2024-11-15T11:31:30-06:00 2023-12-31 990 2023-01-01 390807236 AGNESIAN HEALTHCARE INC AGNE 9209265519 430 E DIVISION ST FOND DU LAC WI 54935 STEPHANIE KING VP FINANCE 9209265519 2024-11-15 0 2023 2024-10-15 13:58:12Z KATHERINE VERGOS 430 E DIVISION ST FOND DU LAC WI 54935 521592972 0 0928 X WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/ST-AGNES-HO X 1892 WI 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. 20 19 3830 354 0 699745 1057580 2755200 459604910 500366408 5610312 15045228 8010341 3305704 474283143 521472540 444254 693525 0 0 196454202 205645124 0 0 610691 292856999 325738591 489755455 532077240 -15472312 -10604700 639250818 689139561 140433680 176384478 498817138 512755083 X 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. 0 0 406849254 693525 500366408 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 406849254 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 0 0 1 3830 1 1 1 0 0 0 0 0 0 0 0 0 X 20 19 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 1 X JACKIE TAYLOR 6082416949 1808 W BELTLINE HWY MADISON WI 53713 STEPHEN M PETERSON DIRECTOR, VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 THOR H GILBERTSON DIRECTOR, CHAIRPERSON 1.00 0.00 X X 0 0 0 SUZANNE ANDERSON DIRECTOR, REGIONAL PRESIDENT 1.00 42.00 X X 0 1428914 540322 JOAN KARSTEN DIRECTOR 1.00 0.00 X 0 0 0 MATTHEW POGODZINSKI MD DIRECTOR 1.00 0.00 X 0 0 0 KATIE KENNEDY DIRECTOR 1.00 0.00 X 0 0 0 JENNIFER MASKEL MD DIRECTOR 1.00 0.00 X 0 142795 14024 SR HERTHA LONGO DIRECTOR 1.00 0.00 X 0 0 0 SR DONNA INNES DIRECTOR 1.00 0.00 X 0 0 0 THOMAS SCHUESSLER DIRECTOR 1.00 0.00 X 0 0 0 PAT LEITZEN FYE DIRECTOR 1.00 0.00 X 0 0 0 WESLEY SPARKMAN DIRECTOR 1.00 0.00 X 0 0 0 DOUG FOWNES MD DIRECTOR 1.00 0.00 X 0 0 0 MARK THOMPSON MD DIRECTOR, REGIONAL CHIEF MEDICAL OFFICER 1.00 0.00 X 0 37398 12674 SR SUSAN M STUCKI DIRECTOR 1.00 0.00 X 0 0 0 THEODORE MILLER MD DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY STRONG MD DIRECTOR 1.00 0.00 X 0 0 0 EMMER RHEA DIRECTOR 1.00 0.00 X 0 0 0 WAYNE MATZKE DIRECTOR 1.00 0.00 X 0 0 0 BRET PASIUK MD DIRECTOR 1.00 0.00 X 0 0 0 MATT HANLEY DIRECTOR, INTERIM REGIONAL PRES - SSM WI 1.00 45.00 X 0 974654 0 KATHERINE VERGOS PRESIDENT - ST. AGNES HOSPITAL 40.00 1.00 X 674601 0 242929 DOUG LONG SECRETARY, GENERAL COUNSEL AT SSM HEALTH 1.00 72.20 X 0 1425239 777013 RANDY COMBS TREASURER, CHIEF FINANCIAL OFFICER AT SSM HEALTH 1.00 69.00 X 0 2182354 1238074 STEVE SMOOT VICE PRESIDENT, COO OF SSM HEALTH 1.00 65.00 X 0 2054358 1204489 MICHAEL DREES VP - OPERATIONS, FOND DU LAC CLINIC 40.00 0.00 X 363052 0 62834 TAMI SCHATTSCHNEIDER VP - PATIENT CARE SERVICES, CNO 40.00 0.00 X 288633 0 100264 TARA RHODES VP - OPERATIONS, ST. AGNES HOSPITAL 40.00 0.00 X 252246 0 92166 STEVEN FLURRY ANESTHESIOLOGIST 40.00 0.00 X 633603 0 61405 SYED MOHIUDDIN DIRECTOR 40.00 0.00 X 666956 0 55922 MICHAEL VANDER KOOY RADIATION ONCOLOGIST 40.00 0.00 X 661704 0 67567 KRISTOF GEHRKE PHYSICIAN 40.00 0.00 X 659537 0 58792 MARCIO SHIOKAWA PHYSICIAN 40.00 0.00 X 600929 0 57978 NANCY A BIRSCHBACH FORMER KEY EMPLOYEE 0.00 0.00 X 0 458076 177602 4801261 8703788 4764055 326 1 1 0 OWENS & MINOR DISTRIBUTION INC 9120 LOCKWOOD BOULEVARD MECHANICSVILLE VA 23116 HEALTHCARE LOGISTIC SERVICES 7109965 FDL REGIONAL CLINIC SC 420 E DIVISION ST FOND DU LAC WI 54935 PHYSICIAN SERVICES 6043134 CD SMITH CONSTRUCTION