Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(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? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
HOSPITAL SISTERS HEALTHCARE WEST |
510157933 | 03 | Yes | Yes | Yes | 0 | |||
| (2)
ST ELIZABETH'S HOSPITAL BELLEVILLE ILLINOIS |
370663567 | 03 | Yes | Yes | Yes | 0 | |||
| (3)
ST JOSEPH'S HOSPITAL BREESE ILLINOIS |
371208459 | 03 | Yes | Yes | Yes | 0 | |||
| (4)
ST JOSEPH'S HOSPITAL HIGHLAND ILLINOIS |
370663568 | 03 | Yes | Yes | Yes | 0 | |||
| (5)
ST JOSEPH'S HOSPITALL CHIPPEWA FALLS WISCONSIN |
390810545 | 03 | Yes | Yes | Yes | 0 | |||
| (6)
ST MARY'S HOSPITAL DECATUR ILLINOIS |
370661244 | 03 | Yes | Yes | Yes | 0 | |||
| (7)
ST MARY'S HOSPITAL STREATOR ILLINOIS |
362169181 | 03 | Yes | Yes | Yes | 0 | |||
| (8)
ST MARY'S HOSPITAL GREEN BAY |
390818682 | 03 | Yes | Yes | Yes | 0 | |||
| (9)
ST ANTHONY'S HOSPITAL EFFINGHAM ILLINOIS |
370661233 | 03 | Yes | Yes | Yes | 0 | |||
| (10)
ST FRANCIS HOSPITAL LITCHFIELD ILLINOIS |
370661236 | 03 | Yes | Yes | Yes | 0 | |||
| (11)
ST JOHN'S HOSPITAL SPRINGFIELD ILLINOIS |
370661238 | 03 | Yes | Yes | Yes | 0 | |||
| (12)
ST VINCENT'S HOSPITAL GREEN BAY WISCONSIN |
390817529 | 03 | Yes | Yes | Yes | 0 | |||
| (13)
SACRED HEART HOSPITAL EAU CLAIRE WISCONSIN |
390807060 | 03 | Yes | Yes | Yes | 0 | |||
| (14)
ST NICHOLAS HOSPITAL SHEBOYGAN WISCONSIN |
390808480 | 03 | Yes | Yes | Yes | 0 | |||
| (15)
HSHS MEDICAL GROUP INC |
263956318 | 03 | Yes | Yes | Yes | 0 | |||
| (16)
HSHS WISCONSIN MEDICAL GROUP INC |
264515959 | 03 | Yes | Yes | Yes | 0 | |||
| Total | 0 | ||||||||
| 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. | ||||||
| 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). | ||||||






| 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.) | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Hospital Sisters Services, Inc. is the sole member of the holding company that serves as the conduit for tax exempt debt financing for the 501(c)(3) affiliated hospitals referred to as the obligated group. The amount of support provided to the members of the obligated group is not determinable. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| RIGHTS OF MEMBERS TO ELECT GOVERNING BODY | FORM 990, PART VI, LINES 6 & 7A | THE sole corporate member OF HOSPITAL SISTERS SERVICES, INC (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH 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. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSHS 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 Hospital Sisters Services, 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 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 HSHS'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"). HSHS' right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS' members. The reserved powers include all rights granted to HSHS 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 HSHS; (g) Approve debt incurred by the corporation or any affiliate in an amount in excess of limits set from time to time by HSHS; (h) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSHS from time to time; (i) Approve the strategic plan and goals of the Corporation or of any Affiliate; (j) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (k) Approve the merger or dissolution of the Corporation or of any Affiliate; (l) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (m) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (n) Approve the financial policies and procedures of the Corporation or of any Affiliate and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (o) Adopt policies to implement the Reserved Powers of HSHS. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, LINE 11B | THE organization EMPLOYS KPMG TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. KPMG PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE organization's CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE organization's CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE organization's 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 usED SINCE JANUARY, 2009 TO establish the practice of managing CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP OR ACTIVITY CONTEMPLATED, ENTERED INTO OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS, AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY, (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWERS ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTEREST OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION, OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. |
