384
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			84,324,387	27	79,921,595
28	Temporarily restricted net assets .....			5,552,567	28	4,704,337
29	Permanently restricted net assets .....			2,297,480	29	2,297,871
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			92,174,434	33	86,923,803
34	Total liabilities and net assets/fund balances .....			158,314,133	34	163,199,187