INC 125 CAMELOT DRIVE FOND DU LAC WI 54935 CONSTRUCTION SERVICES 4851035 MEDTRONIC USA INC 710 MEDTRONIC PARKWAY MINNEAPOLIS MN 55432 MEDICAL TECHNOLOGY SERVICES 4719608 BOSTON SCIENTIFIC CORPORATION 300 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 017521234 BIOMEDICAL ENGINEERING SERVICES 4607729 176 2502029 236165 17006 2755200 NET PATIENT SERVICE REVENUE 623000 440013715 440013715 PHARMACY REVENUE 456110 28090236 28090236 CORPORATE FEES 623000 25343705 25343705 OTHER PROGRAM REVENUE 623000 6918752 6918752 500366408 7994791 7994791 899376 0 899376 899376 899376 7020638 29799 0 0 7020638 29799 7050437 7050437 935948 120432 815516 815516 CAFETERIA REVENUE 722514 1206128 1206128 OTHER REVENUE 900099 384684 384684 1590812 521472540 500366408 0 18350932 X 693525 693525 160205260 156502194 3319061 384005 8036207 7850454 166491 19262 26277887 25670487 544413 62987 11125770 10868603 230499 26668 602031 185564 416467 317102 60146 256956 103764889 17361646 86403243 102975 49187 11671 42117 6775526 5996681 785092 -6247 15268982 15268982 10319856 8175876 2143980 873442 795913 74858 2671 151635 108181 40778 2676 -795 -460 -335 56763968 29979804 26784164 15501535 15285100 215575 860 1769604 1170657 598947 MEDICAL SUPPLIES AND EQ 108723723 108656164 67545 14 TAXES 5126935 35 5126900 LICENSES, DUES & SUBSRI 1712494 1334499 366510 11485 BANK FEES 767542 411027 356515 -2802853 424989 -3292035 64193 532077240 406849254 124617295 610691 7659554 757223 48737014 35084645 5502193 5692450 1266415 679607 319702421 101866193 214767807 217836228 302032449 340468887 21702615 22864017 1191876 37582771 64564628 639250818 689139561 16914743 33265095 58782 411163 123460155 142708220 140433680 176384478 X 490640609 502372074 8176529 10383009 498817138 512755083 639250818 689139561 X -10604700 23450626 -89912 1181931 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 24969 24969 0 PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES. 2562797 2562797 1488000 1075000 203 2562797 1487797 1487797 1487797 1487797 1487297 500 1487797 0.00000 1.00000 0.00000 1 0 15028937 15028937 218530466 50982352 167548114 6954519 4222196 2732323 75748382 46661645 29086737 3440117 3440117 217836228 SSM COMPREHENSIVE INVESTMENT PROGRAM 340468887 F 340468887 ESTIMATED THIRD PARTY SETTLEMENT 854207 PENSION RESTORATION & DEFERRED COMPENSATION 61520820 COLLATERAL HELD UNDER AGREEMENT 2189601 64564628 THIRD PARTY PAYABLES 3836564 INTERCOMPANY PAYABLES 75161713 OPERATING RIGHT-OF-USE LIABILITIES 2189123 DEFERRED COMPENSATION PLAN LIABILITIES 61520820 142708220 X 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 4390412 0 4390412 0.00830 47272833 16232655 31040178 0.05830 5476321 3761738 1714583 0.00320 57139566 19994393 37145173 0.06980 591677 0 591677 0.00110 718193 0 718193 0.00130 2267580 0 2267580 0.00430 15182 0 15182 0.00000 648507 0 648507 0.00120 4241139 4241139 0.00790 61380705 19994393 41386312 0.07770 0 0 0 0 0 0 7750 0 7750 0.00000 0 0 0 0 0 0 18705 0 18705 0.00000 0 0 26455 26455 0.00000 1 5813981 0 33611346 40289937 -6678591 X 1 1 1 1 ST AGNES HOSPITAL 430 E DIVISION STREET FOND DU LAC WI 54935 HTTPS://WWW.SSMHEALTH.COM/LOCATIONS/ST 120 X X X ST AGNES HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH X 1 22 1 HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA X WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA X WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA X X X X X X 1 X 0 X X X X 1 X 0 0 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. 