2024-11-15T12:50:35-06:00 2023-12-31 990 2023-01-01 205769038 MONROE CLINIC AND HOSPITAL FOUNDATION MONR 6083242868 515 22ND AVENUE MONROE WI 53566 STEPHANIE KING VP FINANCE 6083242868 2024-11-15 0 2023 2024-10-15 13:58:12Z STEPHANIE KING 515 22ND AVENUE MONROE WI 53566 834239 0 X WWW.GIVETOSSMHEALTH.ORG/FOUNDATIONS/WISCONSIN/MON X 2006 WI MONROE CLINIC AND HOSPITAL FOUNDATION SERVES AND ENHANCES THE HEALING MISSION OF MONROE CLINIC BY COMBINING THE GIVING SPIRIT OF OUR COMMUNITIES WITH ALL WHO ENTER THROUGH OUR DOORS. 12 9 0 30 0 0 335502 360004 0 201921 193350 253492 -1802 -7560 527050 807857 231780 196012 0 0 174264 186000 0 0 219929 58991 33929 465035 415941 62015 391916 9309828 10660660 321 2499 9309507 10658161 THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. 0 0 196012 196012 201921 SUPPORT THE MONROE CLINIC INC WITH EQUIPMENT PURCHASES AND HEALTH CARE PROGRAMS. OTHER ASSISTANCE PROVIDED TO LOCAL ORGANIZATIONS AS NEEDED. 196012 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JANE SYBERS 6083242868 515 22ND AVENUE MONROE WI 53566 JANE CURRAN-MEULI DIRECTOR, PRESIDENT/CEO OF THE MONROE CLINIC INC 1.00 40.00 X 0 552926 201977 GAINES RICHARDSON DIRECTOR, PHYSICIAN AT THE MONROE CLINIC 1.00 40.00 X 0 269341 64201 JANE SYBERS EXECUTIVE DIRECTOR 40.00 0.00 X X 0 123304 45619 JOE KLEIN DIRECTOR & CHAIR 1.00 0.00 X X 0 0 0 TEENA BUHOLZER DIRECTOR, VICE CHAIR, ASSISTANT TREASURER 1.00 0.00 X X 0 0 0 ALESSANDRO ROSSI MD DIRECTOR, ASSISTANT SECRETARY 1.00 0.00 X X 0 0 0 DEB THOMPSON DIRECTOR 1.00 0.00 X 0 0 0 JILL LEITZEN DIRECTOR 1.00 0.00 X 0 0 0 KIM MARKHAM DIRECTOR 1.00 0.00 X 0 0 0 SUE ANDERSON DIRECTOR, REGIONAL PRESIDENT OF SSM HEALTH WISCONS 1.00 40.00 X 0 1428914 540322 JIM DAVIDSON MD DIRECTOR 1.00 0.00 X 0 0 0 AMANDA FIELDS DIRECTOR 1.00 0.00 X 0 0 0 RANDY COMBS TREASURER, CFO AT SSM HEALTH 1.00 50.00 X 0 2182354 1238074 DOUGLAS LONG SECRETARY, CHIEF LEGAL OFFICER AT SSM HEALTH 1.00 50.00 X 0 1425239 777013 0 5982078 2867206 0 0 1 0 0 131796 15705 1340 211163 77334 360004 201921 201921 201921 254528 254528 1036 -1036 -1036 -1036 16976 131796 25346 -8370 -8370 810 0 810 810 807857 201921 0 245932 161815 161815 34197 34197 172710 172710 13290 13290 345 345 21968 21968 4537 4537 343 343 75 75 BANK FEES 2412 2412 LICENSES, DUES & SUBSCR 145 145 4104 4104 415941 196012 0 219929 1483929 518629 811668 7825899 9330363 9309828 10660660 321 2499 321 2499 X 1171972 1557234 8137535 9100927 9309507 10658161 9309828 10660660 X 391916 981123 -24387 X 0 1 X 1 1 1 X 305340 319585 1067351 335502 360004 2387782 305340 319585 1067351 335502 360004 2387782 503302 1884480 131298 101938 83865 154219 254528 725848 59671 21602 38969 24916 17786 162944 3276574 201921 0.57510 0.59330 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: FUNDRAISING ACTIVITIES - 2019 AMOUNT: $ 59,671. 2020 AMOUNT: $ 21,602. 2021 AMOUNT: $ 38,969. 2022 AMOUNT: $ 24,916. 2023 AMOUNT: $ 17,786. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5893458 94138 1058980 175879 6870697 5168051 747841 137457 159891 5893458 5489706 252166 843308 1417129 5168051 4610640 29793 849273 5489706 3745187 127089 867013 128649 4610640 0.14310 0.38490 0.47200 0 0 0 811668 F 811668 PROGRAM-RELATED INVESTMENTS 9330363 F 9330363 THIRD PARTY PAYABLES 2499 2499 X PART V, LINE 4: THE OPERATING ENDOWMENT HAS BEEN ESTABLISHED TO SUPPORT THE OPERATING COST OF THE MONROE CLINIC AND HOSPITAL FOUNDATION. THE FUTURE OF HEATH CARE ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE FUNDING FOR THE GRANTS AND PROGRAMS THAT SUPPORT THE MONROE CLINIC AND HOSPITAL FOUNDATIONS MISSION. PART X, LINE 2: MONROE CLINIC AND HOSPITAL FOUNDATION'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. BIG GOLF 89740 74510 15230 9541 5650 6974 HOSPICE LITTLE GOLF 59032 57286 1746 3181 148772 131796 16976 9541 5650 10155 25346 -8370 1 THE MONROE CLINIC INC 515 2ND AVENUE MONROE WI 53566 390808509 501(C)(3) 145852 15963 BOOK FOOD & GIFT BASKETS FOR EMPLOYEE APPRECIATION & WHEELCHAIR FOR PATIENTS SUPPORT FOR SSM HEALTH MONROE HOSPITAL EMPLOYEE ASSISTANCE 4 6219 SCHOLARSHIPS 29 27978 PART I, LINE 2: GRANTS TO ORGANIZATIONS WERE MADE TO RELATED ORGANIZATIONS THAT ARE TAX-EXEMPT UNDER SECTION 501(C)(3). THE ORGANIZATIONS HAVE DEVELOPED INTERNAL CONTROL PROCEDURES FOR THE USE OF GRANT FUNDS. ALL GRANTS TO INDIVIDUALS INCLUDE A GRANT APPLICATION PROCESS THROUGH A PARTNER ORGANIZATION. APPROVED GRANT APPLICATIONS ARE FORWARDED TO THE FOUNDATION AND THE FOUNDATION PAYS THE REQUESTED EXPENDITURES. X 1 1 0 1 0 0 0 0 0 0 0 RANDY COMBS TREASURER, CFO AT SSM HEALTH 0 1242308 0 669269 0 270777 0 1203989 0 34085 0 3420428 0 669269 DOUGLAS LONG SECRETARY, CHIEF LEGAL OFFICER AT SS 0 759270 0 495539 0 170430 0 753634 0 23379 0 2202252 0 495539 SUE ANDERSON DIRECTOR, REGIONAL PRESIDENT OF SSM 0 765767 0 330759 0 332388 0 520449 0 19873 0 1969236 0 253821 JANE CURRAN-MEULI DIRECTOR, PRESIDENT/CEO OF THE MONRO 0 388761 0 118561 0 45604 0 171633 0 30344 0 754903 0 118561 GAINES RICHARDSON DIRECTOR, PHYSICIAN AT THE MONROE CL 0 262337 0 0 0 7004 0 24691 0 39510 0 333542 0 10361 JANE SYBERS EXECUTIVE DIRECTOR 0 110500 0 11230 0 1574 0 16003 0 29616 0 168923 0 11230 PART I, LINE 1A AN INDIVIDUAL LISTED ON PART VII, SECTION A, RECEIVED TAX INDEMNIFICATION/GROSS UP PAYMENTS IN 2023, WHICH WAS INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE COMPENSATION OF THE EXECUTIVE DIRECTOR IS PAID FOR BY THE MONROE CLINIC, A RELATED ORGANIZATION. THE MONROE CLINIC ESTABLISHES MARKET-BASED COMPENSATION THROUGH A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B PENSION RESTORATION PLAN: SSM HEALTH (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: RANDALL COMBS - $153,458 DOUGLAS LONG - $161,286 GAINES RICHARDSON, MD - $8,297 JANE CURRAN-MEULI - $38,469 SUE ANDERSON - $153,458 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. GAINES RICHARDSON, MD - $4,559 SUE ANDERSON - $132,843 X 5988 COST X 7078 COST X 265 41272 MARKET VALUE X 1 900 COST X AUCTION ITEMS 73 15908 MARKET VALUE X STAFF APPRECIATION 3 1230 COST 0 0 1 0 PART I, COLUMN (B): STOCK - NUMBER OF SHARES DONATED ALL OTHER ITEMS - NUMBER OF DONATIONS FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC. SSM HEAL TH CARE OF WISCONSIN, INC, IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH MONROE CLINIC AND HOSPITAL FOUNDATION 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 ADOPT OR CHANGE THE MISSION, PHILOSOPHY, AND VALUES OF THE CORPORATION. B) TO REVIEW THE EFFECTIVENESS OF THE CORPORATION IN FULFILLING THE MISSION, PHILOSOPHY, AND VALUES OF THE CORPORATION. C) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS WHICH AFFECT THE RESERVED POWERS OF THE MEMBER. D) TO FIX THE NUMBER OF DIRECTORS OF THIS CORPORATION, APPOINT THE BOARD OF DIRECTORS OF THIS CORPORATION AND REMOVE SUCH DIRECTORS AT ANY TIME WITH OR WITHOUT CAUSE. E) UPON THE RECOMMENDATION OF THE BOARD OF DIRECTORS, TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION. F) TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS. G) RESERVED. H) TO APPROVE THE ESTABLISHMENT OF ANY NEW SUBSIDIARY OR AFFILIATE OF THE CORPORATION. I) TO APPROVE ANY ACQUISITIONS, JOINT VENTURES OR OTHER CORPORATE AFFILIATIONS. J) TO REVIEW AND APPROVE THE STRATEGIC, LONG-RANGE PLAN OF THE CORPORATION. K) TO RECEIVE AND REVIEW THE ANNUAL REPORT PREPARED BY THE EXECUTIVE DIRECTOR OF THE CORPORATION. L) TO APPROVE ANY AGREEMENT PURSUANT TO WHICH A THIRD PARTY OBTAINS THE RIGHT OR OBLIGATION TO MANAGE ALL OR SUBSTANTIALLY ALL OF THE OPERATIONS OF THE CORPORATION OR APPROVE ANY AGREEMENT PURSUANT TO WHICH THE CORPORATION MANAGES ANY ENTITY OR INSTITUTION WHICH IS NOT AN AFFILIATE OF SSMHCC. M) TO APPROVE FOR THIS CORPORATION, OR FOR ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING SHAREHOLDER OR MEMBER, THE ACQUISITION OF LAND OR BUILDINGS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE, TRANSFER, ASSIGNMENT, OR ENCUMBRANCE OF THE ASSETS OF SUCH CORPORATION. N) TO APPROVE THE DISSOLUTION AND/OR LIQUIDATION OF THIS CORPORATION OR ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING SHAREHOLDER OR MEMBER OR THE CONSOLIDATION OR MERGER OF THIS CORPORATION WITH ANOTHER CORPORATION OR ENTITY OR THE CLOSURE OF ANY INSTITUTION OR MAJOR MINISTRY OR WORK CONDUCTED BY THE CORPORATION. O) TO REMOVE AND APPOINT THE SECRETARY AND TREASURER OF THE CORPORATION. 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 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, CONFLICT OF INTEREST STATEMENTS AND POLICY ARE DISTRIBUTED TO MEMBERS OF THE BOARD AND ANY EMPLOYEE WHO HAS AUTHORITY TO ENTER INTO CONTRACTS AND OTHER TRANSACTIONS ON BEHALF OF MONROE CLINIC. THE COMPLETED FORMS ARE REVIEWED BY ADMINISTRATION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THE COMMITTEE REVIEWS COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY THE POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER.ADDITIONALLY, THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE YEAR-END AUDITED CONSOLIDATED FINANCE STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE WISCONSIN SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: DIRECT DONOR BENEFIT -24,387. 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