AGNESIAN HEALTHCARE INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- AGNESIAN HEALTHCARE INC (EIN 39-0807236)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-11-15
- IRS object ID
- 202423209349310802
- Schema version
- 2023v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-11-15T11:31:30-06:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807236 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AGNESIAN HEALTHCARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AGNE | BusinessNameControlTxt |
| Phone | 9209265519 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E DIVISION ST | AddressLine1Txt |
| City | FOND DU LAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHANIE KING | PersonNm |
| Person Title | VP FINANCE | PersonTitleTxt |
| Phone | 9209265519 | PhoneNum |
| Signature | 2024-11-15 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KATHERINE VERGOS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E DIVISION ST | AddressLine1Txt |
| City | FOND DU LAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $521,592,972 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/ST-AGNES-HO | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1892 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 19 | VotingMembersIndependentCnt |
| Total Employee | 3830 | TotalEmployeeCnt |
| Total Volunteers | 354 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $699,745 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,057,580 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,755,200 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $459,604,910 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $500,366,408 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,610,312 | PYInvestmentIncomeAmt |
| CY Investment Income | $15,045,228 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,010,341 | PYOtherRevenueAmt |
| CY Other Revenue | $3,305,704 | CYOtherRevenueAmt |
| PY Total Revenue | $474,283,143 | PYTotalRevenueAmt |
| CY Total Revenue | $521,472,540 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $444,254 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $693,525 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $196,454,202 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $205,645,124 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $610,691 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $292,856,999 | PYOtherExpensesAmt |
| CY Other Expenses | $325,738,591 | CYOtherExpensesAmt |
| PY Total Expenses | $489,755,455 | PYTotalExpensesAmt |
| CY Total Expenses | $532,077,240 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$15,472,312 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$10,604,700 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $639,250,818 | TotalAssetsBOYAmt |
| Total Assets EOY | $689,139,561 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $140,433,680 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $176,384,478 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $498,817,138 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $512,755,083 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $406,849,254 | ExpenseAmt |
| Grant | $693,525 | GrantAmt |
| Revenue | $500,366,408 | RevenueAmt |
| Desc | SINCE IT WAS FOUNDED IN 1872 BY CATHOLIC SISTERS, SSM HEALTH (SSMH) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. SSMH IS A CATHOLIC, NOT-FOR-PROFIT HEALTH SYSTEM SERVING THE COMPREHENSIVE HEALTH NEEDS OF COMMUNITIES ACROSS THE MIDWEST THROUGH ONE OF THE LARGEST INTEGRATED DELIVERY SYSTEMS IN THE NATION. WITH CARE DELIVERY SITES IN ILLINOIS, MISSOURI, OKLAHOMA, AND WISCONSIN, SSMH INCLUDES 23 ACUTE CARE HOSPITALS, ONE CHILDREN'S HOSPITAL, MORE THAN 650 PHYSICIAN OFFICES AND OTHER OUTPATIENT AND VIRTUAL CARE SERVICES, 12 POST-ACUTE FACILITIES, COMPREHENSIVE HOME CARE AND HOSPICE SERVICES, A PHARMACY BENEFIT COMPANY, AND AN ACCOUNTABLE CARE ORGANIZATION. THE HEALTH SYSTEM EMPLOYS NEARLY 40,000 PEOPLE AND IS AFFILIATED WITH 13,900 PHYSICIANS MAKING IT ONE OF THE LARGEST EMPLOYERS IN EVERY COMMUNITY IT SERVES. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMH STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL HEALTH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. ABOUT AGNESIAN HEALTHCARE INC:AGNESIAN HEALTHCARE INC, OPERATING AS ST. AGNES HOSPITAL, HAS BEEN PROVIDING HEALING CARE FOR ALMOST 125 YEARS. THE HOSPITAL HAS GROWN INTO BOTH AN INPATIENT AND OUTPATIENT FACILITY PROVIDING INNOVATIVE COMMUNITY AND REGIONAL HEALTHCARE SERVICES TO THE GREATER FOND DU LAC AREA. AS A NONPROFIT CATHOLIC INSTITUTION, ST. AGNES HOSPITAL SERVES PEOPLE OF ALL FAITHS AND BELIEFS. IT IS A LEADER IN PROVIDING QUALITY STATE-OF-THE-ART HEALTHCARE SERVICES, WHETHER IT IS CANCER TREATMENT; COMPREHENSIVE HEART CARE THROUGH THE DALE MICHELS CENTER FOR HEART CARE, INCLUDING ANGIOPLASTY AND OPEN-HEART SURGERY; HOME OR HOSPICE CARE; MATERNITY SERVICES; LASER SURGERY; SPORTS MEDICINE; BEHAVIORAL HEALTH SERVICES; WOMEN'S HEALTH SERVICES; OCCUPATIONAL HEALTH SERVICES; REHABILITATION SERVICES AND 24-HOUR EMERGENCY CARE. IN 2018, ST. AGNES HOSPITAL RECEIVED THE AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES - HEART FAILURE SILVER PLUS QUALITY ACHIEVEMENT AWARD. THE AWARD RECOGNIZES THE HOSPITAL'S COMMITMENT TO ENSURING HEART FAILURE PATIENTS RECEIVE THE MOST APPROPRIATE TREATMENT ACCORDING TO NATIONALLY RECOGNIZED, RESEARCH-BASED GUIDELINES FOUNDED IN THE LATEST SCIENTIFIC EVIDENCE. ST. AGNES HOSPITAL EARNED THE AWARD BY MEETING SPECIFIC QUALITY ACHIEVEMENT MEASURES FOR THE DIAGNOSIS AND TREATMENT OF HEART FAILURE PATIENTS AT A SET LEVEL FOR A DESIGNATED PERIOD. ST. AGNES ALSO EARNED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S HEART-CHECK MARK FOR ADVANCED CERTIFICATION AND QUALITY FOR PRIMARY STROKE CENTERS. THE HOSPITAL WAS ALSO ONE OF THE 250 RECIPIENTS OF HEALTHGRADES' 2018 DISTINGUISHED HOSPITAL AWARD FOR CLINICAL EXCELLENCE. AGNESIAN HEALTHCARE INC ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: * OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY * HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA * ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, * PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS * ALL SURPLUS FUNDS GENERATED BY SSMH ENTITIES ARE REINVESTED IN IMPROVING OUR PATIENT CARE DELIVERY SYSTEM QUANTIFIABLE UNCOMPENSATED CARE: THIS SECTION INCLUDES A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE QUANTIFIED AS UNCOMPENSATED CARE: TRADITIONAL CHARITY CARE $ 1,608,151 UNPAID COST OF MEDICAID $ 34,431,126 UNPAID COST OF OTHER GOVERNMENT PROGRAMS $ 2,128,800 UNPAID COST OF MEDICARE $ 7,205,249 TOTAL QUANTIFIABLE UNCOMPENSATED CARE $ 45,373,326 | Desc |
| Total Program Service Expenses | $406,849,254 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | Yes (1) | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3830 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 19 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JACKIE TAYLOR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6082416949 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 W BELTLINE HWY | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53713 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (34 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| STEPHEN M PETERSON | ||||||||||
| DIRECTOR, VICE CHAIRPERSON | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| THOR H GILBERTSON | ||||||||||
| DIRECTOR, CHAIRPERSON | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| SUZANNE ANDERSON | ||||||||||
| DIRECTOR, REGIONAL PRESIDENT | 1.00 | 42.00 | Yes (X) | Yes (X) | $0 | $1,428,914 | $540,322 | |||
| JOAN KARSTEN | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MATTHEW POGODZINSKI MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| KATIE KENNEDY | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| JENNIFER MASKEL MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $142,795 | $14,024 | ||||
| SR HERTHA LONGO | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| SR DONNA INNES | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| THOMAS SCHUESSLER | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| PAT LEITZEN FYE | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| WESLEY SPARKMAN | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| DOUG FOWNES MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARK THOMPSON MD | ||||||||||
| DIRECTOR, REGIONAL CHIEF MEDICAL OFFICER | 1.00 | 0.00 | Yes (X) | $0 | $37,398 | $12,674 | ||||
| SR SUSAN M STUCKI | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| THEODORE MILLER MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| JEFFREY STRONG MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| EMMER RHEA | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| WAYNE MATZKE | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| BRET PASIUK MD | ||||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MATT HANLEY | ||||||||||
| DIRECTOR, INTERIM REGIONAL PRES - SSM WI | 1.00 | 45.00 | Yes (X) | $0 | $974,654 | $0 | ||||
| KATHERINE VERGOS | ||||||||||
| PRESIDENT - ST. AGNES HOSPITAL | 40.00 | 1.00 | Yes (X) | $674,601 | $0 | $242,929 | ||||
| DOUG LONG | ||||||||||
| SECRETARY, GENERAL COUNSEL AT SSM HEALTH | 1.00 | 72.20 | Yes (X) | $0 | $1,425,239 | $777,013 | ||||
| RANDY COMBS | ||||||||||
| TREASURER, CHIEF FINANCIAL OFFICER AT SSM HEALTH | 1.00 | 69.00 | Yes (X) | $0 | $2,182,354 | $1,238,074 | ||||
| STEVE SMOOT | ||||||||||
| VICE PRESIDENT, COO OF SSM HEALTH | 1.00 | 65.00 | Yes (X) | $0 | $2,054,358 | $1,204,489 | ||||
| MICHAEL DREES | ||||||||||
| VP - OPERATIONS, FOND DU LAC CLINIC | 40.00 | 0.00 | $363,052 | $0 | $62,834 | Yes (X) | ||||
| TAMI SCHATTSCHNEIDER | ||||||||||
| VP - PATIENT CARE SERVICES, CNO | 40.00 | 0.00 | $288,633 | $0 | $100,264 | Yes (X) | ||||
| TARA RHODES | ||||||||||
| VP - OPERATIONS, ST. AGNES HOSPITAL | 40.00 | 0.00 | $252,246 | $0 | $92,166 | Yes (X) | ||||