4 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 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 0 SOCIETY OF ST VINCENT DE PAUL FOND DU LAC COUNTY 330 N PETERS AVENUE FOND DU LAC WI 54935 390824875 501(C)(3) 101000 0 GENERAL SUPPORT BOYS & GIRLS CLUB OF FOND DU LAC INC 6 WEST 2ND STREET FOND DU LAC WI 54936 391896496 501(C)(3) 60000 0 GENERAL SUPPORT FOND DU LAC COUNTY 160 S MACY ST FOND DU LAC WI 54935 396005696 FOND DU LAC COUNTY 40000 0 GENERAL SUPPORT FOND DU LAC FAMILY YMCA ATTN KATE MUELLER 90 W SECOND ST FOND DU LAC WI 54935 390806436 501(C)(3) 30000 0 GENERAL SUPPORT MARIAN UNIVERSITY 3200 COLD SPRING ROAD INDIANAPOLIS IN 46222 350868175 501(C)(3) 30000 0 GENERAL SUPPORT HOLY FAMILY CONGREGATION 271 FOURTH STREET WAY FOND DU LAC WI 54937 391998002 501(C)(3) 20000 0 GENERAL SUPPORT FONDY FOOD PANTRY INC PO BOX 492 FOND DU LAC WI 54936 510156435 501(C)(3) 16980 0 GENERAL SUPPORT SOLUTIONS CENTER INC 39 N SOPHIA STREET FOND DU LAC WI 54935 391452956 501(C)(3) 15000 0 GENERAL SUPPORT THE ARC FOND DU LAC INC 500 N PARK AVE FOND DU LAC WI 54935 391034161 501(C)(3) 15000 0 GENERAL SUPPORT FRIENDS OF WOMEN IN RECOVERY INC DBA BEACON HOUSE PO BOX 1524 FOND DU LAC WI 549361524 391678741 501(C)(3) 10000 0 GENERAL SUPPORT FDL SCHOOL DISTRICT ADMINISTRATIVE OFFICES 72 W NINTH STREET FOND DU LAC WI 54935 391411371 SCHOOL DISTRICT 20000 0 GENERAL SUPPORT EBONY VISION 14 WESTERN AVE SUITE 203 FOND DU LAC WI 54936 274179193 501(C)(3) 10000 0 GENERAL SUPPORT FOND DU LAC LITERACY SVCS INC 32 SHEBOYGAN ST FOND DU LAC WI 54935 391901303 501(C)(3) 10000 0 GENERAL SUPPORT CHILDRENS MUSEUM OF FOND DU LAC INC 75 W SCOTT ST FOND DU LAC WI 54935 562471187 501(C)(3) 10000 0 GENERAL SUPPORT BLANDINE HOUSE INC 25 N PARK AVE FOND DU LAC WI 54935 237025601 501(C)(3) 10000 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) 10000 0 GENERAL SUPPORT TREFFERT WAY FOR THE EXCEPTIONAL MIND CHARTER SCHOOL 706 MINNESOTA AVE NORTH FOND DU LAC WI 54937 999999999 501(C)(3) 10000 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) 7500 0 GENERAL SUPPORT FONDY FOOD PANTRY INC PO BOX 492 FOND DU LAC WI 54936 510156435 501(C)(3) 7500 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) 7500 0 GENERAL SUPPORT BISHOP & CHAPTER OF ST PAULS CATHEDRAL - BROKEN BREAD FOOD 51 WEST DIVISION STREET FOND DU LAC WI 54935 501(C)(3) 7500 0 GENERAL SUPPORT MAHALA'S HOPE INC N4590 HWY 45 EDEN WI 53019 841680693 501(C)(3) 6000 0 GENERAL SUPPORT FOND DU LAC COUNTY UNITED WAY 74 S MAIN ST FOND DU LAC WI 54935 390806194 501(C)(3) 6000 0 GENERAL SUPPORT 34 2 X 1 1 X X 0 1 0 0 0 0 0 0 0 RANDY COMBS TREASURER, CHIEF FINANCIAL OFFICER A 0 1242308 0 669269 0 270777 0 1203989 0 34085 0 3420428 0 669269 STEVE SMOOT VICE PRESIDENT, COO OF SSM HEALTH 0 1173646 0 737192 0 143520 0 1164125 0 40364 0 3258847 0 878090 DOUG LONG SECRETARY, GENERAL COUNSEL AT SSM HE 0 759270 0 495539 0 170430 0 753634 0 23379 0 2202252 0 495539 SUZANNE ANDERSON DIRECTOR, REGIONAL PRESIDENT 0 765767 0 330759 0 332388 0 520449 0 19873 0 1969236 0 253821 MATT HANLEY DIRECTOR, INTERIM REGIONAL PRES - SS 0 0 0 974654 0 0 0 0 0 0 0 974654 0 0 KATHERINE VERGOS PRESIDENT - ST. AGNES HOSPITAL 495539 0 140411 0 