| WHISTLEBLOWER POLICY | FORM 990, PART VI, LINE 13 | provisions within the corporate compliance program and conflict of interest policy provide protections for whistleblower type activities. |
| COMPENSATION PROCESS | FORM 990, PART VI, LINE 15 | HOSPITAL SISTERS SERVICES INC. DOES NOT COMPENSATE EMPLOYEES. HOWEVER, SEVERAL OF THE HOSPITAL SISTERS SERVICES INC. OFFICERS ARE COMPENSATED BY A RELATED ORGANIZATION, hospital sisters health system ("hshs"). HOSPITAL SISTERS SERVICES INC. DEFERS TO THE HSHS COMPENSATION POLICY FOR DETERMINATION OF COMPENSATION FOR THESE OFFICERS. THE HSHS COMPENSATION POLICY IS AS FOLLOWS: 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. |
| COMPENSATION ARRANGEMENT | FORM 990, PART VII, SECTION A | HOSPITAL SISTERS HEALTH SYSTEM EMPLOYS THE MANAGEMENT/OFFICERS OF THE VARIOUS ENTITIES WHICH ARE CENTRALLY SUPPORTED FOR THE BENEFIT OF THE THIRTEEN HOSPITALS IT SPONSORS. |
| POOLED INVESTMENT FUND | FORM 990, PART X, LINE 11 | HSSI CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORSED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES that are publicly traded. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTIAN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS," INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE NOT IDENTIFIED TO THE PARTICIPANTS. |
| OTHER CHANGES IN NET ASSETS OR FUND BALANCES | FORM 990, PART XI, LINE 5 | UNREALIZED LOSSES (23,383) TRANSFER FROM RELATED ENTITY 6,588,901 --------- Total other changes in net assets or fund balances 6,565,518 ========= |
| DESCRIPTION OF PURPOSE OF TAX-EXEMPT BONDS | FORM 990, SCHEDULE K | Hospital Sisters Services, Inc. (HSSI) and its 13 Hospital affiliates are included in the HSSI - Obligated Group. Under the terms of the Obligated Group Master Trust Indenture, each member of the Obligated Group is jointly and severally liable for all obligations issued thereunder. The tax exempt bonds are issued by Illinois Finance Authority and Wisconsin health and Educational facilities authority on behalf of HSSI and then allocated to the 13 Hospitals for reporting on the balance sheet. The bonds are reported on Schedule K of the HSSI return for the entire obligated group. The following detail describes the purpose of each tax exempt bond as used for the entire obligated group. Wisconsin Health and Educational Facilities Authority - CUSIP 97710VRF7, 97710V2Q0, 97710BB74 - The proceeds of the Prior Bonds and the Reissued Bonds were loaned to one or more of the Borrowers and were used to finance or refinance health care facilities of the Borrowers including: (1) the construction of a 24,000 square foot outpatient center at 2661 County Highway I, Chippewa Falls, Wisconsin and the renovation of the front entrance, the first floor and the third floor of the main hospital, the expansion of the surgery department and the radiology department and the relocation of the intensive care unit and the obstetrics/maternity department at St. Joseph's, a 217 bed hospital located in Chippewa Falls, Wisconsin, (2) the completion of the 16,000 square foot renovation of the radiology department, the 15,000 square foot renovation and expansion of the emergency medical and trauma center, the 20,000 square foot renovation and expansion of surgical services, the renovation and upgrade of multiple floors of a patient bed tower, the renovation and upgrade to the mechanical and electrical infrastructure, including a storm water system upgrade and the replacement of the roof at Sacred Heart, a 344 bed hospital located in Eau Claire, Wisconsin, (3) the 11,000 square foot expansion of the cardiac catheterization laboratory, the construction of a 7,000 square foot operating room, the 79,000 square foot expansion of the west side of the main hospital and the renovation of the outpatient nursing center and pharmacy at St. Mary's, a 158 bed hospital located in Green Bay, Wisconsin, (4) the 77,500 square foot addition and renovation of the surgery department, the 15,000 square foot expansion of the heart center, and renovation of the pharmacy, the second floor rehabilitation department and the fifth floor and intensive care unit, the replacement of windows on the second through tenth floors of a patient bed tower, the construction of a parking ramp and the renovation of related areas at St. Vincent, a 547 bed hospital located in Green Bay, Wisconsin, and (5) the renovation of the radiology department and intensive care unit at St. Nicholas, a 185 bed hospital located in Sheboygan, Wisconsin. |