| STEVEN FLURRY | ||||||||||
| ANESTHESIOLOGIST | 40.00 | 0.00 | $633,603 | $0 | $61,405 | Yes (X) | ||||
| SYED MOHIUDDIN | ||||||||||
| DIRECTOR | 40.00 | 0.00 | $666,956 | $0 | $55,922 | Yes (X) | ||||
| MICHAEL VANDER KOOY | ||||||||||
| RADIATION ONCOLOGIST | 40.00 | 0.00 | $661,704 | $0 | $67,567 | Yes (X) | ||||
| KRISTOF GEHRKE | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $659,537 | $0 | $58,792 | Yes (X) | ||||
| MARCIO SHIOKAWA | ||||||||||
| PHYSICIAN | 40.00 | 0.00 | $600,929 | $0 | $57,978 | Yes (X) | ||||
| NANCY A BIRSCHBACH | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | 0.00 | $0 | $458,076 | $177,602 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,801,261 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,703,788 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $4,764,055 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 326 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| OWENS & MINOR DISTRIBUTION INC | |||||
| 9120 LOCKWOOD BOULEVARD | MECHANICSVILLE | VA | 23116 | HEALTHCARE LOGISTIC SERVICES | $7,109,965 |
| FDL REGIONAL CLINIC SC | |||||
| 420 E DIVISION ST | FOND DU LAC | WI | 54935 | PHYSICIAN SERVICES | $6,043,134 |
| CD SMITH CONSTRUCTION INC | |||||
| 125 CAMELOT DRIVE | FOND DU LAC | WI | 54935 | CONSTRUCTION SERVICES | $4,851,035 |
| MEDTRONIC USA INC | |||||
| 710 MEDTRONIC PARKWAY | MINNEAPOLIS | MN | 55432 | MEDICAL TECHNOLOGY SERVICES | $4,719,608 |
| BOSTON SCIENTIFIC CORPORATION | |||||
| 300 BOSTON SCIENTIFIC WAY | MARLBOROUGH | MA | 017521234 | BIOMEDICAL ENGINEERING SERVICES | $4,607,729 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 176 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,502,029 | RelatedOrganizationsAmt |
| Government Grants | $236,165 | GovernmentGrantsAmt |
| All Other Contributions | $17,006 | AllOtherContributionsAmt |
| Total Contributions | $2,755,200 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 623000 | $440,013,715 | $440,013,715 |
| PHARMACY REVENUE | 456110 | $28,090,236 | $28,090,236 |
| CORPORATE FEES | 623000 | $25,343,705 | $25,343,705 |
| OTHER PROGRAM REVENUE | 623000 | $6,918,752 | $6,918,752 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $500,366,408 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,994,791 | TotalRevenueColumnAmt |
| Exclusion | $7,994,791 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $899,376 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $899,376 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $899,376 | TotalRevenueColumnAmt |
| Exclusion | $899,376 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,020,638 | SecuritiesAmt |
| Other | $29,799 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,020,638 | SecuritiesAmt |
| Other | $29,799 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,050,437 | TotalRevenueColumnAmt |
| Exclusion | $7,050,437 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $935,948 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $120,432 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $815,516 | TotalRevenueColumnAmt |
| Exclusion | $815,516 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $1,206,128 | $1,206,128 |
| OTHER REVENUE | 900099 | $384,684 | $384,684 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,590,812 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $521,472,540 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $500,366,408 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $18,350,932 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $693,525 | TotalAmt |
| Program Services | $693,525 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,205,260 | TotalAmt |
| Program Services | $156,502,194 | ProgramServicesAmt |
| Management And General | $3,319,061 | ManagementAndGeneralAmt |
| Fundraising | $384,005 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,036,207 | TotalAmt |
| Program Services | $7,850,454 | ProgramServicesAmt |
| Management And General | $166,491 | ManagementAndGeneralAmt |
| Fundraising | $19,262 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,277,887 | TotalAmt |
| Program Services | $25,670,487 | ProgramServicesAmt |
| Management And General | $544,413 | ManagementAndGeneralAmt |
| Fundraising | $62,987 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,125,770 | TotalAmt |
| Program Services | $10,868,603 | ProgramServicesAmt |
| Management And General | $230,499 | ManagementAndGeneralAmt |
| Fundraising | $26,668 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $602,031 | TotalAmt |
| Program Services | $185,564 | ProgramServicesAmt |
| Management And General | $416,467 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $317,102 | TotalAmt |
| Program Services | $60,146 | ProgramServicesAmt |
| Management And General | $256,956 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,764,889 | TotalAmt |
| Program Services | $17,361,646 | ProgramServicesAmt |
| Management And General | $86,403,243 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,975 | TotalAmt |
| Program Services | $49,187 | ProgramServicesAmt |
| Management And General | $11,671 | ManagementAndGeneralAmt |
| Fundraising | $42,117 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,775,526 | TotalAmt |
| Program Services | $5,996,681 | ProgramServicesAmt |
| Management And General | $785,092 | ManagementAndGeneralAmt |
| Fundraising | -$6,247 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,268,982 | TotalAmt |
| Program Services | $15,268,982 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,319,856 | TotalAmt |
| Program Services | $8,175,876 | ProgramServicesAmt |
| Management And General | $2,143,980 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $873,442 | TotalAmt |
| Program Services | $795,913 | ProgramServicesAmt |
| Management And General | $74,858 | ManagementAndGeneralAmt |
| Fundraising | $2,671 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,635 | TotalAmt |
| Program Services | $108,181 | ProgramServicesAmt |
| Management And General | $40,778 | ManagementAndGeneralAmt |
| Fundraising | $2,676 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$795 | TotalAmt |
| Program Services | -$460 | ProgramServicesAmt |
| Management And General | -$335 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,763,968 | TotalAmt |
| Program Services | $29,979,804 | ProgramServicesAmt |
| Management And General | $26,784,164 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,501,535 | TotalAmt |
| Program Services | $15,285,100 | ProgramServicesAmt |
| Management And General | $215,575 | ManagementAndGeneralAmt |
| Fundraising | $860 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,769,604 | TotalAmt |
| Program Services | $1,170,657 | ProgramServicesAmt |
| Management And General | $598,947 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES AND EQ | $108,723,723 | $108,656,164 | $67,545 | $14 |
| TAXES | $5,126,935 | $35 | $5,126,900 | |
| LICENSES, DUES & SUBSRI | $1,712,494 | $1,334,499 | $366,510 | $11,485 |
| BANK FEES | $767,542 | $411,027 | $356,515 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$2,802,853 | TotalAmt |
| Program Services | $424,989 | ProgramServicesAmt |
| Management And General | -$3,292,035 | ManagementAndGeneralAmt |
| Fundraising | $64,193 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $532,077,240 | TotalAmt |
| Program Services | $406,849,254 | ProgramServicesAmt |
| Management And General | $124,617,295 | ManagementAndGeneralAmt |
| Fundraising | $610,691 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,659,554 | BOYAmt |
| EOY | $757,223 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,737,014 | BOYAmt |
| EOY | $35,084,645 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,502,193 | BOYAmt |
| EOY | $5,692,450 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,266,415 | BOYAmt |
| EOY | $679,607 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $319,702,421 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $101,866,193 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,767,807 | BOYAmt |
| EOY | $217,836,228 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,032,449 | BOYAmt |
| EOY | $340,468,887 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,702,615 | BOYAmt |
| EOY | $22,864,017 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,191,876 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,582,771 | BOYAmt |
| EOY | $64,564,628 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $639,250,818 | BOYAmt |
| EOY | $689,139,561 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,914,743 | BOYAmt |
| EOY | $33,265,095 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,782 | BOYAmt |
| EOY | $411,163 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,460,155 | BOYAmt |
| EOY | $142,708,220 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $140,433,680 | BOYAmt |
| EOY | $176,384,478 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $490,640,609 | BOYAmt |
| EOY | $502,372,074 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,176,529 | BOYAmt |
| EOY | $10,383,009 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,817,138 | BOYAmt |
| EOY | $512,755,083 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $639,250,818 | BOYAmt |
| EOY | $689,139,561 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$10,604,700 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $23,450,626 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$89,912 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $1,181,931 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $24,969 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $24,969 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,562,797 | BeginningYearBalanceAmt |
| End Year Balance | $2,562,797 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,488,000 | BeginningYearBalanceAmt |