38651 0 200445 0 42484 0 917530 0 177206 0 MICHAEL VANDER KOOY RADIATION ONCOLOGIST 656802 0 0 0 4902 0 18669 0 48898 0 729271 0 0 0 SYED MOHIUDDIN DIRECTOR 664361 0 0 0 2595 0 16385 0 39537 0 722878 0 0 0 KRISTOF GEHRKE PHYSICIAN 657003 0 0 0 2534 0 17205 0 41587 0 718329 0 0 0 STEVEN FLURRY ANESTHESIOLOGIST 630981 0 0 0 2622 0 28279 0 33126 0 695008 0 0 0 MARCIO SHIOKAWA PHYSICIAN 593244 0 6001 0 1684 0 15623 0 42355 0 658907 0 0 0 NANCY A BIRSCHBACH FORMER KEY EMPLOYEE 0 339363 0 86372 0 32341 0 151485 0 26117 0 635678 0 114067 MICHAEL DREES VP - OPERATIONS, FOND DU LAC CLINIC 299423 0 44945 0 18684 0 32646 0 30188 0 425886 0 56410 0 TAMI SCHATTSCHNEIDER VP - PATIENT CARE SERVICES, CNO 249646 0 37384 0 1603 0 61324 0 38940 0 388897 0 37384 0 TARA RHODES VP - OPERATIONS, ST. AGNES HOSPITAL 219826 0 31297 0 1123 0 53432 0 38734 0 344412 0 31297 0 JENNIFER MASKEL MD DIRECTOR 0 142370 0 0 0 425 0 10628 0 3396 0 156819 0 0 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 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DXT8 2017-08-10 62792652 (1) FINANCE CAPITAL IMPROVEMENTS AND (2) REFUND 2010 AND 2012 BONDS 0 0 0 A 8815000 63094342 656999 23301620 39135724 2020 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 FOND DU LAC REGIONAL CLINIC SC DIRECTORS ARE EMPLOYEE-OWNERS OF INTERESTED PERSON 6043134 PHYSICIAN SERVICES 0 HOLIDAY AUTO ENTITY OWNED BY THOR H GILBERTSON, DIRECTOR/OFFICER 190584 SALES AND SERVICE TO VEHICLES 0 SCHEDULE L, PART IV, COLUMN(B) - FOND DU LAC REGIONAL CLINIC SC OWNERS 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 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. CONSULTANTS LABORATORY OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC WI 54935 391528550 LAB SERVICES WI 12599477 4381478 AGNESIAN HEALTHCARE INC AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC WI 54935 392038757 RETAIL PHARMACY WI -2471070 3573315 AGNESIAN HEALTHCARE INC 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 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 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 1 SSM POLICY INSTITUTE 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431788151 HEALTH CARE MO 501(C)(4) SSM HEALTH CARE CORPORATION 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 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 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 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 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 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 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 1 DELLS MEDICAL BUILDING INC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 391613292 MOB WI 501(C)(2) SSM HEALTH CARE OF WISCONSIN 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 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 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 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 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 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 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 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 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 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 1 ST MARY'S - 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