| DESCRIPTION OF PURPOSE OF TAX-EXEMPT BONDS (CONTINUED) | FORM 990, SCHEDULE K, PART I | Illinois Finance Authority - CUSIP # 45200P2X8, 45200BX94 - The proceeds of the Prior Bonds and the Reissued Bonds were loaned to one or more of the Borrowers and were used to finance or refinance health care facilities of the Borrowers, including: (i) various equipping projects and facility renovations, the renovation and equipping of a cardiac catheterization lab, the 28,000 square foot expansion of the intensive care unit and ancillary departments, the construction of a 110,000 square foot parking structure and the construction and renovation of the surgery department at St. Elizabeth's, a 506 bed hospital located in Belleville, Illinois, (ii) various equipping projects, the construction of a 26,132 square foot outpatient facility, the acquisition of a portion of the existing facilities, the construction of a parking lot and emergency room, the renovation and expansion of the laboratory, surgery department, billing office and registration area and the renovation of the physical therapy department, diagnostic imaging department, medical and surgical unit, dining area and nursing department at St. Joseph's Breese, an 85 bed hospital located in Breese, Illinois, (iii) various equipping projects, the purchase of an MRI unit, the replacement of an approximately 386 space surface parking lot, the expansion and renovation of the emergency department and the renovation of the infrastructure, intensive care unit, medical and surgical unit, rehabilitation department and ancillary departments, and the radiology department at St. Mary's Decatur, a 371 bed hospital located in Decatur, Illinois, (iv) various equipping projects and facility renovations, the expansion, renovation and equipping of a cardiac services building, the renovation of the maternity department, patient floors, and surgery facility, the construction of a facility for outpatient surgery and for the emergency room at St. Anthony's, a 146 bed hospital located in Effingham, Illinois, (v) various equipping projects, the expansion and renovation of the emergency department, and the renovation of the operating room and the medical and surgical unit at St. Francis, a 182 bed hospital located in Litchfield, Illinois, (vi) various equipping projects, the renovation of the surgery department, nursing department, cardiac rehabilitation department, mammography department, roof, cafeteria, infrastructure of a patient bed tower, intensive care unit, critical care unit and medical and surgical unit and certain other facility renovations, the replacement of a parking ramp and the construction of a parking lot at St. John's, a 733 bed hospital located in Springfield, Illinois and (vii) the renovation of the emergency and maternity departments at St. Mary's Streator, a 251 bed hospital located in Streator, Illinois. Illinois Finance Authority - CUSIP # 45200PZX8 - Pay or reimburse the Borrowers for the costs of acquiring, constructing, renovating, remodeling and equipping certain health care facilities of the Borrowers at the addresses listed below, including without limitation: (1) the renovation and equipping of a cardiac catheterization lab and construction of a new surgery department at St. Elizabeth's, a 506 bed hospital located in Belleville, Illinois, (2) the purchase of an MRI unit, the replacement of an approximately 386 space surface parking lot and the renovation of the radiology department at St. Mary's, a 371 bed hospital located in Decatur, Illinois, (3) various equipping projects and facility renovations and the expansion, renovation and equipping of a cardiac services building at St. Anthony's, a 146 bed hospital located in Effingham, Illinois, (4) various equipping projects and facility renovations at St. Francis, a 182 bed hospital located in Litchfield, Illinois, (5) the purchase of capital equipment, the renovation of the surgery department and the construction of an approximately 90,000 square foot administrative services building on the hospital campus of St. John's, a 731 bed hospital located in Springfield, Illinois, and (6) the renovation of the emergency and maternity departments at St. Mary's Streator, a 251 bed hospital located in Streator, Illinois. Illinois Finance Authority - CUSIP # 45200BX37 - pay or reimburse the Borrowers for the costs of acquiring, constructing, renovating, remodeling and equipping certain health facilities of the Borrowers, including necessary and attendant equipment, facilities, sitework