| Contributions | $1,075,000 | ContributionsAmt |
| Other Expenditures | $203 | OtherExpendituresAmt |
| End Year Balance | $2,562,797 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,487,797 | BeginningYearBalanceAmt |
| End Year Balance | $1,487,797 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,487,797 | BeginningYearBalanceAmt |
| End Year Balance | $1,487,797 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,487,297 | BeginningYearBalanceAmt |
| Contributions | $500 | ContributionsAmt |
| End Year Balance | $1,487,797 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,028,937 | OtherCostOrOtherBasisAmt |
| Book Value | $15,028,937 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $218,530,466 | OtherCostOrOtherBasisAmt |
| Depreciation | $50,982,352 | DepreciationAmt |
| Book Value | $167,548,114 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,954,519 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,222,196 | DepreciationAmt |
| Book Value | $2,732,323 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $75,748,382 | OtherCostOrOtherBasisAmt |
| Depreciation | $46,661,645 | DepreciationAmt |
| Book Value | $29,086,737 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,440,117 | OtherCostOrOtherBasisAmt |
| Book Value | $3,440,117 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $217,836,228 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SSM COMPREHENSIVE INVESTMENT PROGRAM | Desc |
| Book Value | $340,468,887 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $340,468,887 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ESTIMATED THIRD PARTY SETTLEMENT | $854,207 |
| PENSION RESTORATION & DEFERRED COMPENSATION | $61,520,820 |
| COLLATERAL HELD UNDER AGREEMENT | $2,189,601 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $64,564,628 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYABLES | $3,836,564 |
| INTERCOMPANY PAYABLES | $75,161,713 |
| OPERATING RIGHT-OF-USE LIABILITIES | $2,189,123 |
| DEFERRED COMPENSATION PLAN LIABILITIES | $61,520,820 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $142,708,220 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENTS ARE DESIGNATED FOR MEDICAL CARE FOR THOSE IN FINANCIAL NEED, HEART AND CANCER CARE, AND OTHER HEALTH-RELATED NEEDS. |
| PART X, LINE 2: | AGNESIAN HEALTHCARE INC'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2023 OR 2022. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,390,412 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,390,412 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,272,833 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,232,655 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $31,040,178 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05830 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,476,321 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,761,738 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,714,583 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,139,566 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,994,393 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $37,145,173 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06980 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $591,677 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $591,677 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $718,193 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $718,193 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,267,580 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,267,580 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,182 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,182 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $648,507 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $648,507 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,241,139 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,241,139 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00790 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $61,380,705 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,994,393 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $41,386,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07770 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,750 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,705 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $18,705 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,455 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,455 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,813,981 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $33,611,346 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $40,289,937 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$6,678,591 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST AGNES HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E DIVISION STREET | AddressLine1Txt |
| City | FOND DU LAC | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.SSMHEALTH.COM/LOCATIONS/ST | WebsiteAddressTxt |
| State License | 120 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST AGNES HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 3J: THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS COMPRISED OF FIVE DIFFERENT DATA COLLECTION METHODS TO INCLUDE PRIMARY, SECONDARY, QUALITATIVE, AND QUANTITATIVE DATA. ONCE IT WAS COLLECTED, IT WAS ORGANIZED INTO FIVE HEALTH FOCUS AREAS. COMMUNITY HEALTH SURVEY THE COMMUNITY HEALTH SURVEY CONDUCTED BY JKV RESEARCH, LLC., PROVIDES PRIMARY, QUANTITATIVE DATA COLLECTED FROM FOND DU LAC COUNTY RESIDENTS. THE DATA PROVIDES AN OVERVIEW OF BEHAVIORAL AND LIFESTYLE HABITS AS WELL AS PREVALENCE OF RISK FACTORS AND DISEASE CONDITIONS EXISTING WITHIN THE FOND DU LAC COUNTY ADULT POPULATION. THE SURVEY WAS MAILED OUT TO A RANDOM SAMPLE AND 674 ADULTS PARTICIPATED. AGGREGATE DATA FROM SIX SCHOOL DISTRICTS IN FOND DU LAC COUNTY IS INCLUDED IN THE COMMUNITY HEALTH SURVEY REPORT TO PROVIDE STUDENT DATA WHEN AVAILABLE. PUBLIC INPUT SURVEY THE PRIORITY HEALTH ISSUES SURVEY WAS CONDUCTED TO PROVIDE AN OUTLET FOR THE COMMUNITY AT LARGE TO PROVIDE ADDITIONAL INPUT AND VOICE THEIR CONCERNS REGARDING THE MOST PRESSING COUNTY HEAL TH ISSUES. THE SURVEY WAS AVAILABLE IN HARD COPY AT THE HEALTH DEPARTMENT AND ONLINE ON THE HEAL TH DEPARTMENT'S WEBSITE. THE SURVEY WAS AVAILABLE TO TAKE IN ENGLISH AND SPANISH. RESIDENTS WERE ENCOURAGED TO REVIEW KEY FINDINGS FROM THE 2020 COMMUNITY HEALTH SURVEY BEFOREHAND TO PROVIDE ADDITIONAL FEEDBACK. A TOTAL OF 284 FOND DU LAC COUNTY RESIDENTS COMPLETED THE SURVEY. THE HEALTH FOCUS AREAS RANKED MOST CONSISTENTLY IN THE TOP FIVE BY RESPONDENTS WERE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG USE, SOCIAL DETERMINANTS OF HEAL TH, FOOD SECURITY AND NUTRITION AND INFECTIOUS DISEASE. KEY INFORMANT INTERVIEWS A TOTAL OF 37 KEY INFORMANT INTERVIEWS WERE CONDUCTED TO PROVIDE FURTHER QUALITATIVE DATA REGARDING COMMUNITY NEEDS. KEY INFORMANTS IDENTIFIED WERE CONSIDERED COMMUNITY EXPERTS WHO CAN PROVIDE VALUABLE INSIGHT ON PRESSING HEAL TH ISSUES IN THE FOND DU LAC COUNTY COMMUNITY. THE TOP HEALTH FOCUS AREAS RANKED MOST CONSISTENTLY BY KEY INFORMANTS WERE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG USE, SOCIAL DETERMINANTS OF HEALTH, CHRONIC DISEASE, ORAL HEALTH AND FOOD SECURITY AND NUTRITION. COMMUNITY CONVERSATIONS NEW FOR THE 2021 COMMUNITY HEALTH ASSESSMENT WAS DATA COLLECTED FROM COMMUNITY CONVERSATIONS THESE CONVERSATIONS WERE ORGANIZED BY MEMBERS OF THE SSM HEALTH GREATER FOND DU LAC REGION, FOND DU LAC COUNTY HEAL TH DEPARTMENT AND OTHER ENTITIES THAT SERVED AS HOST LOCATIONS FOR THESE EVENTS. THE PURPOSE OF THESE COMMUNITY CONVERSATIONS WAS TO FURTHER ENGAGE THE PUBLIC AND PROVIDE AN OPPORTUNITY FOR VARIOUS POPULATIONS TO VOICE THEIR INPUT THAT MAY OTHERWISE HAVE NOT BEEN HEARD. 16 COMMUNITY CONVERSATIONS WERE HELD ACROSS THE COUNTY, PROVIDING FURTHER INFORMATION REGARDING THE HEAL TH NEEDS OF RESIDENTS IN FOND DU LAC COUNTY. TOP NEEDS IDENTIFIED FROM COMMUNITY CONVERSATIONS INCLUDE: ACCESS TO RESOURCES, MENTAL HEALTH, TRANSPORTATION, ACCESS TO CARE AND RACISM. HIGHLIGHTS AND THEMES FROM THESE CONVERSATIONS CAN BE FOUND THROUGHOUT THE REPORT. SECONDARY DATA SECONDARY DATA WAS COLLECTED FROM LOCAL, STATE, AND NATIONAL HEALTH SOURCES TO SUPPLEMENT THE COMMUNITY HEALTH SURVEY AND OTHER DATA COLLECTION INFORMATION LISTED ABOVE. THIS DATA HELPED BUILD A COMMUNITY HEALTH PROFILE FOR FOND DU LAC COUNTY AND ALLOWED THIS REPORT TO BE COMPARABLE TO OTHER COUNTIES AS WELL AS STATE AND NATIONAL BENCHMARKS. THE SECONDARY DATA COLLECTED IS INCLUDED IN THROUGHOUT THE HEALTH FOCUS AREA AND THE DEFINITION OF COMMUNITY PROFILES. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 6A: HOSPITALS INCLUDED IN THE CHNA WERE AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL), WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 6B: ST. AGNES HOSPITAL PARTNERED WITH THE FOND DU LAC COUNTY HEALTH DEPARTMENT AND HEALTHY FOND DU LAC COUNTY. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED VARIOUS HEALTH NEEDS IN THE 2021 CHNA. IN ORDER TO MAKE MEANINGFUL IMPACT, AND TO USE ITS FINANCES MOST EFFECTIVELY AND EFFICIENCY, THE HOSPITAL WILL PLACE PRIMARY FOCUS ON THE FOLLOWING KEY PRIORITIES:- MENTAL HEALTH - CHRONIC DISEASE- SUBSTANCE USE MENTAL HEALTH ACCORDING TO THE WORLD HEALTH ORGANIZATION, THE DEFINITION OF HEALTH IS A "STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY." MENTAL HEALTH IS SOMETHING WE ALL HAVE, AND IT VARIES IN ITS DEGREE FROM TIME TO TIME. IF THERE IS A SIGNIFICANT IMPACT ON OUR THINKING, FEELING AND/OR BEHAVIOR, TREATMENT, SERVICES OR INTERVENTION MAY BE REQUIRED. IN GENERAL, THE SOONER ONE GETS TREATMENT, THE BETTER THE OUTCOME. HAVING AN UNTREATED MENTAL DISORDER CAN CREATE SERIOUS PROBLEMS SUCH AS INCREASING THE CHANCE OF RISKY BEHAVIORS, DRUG OR ALCOHOL ADDICTION, AND IN EXTREME CASES, DEATH. IT ALSO CAN RUIN RELATIONSHIPS, CAUSE PROBLEMS AT WORK, AND MAKE IT DIFFICULT TO OVERCOME SERIOUS ILLNESSES. MENTAL HEALTH WAS IDENTIFIED AS THE NUMBER ONE PRIORITY TO ADDRESS AS A RESULT OF THE 2021 CHNA. MENTAL HEALTH NEEDS IN FOND DU LAC COUNTY MAY INCLUDE, BUT IS NOT LIMITED TO CHALLENGES, BARRIERS OR NEEDS RELATED TO PROVIDER AVAILABILITY, AFFORDABILITY, TRANSPORTATION, INSURANCE, STIGMA, SUBSTANCE USE, CULTURALLY SENSITIVE AND DIVERSE PROVIDERS AND SERVICES, STRESS, AND SUICIDE. ADDITIONALLY, STATISTICS SHOW: - 20 DEATHS BY SUICIDE REPORTED IN FOND DU LAC COUNTY IN 2020 - 1 IN 5 ADULTS REPORTED TO HAVE A MENTAL HEALTH CONDITION IN THE PAST THREE YEARS- 1 IN 5 YOUTH REPORTED THEY ALWAYS OR NEARLY ALWAYS FELT SAD, BLUE OR DEPRESSED - 44% UNSERVED CHILDREN WITH MENTAL ILLNESS IN FOND DU LAC COUNTY- 79% ADULTS REPORT TO HAVE THEIR MENTAL HEALTH CONDITION UNDER CONTROL (DOWN FROM 96% IN 2017) IN ORDER TO DECREASE THE NUMBER OF DEATHS BY SUICIDE IN FOND DU LAC COUNTY, AS WELL AS INCREASE ACCESS TO BEHAVIORAL HEAL TH SERVICES, THE HOSPITAL'S ACTION PLAN INCLUDES THE FOLLOWING INITIATIVES: - EXPAND TRAININGS FOR QUESTION, PERSUADE, REFER (QPR), MENTAL HEAL TH FIRST AID FOR ADULTS (MHFA), YOUTH MENTAL HEALTH FIRST AID (YMHFA). EXPLORE ADDITIONAL TRAININGS AND PROGRAMS FOR SUICIDE PREVENTION AND MENTAL HEALTH- POTENTIAL NEW PARTNERS AND COLLABORATIONS: BUSINESSES AND EMPLOYERS- INCREASE MEANS FOR DATA COLLECTION, MONITORING AND EVALUATION OF MENTAL HEALTH NEEDS, WITH COMMUNITY PARTNERS SUCH AS DCP, AND PUBLIC SAFETY DEPARTMENTS- RESEARCH UNIVERSAL AND INDIVIDUAL SCREENING TOOLS FOR BEHAVIORAL AND MENTAL HEALTH NEEDS ACROSS THE LIFESPAN AND DEVELOP A PLAN TO ASSESS AND EXPAND SBIRT AT THE HOSPITAL- INCREASE MENTAL HEALTH/BEHAVIORAL HEAL TH SERVICES AND ACCESS TO THEM- INCREASE MENTAL HEALTH RESOURCES AND NAVIGATION TOOLS - DEVELOP MORE UNIVERSAL APPROACH TO SAFETY PLANNING ACROSS THE COUNTRY- DECREASE STIGMA, CAMPAIGNS, AWARENESS, TIC, ACES, BUILD COMMUNITY CHRONIC DISEASE CHRONIC DISEASES ARE ILLNESSES THAT LAST A LONG TIME, DO NOT GO AWAY ON THEIR OWN, ARE RARELY CURED, AND OFTEN RESULT IN DISABILITY LATER IN LIFE. MULTIPLE HEAL TH CONDITIONS ARE CLASSIFIED AS CHRONIC DISEASES SUCH AS HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, HEART DISEASE, OBESITY, DIABETES, ASTHMA AND MORE. NUTRITION AND PHYSICAL ACTIVITY ARE IMPORTANT TO MAINTAIN AND IMPROVE OVERALL HEALTH AND BOTH PLAY A PROMINENT ROLE IN OBESITY PREVENTION AND CONTROL. AS ESTABLISHED IN THE U.S. DIETARY GUIDELINES, GOOD NUTRITION INCLUDES MEETING NUTRIENT RECOMMENDATIONS YET KEEPING CALORIES UNDER CONTROL. PHYSICAL ACTIVITY MEANS ANY BODILY ACTIVITY THAT ENHANCES OR MAINTAINS PHYSICAL FITNESS AND OVERALL HEALTH. OBESITY IS ONE OF THE MOST CRITICAL HEALTH ISSUES OF OUR TIME AND IS A COMPLEX HEALTH ISSUE RESULTING FROM MANY INTERACTING CAUSES AND FACTORS IN OUR SOCIETY, BEHAVIOR, AND GENETICS. OBESITY IS ALSO ASSOCIATED WITH POORER MENTAL HEALTH OUTCOMES AND REDUCES QUALITY OF LIFE. THE BURDEN OF OBESITY AND OTHER DIET-RELATED CHRONIC DISEASES ARE VAST, AND RATES CONTINUE TO RISE. CHANGES AT THE COMMUNITY LEVEL, SUCH AS POLICIES, SYSTEMS, AND ENVIRONMENT, ARE MORE LIKELY TO BE EFFECTIVE, ALTHOUGH THEY MAY BE MORE DIFFICULT TO ACHIEVE. ACCORDING TO FOND DU LAC COMMUNITY MEMBERS RESPONSES THROUGHOUT THE ASSESSMENT, COMMON BARRIERS AND CHALLENGES TO CHRONIC DISEASES AND RELATED HEALTH BEHAVIORS INCLUDED, BUT NOT LIMITED TO, ACCESS AND AFFORDABILITY TO HEAL THY FOODS, AWARENESS OF NUTRITIOUS FOOD AND COOKING HEALTHY MEALS, ACCESS TO INDOOR AND OUTDOOR RECREATION, ACCESS AND AFFORDABILITY OF HEALTHCARE SERVICES. INSURANCE, STIGMA, TRANSPORTATION, AND CULTURAL COMPETENCIES. ADDITIONALLY, STATISTICS SHOW:- HEART DISEASES IS THE NUMBER ONE CAUSE OF DEATH AMONG ADULTS - 75% (3 IN 4) ADULTS WERE CLASSIFIED AS AT LEAST OVERWEIGHT - ABOUT 1 IN 3 YOUTH WERE CLASSIFIED AS AT LEAST OVERWEIGHT - 52% OF ADULTS REPORTED MEETING AEROBIC PHYSICAL ACTIVITY GUIDELINES- 23% OF ADULTS REPORTED EATING THE RECOMMENDED SERVINGS OF FRUIT PER DAY - 17% OF YOUTH REPORTED EATING THE RECOMMENDED SERVINGS OF FRUIT PER DAY - 4,920 (6%) HOUSEHOLDS REPORTED THEY WENT HUNGRY BECAUSE THEY COULDN'T AFFORD ENOUGH FOODIN ORDER TO IMPROVE RESIDENTS' WEIGHT, PHYSICAL ACTIVITY, NUTRITION, AND INCREASE BREASTFEEDING, THE HOSPITAL HAS IMPLEMENTED THE FOLLOWING ACTION ITEMS: - RESEARCH AND IDENTIFY CHRONIC DISEASE PREVENTION AND SELF-MANAGEMENT CLASSES- INCREASE TRAIL USAGE, ENHANCE BIKE AND PEDESTRIAN MASTER PLANS - IMPLEMENT A PHYSICAL ACTIVITY CAMPAIGN - INCREASE SCHOOLS PARTICIPATING IN SAFE ROUTES TO SCHOOL - IDENTIFY EXISTING EFFORTS AND ASSESS IMPACT- INCREASE SNAP USAGE- INCREASE ACCESS TO AND AFFORDABILITY OF FRUITS AND VEGETABLES- ASSESS CURRENT FOOD FORESTS OR COMMUNITY/SHARED GARDENS AND INCREASE VALUE/IMPACT- INCREASE HEAL TH PROMOTION PROGRAMS OFFERED TO LOW-INCOME HOUSING RESIDENTS- INCREASE NUMBER OF CHILDCARE CENTERS AND BUSINESS CENTERS WHO HAVE ADOPTED THE TEN STEPS TO BREASTFEEDING-FRIENDLY TOOLKIT (PROMOTE SUPPORT FOR BREASTFEEDING MOTHERS IN THE WORKPLACE, EARLY CHILDHOOD EDUCATION SETTINGS, AND THROUGHOUT THE COMMUNITY SUBSTANCE USE ALCOHOL AND OTHER DRUG USE MEANS ANY USE OF A SUBSTANCE THAT RESULT IN NEGATIVE CONSEQUENCES. THIS INCLUDES A BROAD ARRAY OF MOOD-ALTERING SUBSTANCES SUCH AS ALCOHOL, TOBACCO, PRESCRIPTION SUBSTANCES, AND ILLEGAL SUBSTANCES LIKE METHAMPHETAMINE AND HEROIN. NEGATIVE CONSEQUENCES OR UNHEALTHY USES INCLUDE BUT ARE NOT LIMITED TO, OPERATING A MOTOR VEHICLE WHILE INTOXICATED, DRINKING WHILE PREGNANT, ALCOHOL DEPENDENCE, FETAL ALCOHOL SPECTRUM DISORDER, ALCOHOL-RELATED HOSPITALIZATIONS, AND MORE. SUBSTANCE USE WAS IDENTIFIED AS THE NUMBER THREE PRIORITY TO ADDRESS IN THE 2022-2024 CHIP. SUBSTANCE USE NEEDS IN FOND DU LAC COUNTY MAY INCLUDE, BUT IS NOT LIMITED TO BARRIERS, CHALLENGES AND NEEDS RELATED TOBACCO, VAPING, DRUGS (NARCOTICS, MARIJUANA, ETC.), PRESCRIPTION MEDICATIONS, AND ALCOHOL USE, MENTAL HEAL TH AND ACCESS TO CARE. THROUGHOUT THE COMMUNITY HEAL TH NEEDS ASSESSMENT, SUBSTANCE USE WAS CONSISTENTLY RANKED AS A TOP PRIORITY. ADDITIONALLY, STATISTICS SHOW: - 25 OPIOID RELATED DEATHS IN FOND DU LAC COUNTY IN 2020, OVER DOUBLE THE DEATHS FROM 2019 - 74% OF ADULTS REPORTED DRINKING ALCOHOL IN THE PAST MONTH - 22% OF YOUTH REPORTED DRINKING ALCOHOL IN THE PAST MONTH - 37% OF ADULTS REPORTED BINGE DRINKING ALCOHOL IN THE PAST MONTH - 37% OF ADULTS REPORTED BINGE DRINKING ALCOHOL IN THE PAST MONTH THE HOSPITAL'S ACTION PLAN INCLUDES THE FOLLOWING INITIATIVES TO DECREASE UNDERAGE DRINKING AND BINGE DRINKING, AND DECREASE MISUSE OF OPIOIDS/PRESCRIPTION MEDICATION: - INCREASE FESTIVALS EVALUATED ANNUALLY USING THE COMMUNITY EVENTS BEST PRACTICES TOOLKIT - INCREASE NUMBER OF LAW ENFORCEMENT AGENCIES COMPLETING ANNUAL COMPLIANCE CHECKS - DECREASE ALCOHOL OUTLET DENSITY - AWARENESS AND EDUCATION CAMPAIGN- INCREASE NUMBER OF NARCAN TRAININGS AND KITS DISTRIBUTED- SYRINGE SERVICES PROGRAM - PRESCRIPTION MEDICATION PRESCRIBING PRACTICES AND PAIN MANAGEMENT- PRESCRIPTION MEDICATION DISPOSAL THE HOSPITAL HAS NO PLANS TO DISCONTINUE OTHER COMMUNITY BENEFIT EFFORTS ADDRESSING THE REMAINING CHNA-IDENTIFIED NEEDS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - FOND DU LAC REGIONAL CLINIC | ||||
| 420 E DIVISION STREET | FOND DU LAC | WI | 54935 | OUTPATIENT CLINIC |
| 2 - CONSULTANTS LAB OF WISCONSIN LLC | ||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | LABORATORY AND TESTING |
| 3 - AGNESIAN HEALTHCARE ENTERPRISES LLC | ||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | PHARMACEUTICALS, HOME HEALTH, AND MEDICAL SUPPLIES |
| 4 - SSM HEALTH EYE CARE | ||||
| 421 CAMELOT DRIVE | FOND DU LAC | WI | 54935 | OUTPATIENT CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | PATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF THE HOSPITAL; HOWEVER THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO COMMERCIALLY INSURED [OR MEDICARE] PATIENTS. IN SUCH CASES, OTHER FACTORS MAY BE CONSIDERED IN DETERMINING THEIR ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES, INCLUDING: *BANK ACCOUNTS, INVESTMENTS AND OTHER ASSETS*EMPLOYMENT STATUS AND EARNING CAPACITY*AMOUNT AND FREQUENCY OF BILLS FOR HEAL TH CARE SERVICES*OTHER FINANCIAL OBLIGATIONS AND EXPENSES*GENERALLY, FINANCIAL RESPONSIBILITY WILL BE NO MORE THAN 25% OF GROSS FAMILY INCOME. THE HOSPITAL MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. THIS PROCESS IS CALLED "PRESUMPTIVE ELIGIBILITY." |
| PART I, LINE 6A: | SSM HEALTH CARE CORPORATION, 46-6029223 |
| PART I, LINE 7: | THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A, 7B, AND 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E, 7F, 7G, 7H, AND 71 ARE REPORTED AT COST AS REPORTED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE CALCULATION OF SCHEDULE H, PART I, LINE 7, COLUMN F UTILIZES 990, PART IX, LINE 25, COLUMN A, WHICH DOES NOT INCLUDE BAD DEBT EXPENSE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | AGNESIAN HEALTHCARE INC PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: ENVIRONMENTAL IMPROVEMENTS: SAFE SHARPS DISPOSAL; LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: SUPPORT TO HELP PROGRAMMING AND TUITION FOR VULNERABLE STUDENTS AT MARIAN UNIVERSITY; WORKFORCE DEVELOPMENT: YOUTH APPRENTICESHIP AND JOB SHADOWING; SUPPORT FOR THE FOND DU LAC WORKS PROGRAM AND ECONOMIC FORECAST BREAKFAST. |
| PART III, LINE 2: | AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. |
| PART III, LINE 3: | FOR FINANCIAL STATEMENT PURPOSES, SSM HEALTH HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THEREFORE, THERE IS NO AMOUNT REPORTED ON PART III, LINE 3 FOR THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER SSM HEALTH'S FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 4: | AGNESIAN HEALTHCARE INC IS PART OF THE SSM HEALTH CONSOLIDATED AUDIT. THE FOOTNOTE THAT REFERENCES THE TREATMENT OF UNCOLLECTIBLE ACCOUNTS AND IMPLICIT PRICE CONCESSIONS IN THE DECEMBER 31, 2023 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEAL TH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST. |
| PART III, LINE 9B: | AGNESIAN HEALTHCARE INC HAS ESTABLISHED A WRITTEN CREDIT AND COLLECTION POLICY AND PROCEDURES. THE BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES OF SSM HEALTH, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. AGNESIAN HEALTHCARE INC EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH IT PARTICIPATES BY ESTABLISHING SOUND BUSINESS PRACTICES. AGNESIAN HEALTHCARE INC'S BILLING AND COLLECTION PRACTICES WILL BE FAIRLY AND CONSISTENTLY APPLIED. ALL STAFF AND VENDORS ARE EXPECTED TO TREAT ALL PATIENTS CONSISTENTLY AND FAIRLY REGARDLESS OF THEIR ABILITY TO PAY. THEY RESPOND TO PATIENTS IN A PROMPT AND COURTEOUS MANNER REGARDING ANY QUESTIONS ABOUT THEIR BILLS AND PROVIDE NOTIFICATION OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL UNINSURED PATIENTS WILL BE PROVIDED A STANDARD DISCOUNT FOR MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES, INCLUDING SERVICES PROVIDED AT OFF-CAMPUS OUTPATIENT SITES. THE HOSPITAL DETERMINED THE AMOUNT OF THE DISCOUNT BASED ON THE LOCAL MANAGED CARE MARKET, APPLICABLE STATUTORY REQUIREMENTS AND OTHER RELEVANT LOCAL CIRCUMSTANCES. THE RATE MUST BE NO LESS THAN THE LOWEST EFFECTIVE DISCOUNT RATE AND NO GREATER THAN THE HIGHEST EFFECTIVE DISCOUNT RATE FOR THE CURRENT MANAGED CARE CONTRACTS OF THE HOSPITAL. UNINSURED PATIENTS MAY ALSO QUALIFY FOR AN ADDITIONAL DISCOUNT BASED UPON FINANCIAL NEED UNDER THE SYSTEM FINANCIAL ASSISTANCE POLICY. ALL ACCOUNTS DUE FROM THE PATIENT WILL RECEIVE A STATEMENT AFTER DISCHARGE OR AFTER FINAL ADJUDICATION FROM PATIENT'S INSURANCE. GENERALLY THE PATIENT WILL RECEIVE 4 MONTHS (120 DAYS) OF IN-HOUSE COLLECTION EFFORTS (INCLUDING EARLY OUT VENDORS) AND 12 MONTHS OF BAD DEBT COLLECTION EFFORTS. THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO DETERMINE FAP ELIGIBILITY INCLUDING: 1. THE FINANCIAL ASSISTANCE SUMMARY WILL BE INCLUDED WITH EACH BILLING STATEMENT 2. EXTRAORDINARY COLLECTION ACTIVITY (ECAS) MAY NOT OCCUR UNTIL BAD DEBT PLACEMENT AND ONLY AFTER 120 DAYS. 3. ECAS MUST BE SUSPENDED IF A GUARANTOR SUBMITS A FAP APPLICATION DURING THE APPLICATION PERIOD. 4. REASONABLE MEASURES MUST BE TAKEN TO REVERSE ECAS IF THE APPLICATION IS APPROVED WHICH MAY INCLUDE REFUNDING ANY PAYMENTS MADE IN EXCESS OF AMOUNTS OWED AS AN FAP-ELIGIBLE INDIVIDUAL. 5. BAD DEBT VENDORS WILL GAIN WRITTEN APPROVAL FROM SSM PRIOR TO ENGAGING IN ECAS. SSM WILL REVIEW THE ACCOUNTS AND VERIFY SATISFACTORY COMPLETION OF REASONABLE EFFORTS DURING THE NOTIFICATION AND APPLICATION PERIOD. A WAIVER IS NOT CONSIDERED REASONABLE EFFORTS. OBTAINING A SIGNED WAIVER THAT AN INDIVIDUAL DOES NOT WISH TO APPLY FOR FAP ASSISTANCE OR RECEIVE FAP APPLICATION INFORMATION WILL NOT MEET THE REQUIREMENT TO MAKE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE BEFORE ENGAGING IN ECAS. ALL OUTSIDE COLLECTION AGENCIES MUST COMPLY WITH STATE AND FEDERAL LAWS, COMPLY WITH THE ASSOCIATION OF CREDIT AND COLLECTION PROFESSIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY AND COMPLY WITH AGNESIAN HEALTHCARE INC'S COLLECTION AND FINANCIAL ASSISTANCE POLICIES. |
| PART VI, LINE 2: | SSM HEALTH (SSMH) PARTICIPATES IN COMMUNITY BENEFIT ACCORDING TO OUR VISION, THROUGH OUR PARTICIPATION IN THE HEALING MINISTRY OF JESUS CHRIST, COMMUNITIES, ESPECIALLY THOSE THAT ARE ECONOMICALLY, PHYSICALLY, AND SOCIALLY MARGINALIZED, WILL EXPERIENCE IMPROVED HEALTH IN MIND, BODY, SPIRIT AND ENVIRONMENT. IN THE TRADITION OF OUR FOUNDERS, THE FRANCISCAN SISTERS OF MARY, CARING FOR THOSE IN GREATEST NEED REMAINS OUR ORGANIZATIONAL PRIORITY. TODAY OUR SYSTEM BOARD MONITORS COMMUNITY BENEFIT EFFORTS, AND VIEWS ACHIEVEMENT OF OUR VISION AS A PRIMARY RESPONSIBILITY. THE PURPOSE OF SSMH'S COMMUNITY BENEFIT PROGRAM IS TO ASSESS AND ADDRESS COMMUNITY HEAL TH NEEDS. MAKING OUR COMMUNITIES HEALTHIER IN MEASURABLE WAYS IS ALWAYS OUR GOAL. TO FULFILL THIS COMMITMENT, SSMH'S COMMUNITY BENEFIT IS DIVIDED INTO TWO PARTS: 1) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND 2) COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CHNA IS AN ASSESSMENT AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS AND THE ADOPTION AND IMPLEMENTATION OF STRATEGIES TO ADDRESS THOSE NEEDS. A CHNA IS CONDUCTED EVERY THREE YEARS BY EACH HOSPITAL ACCORDING TO THE FOLLOWING STEPS: *ASSESS AND PRIORITIZE COMMUNITY HEALTH NEEDS: GATHER CHNA DATA FROM SECONDARY SOURCES; OBTAIN INPUT FROM STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY THROUGH INTERVIEWS AND FOCUS GROUPS; USE DATA TO SELECT TOP HEALTH PRIORITIES; AND COMPLETE WRITTEN CHNA. *DEVELOP, ADOPT, AND IMPLEMENT STRATEGIES TO ADDRESS TOP-HEAL TH PRIORITIES: ESTABLISH STRATEGIES TO ADDRESS PRIORITIES; COMPLETE STRATEGIC IMPLEMENTATION PLAN; OBTAIN REGIONAUDIVISIONAL BOARD APPROVAL; AND INTEGRATE STRATEGIES INTO OPERATIONAL PLAN. *MAKE CHNA WIDELY AVAILABLE TO THE PUBLIC: PUBLISH CHNA AND SUMMARY DOCUMENT ON HOSPITAL'S WEBSITE. *MONITOR, TRACK, AND REPORT PROGRESS ON TOP HEAL TH PRIORITIES: COLLECT DATA AND EVALUATE PROGRESS; REPORT TO REGIONAUDIVISIONAL BOARD EVERY SIX MONTHS AND SYSTEM BOARD EVERY YEAR; SHARE FINDINGS WITH COMMUNITY STAKEHOLDERS; AND SEND RESULTS TO FINANCE FOR SUBMISSION TO THE INTERNAL REVENUE SERVICE (IRS). SYSTEM OFFICE STAFF AND LEADERS OVERSEE AND MONITOR SSMH'S COMMUNITY BENEFIT PROGRAM, AND ENSURE REPORTING IS IN COMPLIANCE WITH IRS REGULATIONS. IN COLLABORATION WITH COMMUNITY STAKEHOLDERS AND PARTNER ORGANIZATIONS, SSM HEALTH CARE CORPORATION ALSO IDENTIFIES NEEDS BASED ON ASSESSMENTS AND RESEARCH, AND SSMH FACILITIES ALSO INVOLVE CASE MANAGERS AND CARE TEAM STAFF TO PINPOINT CRITICAL HEAL TH ISSUES IN THE COMMUNITY. ALL HOSPITAL CHNAS ARE COMPLETED, APPROVED, AND INTEGRATED INTO THE ORGANIZATION'S STRATEGIC PLAN. WE CONTINUE TO MONITOR AND ASSESS THE PROGRESS OF OUR LOCAL EFFORTS IN THE SPIRIT OF CARING FOR OTHERS AND IMPROVING COMMUNITY HEALTH. |
| PART VI, LINE 3: | EACH ENTITY PROVIDING MEDICAL SERVICE SHALL PROVIDE INFORMATION TO THE PUBLIC REGARDING ITS CHARITY CARE POLICIES AND THE QUALIFICATION REQUIREMENTS FOR EACH OF ITS FACILITIES. WHEN STANDARD SYSTEM NOTICES AND COMMUNICATION REGARDING CHARITY CARE ARE AVAILABLE, THESE MUST BE USED. MODIFICATIONS TO THE STANDARD MAY BE MADE TO COMPLY WITH STATE AND LOCAL LAWS, AS WELL AS REFLECT CULTURALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES ARE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY PROVIDE INFORMATION ABOUT: * THE PATIENT'S RESPONSIBILITY FOR PAYMENT,* THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND ENTITY CHARITY CARE AND PAYMENT ARRANGEMENTS* THE ENTITY'S CHARITY POLICY AND APPLICATION PROCESS, AND* WHO TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELINGTHE FOLLOWING TYPES OF NOTICES TO THE PUBLIC ARE PROVIDED: *SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS. *BROCHURES OR FLIERS PROVIDED AT TIME OF REGISTRATION AND AVAILABLE IN THE FINANCIAL COUNSELING AREAS. *NOTICES SENT WITH OR ON PATIENT BILLS OR COMMUNICATIONS SENT TO PATIENTS AND GUARANTORS RELATED TO MEDICAL SERVICES. *APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION. THE APPLICATION FOR CHARITY CARE, TOGETHER WITH ANY INSTRUCTIONS, MUST CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES IS ALSO PROVIDED TO PUBLIC AGENCIES. |
| PART VI, LINE 4: | ST. AGNES HOSPITAL DEFINES ITS COMMUNITY AS FOND DU LAC COUNTY AND THE SURROUNDING PORTIONS OF ADJACENT DODGE AND GREEN LAKE COUNTIES WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL'S SECONDARY SERVICE AREAS ALSO INCLUDE A SMALL PORTION OF SHEBOYGAN AND CALUMET COUNTIES. ST. AGNES HOSPITAL IS LOCATED IN FOND DU LAC, WISCONSIN, WHICH HAD AN ESTIMATED POPULATION OF 43,263 ACCORDING TO THE U.S. CENSUS. THE COUNTY AS A WHOLE WAS ESTIMATED AT 103,403 ADULTS. WHEN COMPARED TO WISCONSIN, FOND DU LAC COUNTY'S POPULATION IS SLIGHTLY OLDER AND LESS DIVERSE. THE POPULATION IN FOND CU LAC COUNTY AND THE GREATER FOND DU LAC MARKET IS PREDOMINANTLY WHITE WITH 90.8 PERCENT AND 91.6PERCENT WHITE POPULATION, RESPECTIVELY. ADDITIONAL RACES AND ETHNICITIES THAT MAKE UP THE POPULATION IN FOND DU LAC COUNTY INCLUDE 3.3 PERCENT BLACK/AFRICAN AMERICAN, 5.3 PERCENT HISPANIC/LATINO, AND 1.9 PERCENT ASIAN. FOND DU LAC COUNTY HAS A GREATER PERCENT OF THE POPULATION WITH A HIGH SCHOOL AND SOME COLLEGE EDUCATION AND HAS A LARGER PERCENT OF POPULATION AGE 65 AND OLDER, COMPARED TO WISCONSIN. THE PERCENT OF POPULATION IN FOND DU LAC COUNTY WITH A HOUSEHOLD INCOME OF $50,000-$75,000 IS GREATER COMPARED TO WISCONSIN, AND THE PERCENT OF INDIVIDUALS LIVING IN POVERTY IN FOND DU LAC COUNTY IS LESS COMPARED TO WISCONSIN. ADDITIONALLY, ACCORDING TO THE ASSET LIMITED, INCOME CONSTRAINED, EMPLOYED (ALICE) 24 PERCENT OF HOUSEHOLDS ARE CONSIDERED AN ALICE HOUSEHOLD, COMPARED TO 23 PERCENT IN WISCONSIN. AN ALICE HOUSEHOLD DESCRIBES FAMILIES WHO WORK, EARN ABOVE THE FEDERAL POVERTY LEVEL, BUT DO NOT ENOUGH TO AFFORD A BASIC HOUSEHOLD BUDGET, DRIVING FAMILIES TO MAKE TOUGH CHOICES TO SUPPORT THEIR FAMILIES, SURVIVE AND THRIVE IN THE COMMUNITY. THE HIGHEST RATES OF ALICE ARE AMONG ADULTS 65 YEARS AND OLDER. ADDITIONAL DEMOGRAPHIC AND STATISTICAL DATA ON FOND DU LAC COUNTY'S RESIDENTS AND THEIR HEALTH CAN BE FOUND THROUGHOUT THE 2021 CHNA. |