and utilities thereto, at the addresses listed below, including without limitation: (1) the 28,000 square foot expansion of the intensive care unit and ancillary departments at 211 South Third Street, Belleville, Illinois, the renovation of the surgery department and the rehabilitation and sports medicine department and the construction of a 110,000 square foot parking structure at 220 West Lincoln Street, Belleville, Illinois, all as part of St. Elizabeth's, a 506 bed hospital located in Belleville, Illinois, (2) the construction of a 26,132 square foot outpatient facility at 14160 Jamestown Road, Breese, Illinois, and the renovation of ancillary departments at St. Joseph's Breese, an 85 bed hospital located in Breese, Illinois, (3) the expansion and renovation of the emergency department and the renovation of the intensive care unit, medical and surgical unit, rehabilitation department and ancillary departments at St. Mary's Decatur, a 371 bed hospital located in Decatur, Illinois, (4) various equipping projects and facility renovations and the renovation of the diagnostic imaging department and the medical and surgical unit at St. Anthony's, a 146 bed hospital located in Effingham, Illinois, (5) the expansion and renovation of the emergency department and the renovation of the operating room and the medical and surgical unit at St. Francis, a 182 bed hospital located in Litchfield, Illinois, (6) the purchase of capital equipment, the renovation of the infrastructure of a patient bed tower, the intensive care unit and the critical care unit and the medical and surgical unit and the replacement of a parking ramp at St. John's, a 731 bed hospital located in Springfield, Illinois, (7) a 345 square foot expansion and renovation of the front lobby at 1515 Main Street, Highland, Illinois and the renovation of the ancillary departments, all at St. Joseph's Highland, a 106 bed hospital located in Highland, Illinois and (8) various equipping projects and facility renovations at St. Mary's Streator, a 251 bed hospital located in Streator, Illinois. |
| SUPPLEMENTAL TAX-EXEMPT BOND INFORMATION | FORM 990, SCHEDULE K, PART I | ROW A CONSISTS OF THE FOLLOWING BONDS: 1. WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY HAS AN EIN OF 39-1337855 AND CUSIP NUMBERS OF 97710BB74 AND 97710V2R8. IT WAS ISSUED ON JUNE 17, 2008 AND HAS AN ISSUE PRICE OF $61,750,000. 2. ILLINOIS FINANCE AUTHORITY HAS AN EIN OF 86-1091967 AND CUSIP NUMBERS OF 45200FLG2 AND 45200BX94. IT WAS ISSUED ON JUNE 17, 2008 AND HAS AN ISSUE PRICE OF $227,835,000. ROW B CONSISTS OF THE FOLLOWING BONDS: 1. ILLINOIS FINANCE AUTHORITY HAS AN EIN OF 86-1091967 AND A CUSIP NUMBER OF 45200P2X8. IT WAS ISSUED ON JUNE 17, 2008 AND HAS AN ISSUE PRICE OF $65,550,000 2. WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY HAS AN EIN OF 39-1337855 AND A CUSIP NUMBER OF 97710VRF7. IT WAS ISSUED ON JUNE 17, 2008 AND HAS AN ISSUE PRICE OF $69,850,000. 3. WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY HAS AN EIN OF 39-1337855 AND A CUSIP NUMBER OF 97710V2Q0. IT WAS ISSUED ON JUNE 17, 2008 AND HAS AN ISSUE PRICE OF $76,750,000. ROW C CONSISTS OF THE FOLLOWING BONDS: 1. WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY HAS AN EIN OF 39-1337855 AND A CUSIP NUMBER OF 97710V2Q0. IT WAS ISSUED ON MARCH 13, 2007 AND HAS AN ISSUE PRICE OF $76,750,000. 2. ILLINOIS FINANCE AUTHORITY HAS AN EIN OF 86-1091967 AND A CUSIP NUMBER OF 45200BX37. IT WAS ISSUED ON MARCH 6, 2007 AND HAS AN ISSUE PRICE OF $75,635,104. |
| PROCEEDS AND ISSUANCE COSTS | FORM 990, SCHEDULE K, PART II | LINE 7A COLUMN A: CONSISTS OF 2008A, 2008B, 2007B2 AND 2007C WITH AN UNDERWIRTER'S DISCOUNT OF $276,790 AND OTHER COSTS OF $571,030 FOR A TOTAL OF 847,820. COLUMN B: DOES NOT HAVE ANY ISSUANCE COSTS COLUMN C: CONSISTS OF 2007A AND 2007B1 WITH insurance costs of $1,309,308. LINE 12 HSSI HAS RECEIVED PROJECT FUND EXTENSIONS THROUGH DECEMBER, 2012. |
| AFFILIATED HEALTH SYSTEM | HOSPITAL SISTERS SERVICES, INC. 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 Christ's 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. Joseph's 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 nurse's 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. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's 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. | |