| PART VI, LINE 5: | AGNESIAN HEALTHCARE INC PARTICIPATES IN A WIDE ARRAY OF COMMUNITY PROGRAMS THROUGHOUT THE AREA TO FURTHER ITS EXEMPT PURPOSE OF PROMOTING THE HEAL TH OF THE COMMUNITY. THE COMMUNITY INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. COMMUNITY BENEFIT INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. OUR COMMUNITY HEALTH PROGRAMS PROVIDE COMPASSIONATE AND COMPETENT CARE WHILE THEY PROMOTE HEAL TH IMPROVEMENT BY REACHING DIRECTLY INTO THE COMMUNITY TO ENSURE THAT LOW-INCOME AND UNDER-SERVED PERSONS CAN ACCESS HEAL TH CARE SERVICES. IN RESPONSE TO THE GLOBAL CORONAVIRUS PANDEMIC, AGNESIAN HEALTHCARE INC WORKED RELENTLESSLY TO RESPOND TO COMMUNITY NEEDS BY DEVELOPING AND IMPLEMENTING STRATEGIES TO ADDRESS SOCIAL NEEDS OF THOSE SERVED, PROVIDING SCREENING & TESTING SERVICES, PERSONAL PROTECTIVE EQUIPMENT AND EDUCATION THROUGHOUT THE COMMUNITY, AS WELL AS TREATMENT FOR THOSE WHO PRESENTED WITH COVID-19. AGNESIAN HEALTHCARE INC PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE COMMUNITY HEALTH. AGNESIAN HEALTHCARE INC ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: *OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, *HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, *ENGAGES IN THE TRAINING AND EDUCATION OF HEAL TH CARE PROFESSIONALS, *PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS *ALL SURPLUS FUNDS GENERATED BY SSMH ENTITIES ARE REINVESTED IN IMPROVING OUR PATIENT CARE DELIVERY SYSTEM. |
| PART VI, LINE 6: | AGNESIAN HEALTHCARE INC IS A 501 (C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOW AS SSM HEALTH. SSM HEALTH (SSMH) IS A CENTRALLY MANAGED, FULLY INTEGRATED HEAL TH CARE DELIVERY SYSTEM WITH ITS HEADQUARTERS BASED IN ST. LOUIS, MISSOURI. SSM HEALTH CARE CORPORATION (SSMHCC) (DOING BUSINESS AS SSMH) IS THE PRINCIPAL NOT-FOR-PROFIT CORPORATION AND HAS BEEN ESTABLISHED AS THE PARENT CORPORATION. SSMH OWNS AND OPERATES 22 ADULT HOSPITALS, ONE PEDIATRIC HOSPITAL, THIRTEEN POST-ACUTE CARE FACILITIES, A NATIONAL PHARMACY BENEFIT MANAGEMENT COMPANY (PBM), AN EXTENSIVE NETWORK OF PHYSICIAN PRACTICE OPERATIONS, AND OTHER HEAL TH CARE BUSINESSES. SSMH'S HOSPITAL OPERATIONS ARE LOCATED PRIMARILY IN MISSOURI, WISCONSIN, OKLAHOMA AND ILLINOIS, AND ITS RELATED BUSINESSES PROVIDE HEALTH RELATED SERVICES IN 50 STATES. SSMH'S MISSION STATEMENT IS AS FOLLOWS: THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. SSMHCC AND MOST OF ITS AFFILIATED SUBSIDIARY CORPORATIONS HAVE BEEN GRANTED EXEMPTION FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). CERTAIN SUBSIDIARIES OF SSMH ARE FOR-PROFIT ENTITIES THAT ARE TAXABLE UNDER THE IRC. SSMH IS SPONSORED BY SSM HEALTH MINISTRIES, AN INDEPENDENT NINE-MEMBER BODY COMPOSED OF TWO FRANCISCAN SISTERS OF MARY, ONE SISTER OF ST. AGNES, ONE JESUIT PRIEST, AND FIVE LAY PERSONS WHO COLLECTIVELY HOLD CERTAIN RESERVED POWERS OVER SSMH. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| SOCIETY OF ST VINCENT DE PAUL FOND DU LAC COUNTY | ||||||||
| 330 N PETERS AVENUE | FOND DU LAC | WI | 54935 | 390824875 | 501(C)(3) | $101,000 | $0 | GENERAL SUPPORT |
| BOYS & GIRLS CLUB OF FOND DU LAC INC | ||||||||
| 6 WEST 2ND STREET | FOND DU LAC | WI | 54936 | 391896496 | 501(C)(3) | $60,000 | $0 | GENERAL SUPPORT |
| FOND DU LAC COUNTY | ||||||||
| 160 S MACY ST | FOND DU LAC | WI | 54935 | 396005696 | FOND DU LAC COUNTY | $40,000 | $0 | GENERAL SUPPORT |
| FOND DU LAC FAMILY YMCA ATTN KATE MUELLER | ||||||||
| 90 W SECOND ST | FOND DU LAC | WI | 54935 | 390806436 | 501(C)(3) | $30,000 | $0 | GENERAL SUPPORT |
| MARIAN UNIVERSITY | ||||||||
| 3200 COLD SPRING ROAD | INDIANAPOLIS | IN | 46222 | 350868175 | 501(C)(3) | $30,000 | $0 | GENERAL SUPPORT |
| HOLY FAMILY CONGREGATION | ||||||||
| 271 FOURTH STREET WAY | FOND DU LAC | WI | 54937 | 391998002 | 501(C)(3) | $20,000 | $0 | GENERAL SUPPORT |
| FONDY FOOD PANTRY INC | ||||||||
| PO BOX 492 | FOND DU LAC | WI | 54936 | 510156435 | 501(C)(3) | $16,980 | $0 | GENERAL SUPPORT |
| SOLUTIONS CENTER INC | ||||||||
| 39 N SOPHIA STREET | FOND DU LAC | WI | 54935 | 391452956 | 501(C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| THE ARC FOND DU LAC INC | ||||||||
| 500 N PARK AVE | FOND DU LAC | WI | 54935 | 391034161 | 501(C)(3) | $15,000 | $0 | GENERAL SUPPORT |
| FRIENDS OF WOMEN IN RECOVERY INC DBA BEACON HOUSE | ||||||||
| PO BOX 1524 | FOND DU LAC | WI | 549361524 | 391678741 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| FDL SCHOOL DISTRICT ADMINISTRATIVE OFFICES | ||||||||
| 72 W NINTH STREET | FOND DU LAC | WI | 54935 | 391411371 | SCHOOL DISTRICT | $20,000 | $0 | GENERAL SUPPORT |
| EBONY VISION | ||||||||
| 14 WESTERN AVE SUITE 203 | FOND DU LAC | WI | 54936 | 274179193 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| FOND DU LAC LITERACY SVCS INC | ||||||||
| 32 SHEBOYGAN ST | FOND DU LAC | WI | 54935 | 391901303 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| CHILDRENS MUSEUM OF FOND DU LAC INC | ||||||||
| 75 W SCOTT ST | FOND DU LAC | WI | 54935 | 562471187 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| BLANDINE HOUSE INC | ||||||||
| 25 N PARK AVE | FOND DU LAC | WI | 54935 | 237025601 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| FOND DU LAC AREA ASSOCIATION OF COMMERCE FOUNDATION | ||||||||
| 1020 S MAIN ST SUITE E | FOND DU LAC | WI | 54935 | 510181570 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| TREFFERT WAY FOR THE EXCEPTIONAL MIND CHARTER SCHOOL | ||||||||
| 706 MINNESOTA AVE | NORTH FOND DU LAC | WI | 54937 | 999999999 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| NATIONAL ALLIANCE OF MENTAL ILLNESS OF FOND DU LAC CO WI | ||||||||
| 86 S MACY STREET | FOND DU LAC | WI | 54935 | 391466269 | 501(C)(3) | $7,500 | $0 | GENERAL SUPPORT |
| FONDY FOOD PANTRY INC | ||||||||
| PO BOX 492 | FOND DU LAC | WI | 54936 | 510156435 | 501(C)(3) | $7,500 | $0 | GENERAL SUPPORT |
| BIG BROTHERS BIG SISTERS OF FOND DU LAC CO | ||||||||
| 448 S MILITARY RD | FOND DU LAC | WI | 54935 | 391330971 | 501(C)(3) | $7,500 | $0 | GENERAL SUPPORT |
| BISHOP & CHAPTER OF ST PAULS CATHEDRAL - BROKEN BREAD FOOD | ||||||||
| 51 WEST DIVISION STREET | FOND DU LAC | WI | 54935 | 501(C)(3) | $7,500 | $0 | GENERAL SUPPORT | |
| MAHALA'S HOPE INC | ||||||||
| N4590 HWY 45 | EDEN | WI | 53019 | 841680693 | 501(C)(3) | $6,000 | $0 | GENERAL SUPPORT |
| FOND DU LAC COUNTY UNITED WAY | ||||||||
| 74 S MAIN ST | FOND DU LAC | WI | 54935 | 390806194 | 501(C)(3) | $6,000 | $0 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 34 | Total501c3OrgCnt |
| Total Other Org | 2 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDY COMBS | ||||||||||||||
| TREASURER, CHIEF FINANCIAL OFFICER A | $0 | $1,242,308 | $0 | $669,269 | $0 | $270,777 | $0 | $1,203,989 | $0 | $34,085 | $0 | $3,420,428 | $0 | $669,269 |
| STEVE SMOOT | ||||||||||||||
| VICE PRESIDENT, COO OF SSM HEALTH | $0 | $1,173,646 | $0 | $737,192 | $0 | $143,520 | $0 | $1,164,125 | $0 | $40,364 | $0 | $3,258,847 | $0 | $878,090 |
| DOUG LONG | ||||||||||||||
| SECRETARY, GENERAL COUNSEL AT SSM HE | $0 | $759,270 | $0 | $495,539 | $0 | $170,430 | $0 | $753,634 | $0 | $23,379 | $0 | $2,202,252 | $0 | $495,539 |
| SUZANNE ANDERSON | ||||||||||||||
| DIRECTOR, REGIONAL PRESIDENT | $0 | $765,767 | $0 | $330,759 | $0 | $332,388 | $0 | $520,449 | $0 | $19,873 | $0 | $1,969,236 | $0 | $253,821 |
| MATT HANLEY | ||||||||||||||
| DIRECTOR, INTERIM REGIONAL PRES - SS | $0 | $0 | $0 | $974,654 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $974,654 | $0 | $0 |
| KATHERINE VERGOS | ||||||||||||||
| PRESIDENT - ST. AGNES HOSPITAL | $495,539 | $0 | $140,411 | $0 | $38,651 | $0 | $200,445 | $0 | $42,484 | $0 | $917,530 | $0 | $177,206 | $0 |
| MICHAEL VANDER KOOY | ||||||||||||||
| RADIATION ONCOLOGIST | $656,802 | $0 | $0 | $0 | $4,902 | $0 | $18,669 | $0 | $48,898 | $0 | $729,271 | $0 | $0 | $0 |
| SYED MOHIUDDIN | ||||||||||||||
| DIRECTOR | $664,361 | $0 | $0 | $0 | $2,595 | $0 | $16,385 | $0 | $39,537 | $0 | $722,878 | $0 | $0 | $0 |
| KRISTOF GEHRKE | ||||||||||||||
| PHYSICIAN | $657,003 | $0 | $0 | $0 | $2,534 | $0 | $17,205 | $0 | $41,587 | $0 | $718,329 | $0 | $0 | $0 |
| STEVEN FLURRY | ||||||||||||||
| ANESTHESIOLOGIST | $630,981 | $0 | $0 | $0 | $2,622 | $0 | $28,279 | $0 | $33,126 | $0 | $695,008 | $0 | $0 | $0 |
| MARCIO SHIOKAWA | ||||||||||||||
| PHYSICIAN | $593,244 | $0 | $6,001 | $0 | $1,684 | $0 | $15,623 | $0 | $42,355 | $0 | $658,907 | $0 | $0 | $0 |
| NANCY A BIRSCHBACH | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $339,363 | $0 | $86,372 | $0 | $32,341 | $0 | $151,485 | $0 | $26,117 | $0 | $635,678 | $0 | $114,067 |
| MICHAEL DREES | ||||||||||||||
| VP - OPERATIONS, FOND DU LAC CLINIC | $299,423 | $0 | $44,945 | $0 | $18,684 | $0 | $32,646 | $0 | $30,188 | $0 | $425,886 | $0 | $56,410 | $0 |
| TAMI SCHATTSCHNEIDER | ||||||||||||||
| VP - PATIENT CARE SERVICES, CNO | $249,646 | $0 | $37,384 | $0 | $1,603 | $0 | $61,324 | $0 | $38,940 | $0 | $388,897 | $0 | $37,384 | $0 |
| TARA RHODES | ||||||||||||||
| VP - OPERATIONS, ST. AGNES HOSPITAL | $219,826 | $0 | $31,297 | $0 | $1,123 | $0 | $53,432 | $0 | $38,734 | $0 | $344,412 | $0 | $31,297 | $0 |
| JENNIFER MASKEL MD | ||||||||||||||
| DIRECTOR | $0 | $142,370 | $0 | $0 | $0 | $425 | $0 | $10,628 | $0 | $3,396 | $0 | $156,819 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | AN INDIVIDUAL LISTED ON PART VII, SECTION A RECEIVED A TAX INDEMNIFICATION/GROSSUP PAYMENT IN 2023. THE PAYMENT WAS INCLUDED IN TAXABLE COMPENSATION. |
| PART I, LINE 3 | THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, PRESIDENT, IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| PART I, LINE 4B | SSM HEAL TH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2023. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2023: SUE ANDERSON $153,458 JENNIFER MASKEL $2,131 STEVE SMOOT $249,972 RANDY COMBS $261,633 DOUGLAS LONG $161,286 KATHERINE VERGOS $47,060 MICHAEL DREES $14,170 TARA RHODES $10,459 TAMI SCHATTSCHNEIDER $11,913 STEVEN FLURRY $9,623 NANCY BIRSCHBACH $32,541 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. SUE ANDERSON $132,843 STEVE SMOOT $140,898 KATHERINE VERGOS $37,026 NANCY BIRSCHBACH $28,799 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| CUSIP | 97712DXT8 | CUSIPNum |
| Bond Issued | 2017-08-10 | BondIssuedDt |
| Issue Price | $62,792,652 | IssuePriceAmt |
| Purpose | (1) FINANCE CAPITAL IMPROVEMENTS AND (2) REFUND 2010 AND 2012 BONDS | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $8,815,000 | RetiredAmt |
| Total Proceeds | $63,094,342 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $656,999 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $23,301,620 | CapitalExpendituresAmt |
| Other Spent Proceeds | $39,135,724 | OtherSpentProceedsAmt |
| Substantial Completion | 2020 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | Yes (1) | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| FOND DU LAC REGIONAL CLINIC SC | |||
| DIRECTORS ARE EMPLOYEE-OWNERS OF INTERESTED PERSON | $6,043,134 | PHYSICIAN SERVICES | 0 |
| HOLIDAY AUTO | |||
| ENTITY OWNED BY THOR H GILBERTSON, DIRECTOR/OFFICER | $190,584 | SALES AND SERVICE TO VEHICLES | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV, COLUMN(B) - FOND DU LAC REGIONAL CLINIC SC OWNERS | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING DIRECTORS LISTED ON FORM 990, PART VII ARE EMPLOYEE OWNERS OF THE FOND DU LAC REGIONAL CLINIC: DR BRET PATSIUK, DR JEFFREY STRONG AND DR THEODORE MILLER | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DR JEFFREY STRONG, DR BRET PASIUK AND DR THEODORE MILLER - BUSINESS RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH CARE OF WISCONSIN, INC, IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH AGNESIAN HEALTHCARE INC AND SSM HEALTH CARE OF WISCONSIN, INC. ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION; B. TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS; C. TO APPOINT AND REMOVE THE DIRECTORS; D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION; E. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN; F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY; L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS; M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION; N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION; O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION; P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO SSMHCC OR TO ANY OTHER ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY SSMHCC, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF SSMHCC AS DETERMINED BY SSMHCC; Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN SSMHCC, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO SSMHCC WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION (SSM). THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SSM PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED BOARD MEETING |
| FORM 990, PART VI, SECTION B, LINE 12C | A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON A ANNUAL BASIS TO THE DESIGNATED AUTHORITY A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DESIGNATED AUTHORITY ENSURES THAT ALL STATEMENTS ARE COMPLETED, REVIEWS THEM FOR CONFLICTS, AND SUBMITS TO THE BOARD FOR REVIEW ANY CONFLICT OF INTEREST DISCLOSURE STATEMENTS THAT DISCLOSE ACTUAL OR POTENTIAL CONFLICTS. |
| FORM 990, PART VI, SECTION C, LINE 19 | A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON A ANNUAL BASIS TO THE DESIGNATED AUTHORITY A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DESIGNATED AUTHORITY ENSURES THAT ALL STATEMENTS ARE COMPLETED, REVIEWS THEM FOR CONFLICTS, AND SUBMITS TO THE BOARD FOR REVIEW ANY CONFLICT OF INTEREST DISCLOSURE STATEMENTS THAT DISCLOSE ACTUAL OR POTENTIAL CONFLICTS. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 17,361,646. MANAGEMENT AND GENERAL EXPENSES 86,403,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 103,764,889. |
| FORM 990, PART XI, LINE 9: | CHANGE IN TEPORARILY RESTRICTED NET ASSETS -1,274,236. BENEFICIAL INTEREST IN FOUNDATION 2,456,167. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| CONSULTANTS LABORATORY OF WISCONSIN LLC | |||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 391528550 | LAB SERVICES | WI | $12,599,477 | $4,381,478 | AGNESIAN HEALTHCARE INC |
| AGNESIAN HEALTHCARE ENTERPRISES LLC | |||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 392038757 | RETAIL PHARMACY | WI | -$2,471,070 | $3,573,315 | AGNESIAN HEALTHCARE INC |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (53 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM HEALTH CARE CORPORATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 466029223 | HEALTH CARE | MO | 501(C)(3) | LINE 12A, I | SSM HEALTH MINISTRIES | Yes (1) | |
| SSMHC LIABILITY TRUST I | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 436331003 | INSURANCE | MO | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE CORPORATION | Yes (1) | |
| SSM CONSOLIDATED HEALTH SERVICES | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431473657 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH CARE CORPORATION | Yes (1) | |
| SSM POLICY INSTITUTE | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431788151 | HEALTH CARE | MO | 501(C)(4) | SSM HEALTH CARE CORPORATION | Yes (1) | ||
| SSM HEALTH CARE PORTFOLIO MANAGEMENT CO | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431825256 | MANAGEMENT | MO | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE CORPORATION | Yes (1) | |
| SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430738490 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE ST LOUIS | Yes (1) | |
| CARDINAL GLENNON CHILDREN'S FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431754347 | FUNDRAISING | MO | 501(C)(3) | LINE 7 | SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | Yes (1) | |
| SSM HEALTH FOUNDATION - ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431552945 | FUNDRAISING | MO | 501(C)(3) | LINE 7 | SSM HEALTH CARE ST LOUIS | Yes (1) | |
| SSM HEALTH CARE OF OKLAHOMA INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 730657693 | HEALTH CARE | OK | 501(C)(3) | LINE 3 | SSM HEALTH CARE CORPORATION | Yes (1) | |
| THE ST ANTHONY HOSPITAL FOUNDATION INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 736104300 | FUNDRAISING | OK | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF OKLAHOMA | Yes (1) | |
| SSM HEALTH CARE OF WISCONSIN INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430688874 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE CORPORATION | Yes (1) | |
| DELLS MEDICAL BUILDING INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 391613292 | MOB | WI | 501(C)(2) | SSM HEALTH CARE OF WISCONSIN | Yes (1) | ||
| ST MARY'S FOUNDATION INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431940686 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| ST CLARE HEALTH CARE FOUNDATION INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431940683 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| HOME HEALTH UNITED INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391539827 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| HOME CARE UNITED INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391776340 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| HHU XTRA CARE INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391705111 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| SSM HEALTH AT HOME FOUNDATION OF WISCONSIN INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391839309 | FUNDRAISING | WI | 501(C)(3) | LINE 12A, I | HOME HEALTH UNITED INC | Yes (1) | |
| SSM REGIONAL HEALTH SERVICES | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 440579850 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE CORPORATION | Yes (1) | |
| ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431575307 | FUNDRAISING | MO | 501(C)(3) | LINE 12A, I | SSM REGIONAL HEALTH SERVICES | Yes (1) | |
| GOOD SAMARITAN REGIONAL HEALTH CENTER | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430653587 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | SSM REGIONAL HEALTH SERVICES | Yes (1) | |
| ST MARY'S HOSPITAL CENTRALIA ILLINOIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 370662580 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | SSM REGIONAL HEALTH SERVICES | Yes (1) | |
| ST MARY'S - GOOD SAMARITAN INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 364170833 | HEALTH CARE | IL | 501(C)(3) | LINE 12A, I | SSM REGIONAL HEALTH SERVICES | Yes (1) | |
| GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 262884795 | FUNDRAISING | IL | 501(C)(3) | LINE 7 | ST MARY'S-GOOD SAMARITAN INC | Yes (1) | |
| ST MARY'S HOSPITAL FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 364636691 | FUNDRAISING | IL | 501(C)(3) | LINE 7 | ST MARY'S-GOOD SAMARITAN INC | Yes (1) | |
| ST MARY'S HOSPITAL AUXILIARY | |||||||||||
| 400 N PLEASANT | CENTRALIA | IL | 62801 | 237126345 | FUNDRAISING | IL | 501(C)(3) | LINE 10 | ST MARY'S HOSPITAL FOUNDATION | 0 | |
| SSM HEALTH BUSINESSES | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431333488 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH CARE CORPORATION | Yes (1) | |
| SSM HEALTH CARE ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431343281 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE CORPORATION | Yes (1) | |
| CENTRALIA MEDICAL SERVICES BLDG ASSOC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 237408025 | MOB | IL | 501(C)(3) | LINE 12A, I | SSM REGIONAL HEALTH SERVICES | Yes (1) | |
| ST MARY'S JANESVILLE FOUNDATION INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 273439133 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| SSM HEALTH MINISTRIES | |||||||||||
| 3221 MCKELVEY ROAD SUITE 107 | BRIDGETON | MO | 63044 | 431012492 | RELIGIOUS ORGANIZATION | MO | 501(C)(3) | LINE 1 | 0 | N/A | |
| LEE DEWEY CORPORATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 731279603 | MOB | OK | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF OKLAHOMA | Yes (1) | |
| ST MARY'S HOSPITAL AUXILIARY | |||||||||||
| 100 ST MARYS MEDICAL PLAZA | JEFFERSON CITY | MO | 65101 | 436049878 | FUNDRAISING | MO | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| GOOD SAMARITAN HOSPITAL AUXILIARY | |||||||||||
| 1 GOOD SAMARITAN WAY | MOUNT VERNON | IL | 62864 | 237049599 | FUNDRAISING | IL | 501(C)(3) | LINE 12C, III-FI | 0 | N/A | |
| ST ANTHONY SHAWNEE HOSPITAL INC | |||||||||||