| affiliated health system continued | Better community health: As part of our mission to embody Christ's 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. Joseph's 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. John's 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. St. Mary's Hospital in Streator, Illinois recognized the importance of addressing the psychosocial needs of patients with complicated or serious illnesses. As a result, the hospital developed a supportive care team that includes a physician, nurse, social worker, and chaplain. Working together, the team identifies patient and family goals to manage symptoms. The service is offered free of charge and includes time intensive patient-family communication, and symptom management for pain, anxiety, nausea, difficulty breathing, appetite loss, emotional distress and sleep disturbances. Expanded medical knowledge: HSHS works to advance medical knowledge by supporting research initiatives and educational opportunities. In Fiscal Year 2012, HSHS hospitals and affiliated physician groups contributed more than $16.2 million toward research and education. Examples of this commitment include studying the impact telemedicine has improving care and reducing unplanned readmissions for patients with Congestive Heart Failure, subsidizing medical school residency programs, offering ongoing medical education to physicians and clinicians, and providing job shadowing programs for high school students. Examples of this commitment include St. John's College in Springfield, which offers the last two years of the baccalaureate degree in nursing, as well as continuing education programs for nurses and health professionals St. Elizabeth's Hospital in Belleville, Illinois has students from local community colleges and universities participate in a variety of clinical training programs, including nursing, behavioral health and radiology. In FY2012, 744 area students participated in over 93,000 hours of clinical education. Staff at St. Elizabeth's provided 10,732 hours of mentoring, valued at over $485,000. Colleagues at St. Mary's Hospital in Decatur, Illinois share their knowledge with the community through training programs for local paramedics and first responder groups, as well as CPR classes for the general public. St. Mary's partners with the Decatur Fire Department Prevention Bureau to organize a Junior Fire Cadet program. The program is open to Decatur area youth between ages 8-17 and participants learn about fire safety, first aid, conflict resolution and other life skills. Higher level of care: HSHS's Community Benefit initiatives are a vital part of our overall Mission. We believe that through our work to create greater access to care, better community health, and expanded medical knowledge, we made a positive difference in the lives of tens of thousands of people during Fiscal Year 2012. Our commitment to Community Benefit stems from the Franciscan and Catholic values shared by our 14,000 colleagues in Wisconsin and Illinois. There is still more to do and we remain dedicated to continuously improve upon our Community Benefit work so that we can help more people live healthier lives. | |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER MARY MORIN, OSF TITLE:BOARD MEMBER HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER MARYANN FALBE, OSF TITLE:BOARD MEMBER HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOHN E. STAUDT TITLE:BOARD MEMBER HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER MAUREEN O'CONNOR, OSF TITLE:SECRETARY HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER MARY ANN MINOR, OSF TITLE:CHAIRPERSON HOURS:3 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER MARY MOLLISON, CSA TITLE:VICE CHAIRPERSON HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER BERNICE COREIL, DC TITLE:BOARD MEMBER HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOHN R. COMBES, M.D. TITLE:BOARD MEMBER HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:STEPHEN J. BOCHENEK TITLE:Board Member HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MARY STARMANN-HARRISON TITLE:President & CEO HOURS:60 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ROBERT B. ATWELL TITLE:Board Member HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:STEVEN A. HASSEBROCK TITLE:Board Member HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SISTER GERTRUDE O'CONNOR, OSF TITLE:Board Member HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ANN M. CARR TITLE:TREASURER HOURS:60 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MICHAEL W. COTTRELL TITLE:CFO HOURS:60 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:LAWRENCE SCHUMACHER TITLE:COO HOURS:60 |
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