| 1000 N LEE AVE | OKLAHOMA CITY | OK | 73102 | 455055149 | HEALTH CARE | OK | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF OKLAHOMA | Yes (1) | |
| SSM AUDRAIN HEALTH CARE INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431550298 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM REGIONAL HEALTH SERVICES | Yes (1) | |
| SSM-SLUH INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 474196634 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | SSM HEALTH CARE ST LOUIS | Yes (1) | |
| AGNESIAN HEALTHCARE INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 390807236 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| RIPON MEDICAL CENTER INC | |||||||||||
| 845 PARKSIDE STREET | RIPON | WI | 54971 | 391101287 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | AGNESIAN HEALTHCARE INC | Yes (1) | |
| WAUPUN MEMORIAL HOSPITAL INC | |||||||||||
| 620 WEST BROWN STREET | WAUPUN | WI | 53963 | 390806265 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | AGNESIAN HEALTHCARE INC | Yes (1) | |
| ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC | |||||||||||
| 33 EVERETT STREET | FOND DU LAC | WI | 54935 | 391029998 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | Yes (1) | |
| SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO | |||||||||||
| N8114 COUNTY WW | MOUNT CALVARY | WI | 53057 | 391022770 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | Yes (1) | |
| VILLA ROSA INC | |||||||||||
| N8120 COUNTY WW | MOUNT CALVARY | WI | 53057 | 421670962 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | Yes (1) | |
| THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED | |||||||||||
| 331 BLY STREET | WAUPUN | WI | 53963 | 390884514 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | AGNESIAN HEALTHCARE INC | Yes (1) | |
| THE MONROE CLINIC INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 390808509 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| MONROE CLINIC AND HOSPITAL FOUNDATION INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 205769038 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| AGNESIAN HEALTHCARE FOUNDATION INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 391684956 | FUNDRAISING | WI | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| SHARED MAGNETIC RESONANCE IMAGING FACILITY INC | |||||||||||
| 1104 JOHN NOLEN DRIVE | MADISON | WI | 53713 | 391534744 | HEALTH CARE | WI | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE OF WISCONSIN | Yes (1) | |
| SSM HEALTH CARDINAL GLENNON TRANSPORT | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 863519607 | HEALTH CARE | MO | 501(C)(3) | LINE 12A, I | SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | Yes (1) | |
| SSM HEALTH FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 874109859 | FUNDRAISING | MO | 501(C)(3) | LINE 12A, I | SSM HEALTH CARE CORPORATION | Yes (1) | |
| SSM HEALTH CARE GROUP | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 880988603 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH CARE ST LOUIS | Yes (1) | |
| THE SARAH COMMUNITY | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431784657 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | SSM HEALTH BUSINESSES | Yes (1) | |
| VISITING NURSE ASSOCIATION OF GREATER ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430567000 | HEALTH CARE | MO | 501(C)(3) | LINE 7 | SSM HEALTH BUSINESSES | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (22 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| SSM ST JOSEPH ENDOSCOPY CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 270046559 | SURGERY SERVICES | MO | N/A | 0 | 0 |
| ST CLARE IMAGING SERVICES LLC | |||||||||
| 707 14TH STREET SUITE A | BARABOO | WI | 53913 | 200122365 | DIAG. SERVICES | WI | N/A | 0 | 0 |
| MT VERNON RADIATION THERAPY CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 201382620 | RADIATION THERAPY | IL | N/A | 0 | Yes (1) |
| SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 208468195 | DIAG. SERVICES | IL | N/A | 0 | 0 |
| CHOWSMGSI OFFICE BUILDING LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 371383861 | MOB | IL | N/A | 0 | 0 |
| OZA CANCER CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 201382727 | MOB | IL | N/A | 0 | 0 |
| SHAWNEE REAL ESTATE HOLDINGS LLC | |||||||||
| 1000 N LEE AVE | OKLAHOMA CITY | OK | 73102 | 455458304 | MOB | OK | N/A | 0 | 0 |
| DEAN CLINIC & ST MARY'S HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 452995500 | ACCOUNTABLE CARE ORGANIZATION | WI | N/A | 0 | 0 |
| WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 392016715 | INFORMATION TECHNOLOGY SERVICES | WI | N/A | 0 | 0 |
| WINGRA BUILDING GROUP | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 390237060 | MOB | WI | N/A | 0 | 0 |
| JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP | |||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 396220698 | MOB | WI | N/A | 0 | 0 |
| 1110 N CLASSEN BLVD LLC | |||||||||
| 1110 N CLASSEN BOULEVARD | OKLAHOMA CITY | OK | 73106 | 731158158 | MOB | OK | N/A | 0 | Yes (1) |
| SSM ST CLARE SURGICAL CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 261439695 | SURGERY SERVICES | MO | N/A | 0 | 0 |
| WINDMILL LLP | |||||||||
| 50 VILLAGE VIEW LANE | CHESTERFIELD | MO | 63017 | 431804651 | INVESTMENTS | MO | N/A | 0 | 0 |
| NAVITUS HEALTH SOLUTIONS LLC | |||||||||
| 361 INTEGRITY DRIVE | MADISON | WI | 53717 | 043608530 | PHARMACY BENEFIT MANAGEMENT | WI | N/A | 0 | 0 |
| SSM SELECT REHAB ST LOUIS LLC | |||||||||
| 4714 GETTYSBURG ROAD | MECHANICSBURG | PA | 17055 | 263694972 | HEALTH CARE | DE | N/A | 0 | 0 |
| EPIPHANY RX LLC | |||||||||
| 361 INTEGRITY DRIVE | MADISON | WI | 53717 | 364855405 | PHARMACY BENEFIT MANAGEMENT | DE | N/A | 0 | 0 |
| RXPRECHECK LL | |||||||||
| 278 FRANKLIN RD | BRENTWOOD | TN | 37027 | 812842151 | PHARMACY BENEFIT MANAGEMENT | TN | N/A | 0 | 0 |
| ARCHIMEDES LLC | |||||||||
| 278 FRANKLIN RD | BRENTWOOD | TN | 37027 | 811158028 | PHARMACY BENEFIT MANAGEMENT | TN | N/A | 0 | 0 |
| BLOOM TREE LONG-ONLY FUND QP LP FKA BLOOM TREE PONDEROSA FUNDS QP LP | |||||||||
| 101 PARK AVENUE 33RD FL | NEW YORK | NY | 10178 | 823704522 | INVESTMENTS | DE | N/A | 0 | 0 |
| NECICF II AIV2-B LP | |||||||||
| 300 DELAWARE AVE STE 210 | WILMINGTON | DE | 19801 | 845058167 | INVESTMENTS | DE | N/A | 0 | 0 |
| BISON CAPITAL PARTNERS VI-A LP | |||||||||
| 233 WILSHIRE BLVD STE 425 | SANTA MONICA | CA | 90401 | 874006968 | INVESTMENTS | DE | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (19 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM MANAGED CARE ORGANIZATION LLC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431708511 | HEALTH PROMOTION | MO | N/A | C | 0 | |||
| FPP INC & SUBS | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431465174 | HEALTH CARE | MO | N/A | C | 0 | |||
| DIVERSIFIED HEALTH SERVICES CORP | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431369305 | MEDICAL EQUIPMENT | MO | N/A | C | 0 | |||
| SSM PROPERTIES INC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431462486 | PROPERTY SERVICES | MO | N/A | C | 0 | |||
| HEALTHFIRST PHYSICIAN MANAGEMENT SERVICES | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 731534336 | MEDICAL SERVICES | OK | N/A | C | 0 | |||
| SSMHC LIABILITY TRUST II | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 816128118 | INSURANCE | MO | N/A | C | 0 | |||
| SSM MEDICAL GROUP INC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431664107 | PHYSICIAN OFFICES | MO | N/A | C | 0 | |||
| SSMHC INSURANCE COMPANY | ||||||||||||
| 030310431 | INSURANCE | N/A | C | 0 | PO BOX 1051 GT | CJ | CJ | |||||
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 364161526 | HEALTH CARE | IL | N/A | C | 0 | |||
| DEAN HEALTH SYSTEMS INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 391128616 | PHYSICIAN OFFICES | WI | N/A | C | 0 | |||
| DEAN RETAIL SERVICES INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 391717636 | PROPERTY SERVICES | WI | N/A | C | 0 | |||
| SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 832038674 | CONDO ASSOCIATION | WI | N/A | C | 0 | |||
| SSM HEALTH PHARMACY LLC | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 264031708 | PHARMACY | MO | N/A | C | 0 | |||
| NAVITUS HOLDINGS LLC | ||||||||||||
| 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | 800968174 | PHARMACY | WI | N/A | C | 0 | |||
| MS COMMUNITY JV LLC | ||||||||||||
| 401 CARLSON PARKWAY CP330 | MINNETONKA | MN | 55305 | 873240022 | INSURANCE | DE | N/A | C | 0 | |||
| QUALITY DRUG CORPORATION | ||||||||||||
| 239 BROADWAY | LAGUNA BEACH | CA | 92651 | 330644268 | PHARMACY BENEFITS | CA | N/A | C | 0 | |||
| ST MARY'S HOSPITAL CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC | ||||||||||||
| 707 SOUTH MILLS STREET | MADISON | WI | 53715 | 000000000 | CONDO ASSOCIATION | WI | N/A | C | 0 | |||
| PARTNERS GROUP PMC PRIVATE CREDIT LP | ||||||||||||
| 981439264 | INVESTMENT | N/A | C | 0 | C/O MAPLES CORPORATE SERVICES LTD | CJ | CJ | |||||
| OMNINHEALTH HOLDINGS | ||||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 884144276 | HEALTH CARE CONSULTING | DE | N/A | C | 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (12 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ST FRANCIS HOME OF FOND DU LAC | ||
| M | $986,001 | BOOK |
| THE CHRISTIAN HOME AND REHABILITATION CENTER INC | ||
| M | $390,324 | BOOK |
| RIPON MEDICAL CENTER | ||
| M | $4,560,817 | BOOK |
| WAUPUN MEMORIAL HOSPITAL | ||
| M | $5,807,931 | BOOK |
| AGNESIAN HEALTHCARE FOUNDATION INC | ||
| C | $2,502,029 | BOOK |
| AGNESIAN HEALTHCARE FOUNDATION INC | ||
| L | $685,121 | BOOK |
| RIPON MEDICAL CENTER | ||
| L | $3,483,517 | BOOK |
| SISTER SERVANTS OF CHRIST THE KING | ||
| M | $198,703 | BOOK |
| ST FRANCIS HOME OF FOND DU LAC | ||
| L | $1,054,595 | BOOK |
| THE CHRISTIAN HOME AND REHABILITATION CENTER INC | ||
| L | $254,614 | BOOK |
| WAUPUN MEMORIAL HOSPITAL | ||
| K | $128,352 | BOOK |
| WAUPUN MEMORIAL HOSPITAL | ||
| L | $6,035,965 | BOOK |
Comments