WAUPUN MEMORIAL HOSPITAL: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- WAUPUN MEMORIAL HOSPITAL (EIN 39-0806265)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-11-17
- IRS object ID
- 202503219349326585
- Schema version
- 2024v5.2
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-11-17T19:42:56-06:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806265 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAUPUN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WAUP | BusinessNameControlTxt |
| Phone | 9209265519 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 620 WEST BROWN STREET | AddressLine1Txt |
| City | WAUPUN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53963 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHANIE KING | PersonNm |
| Person Title | VP FINANCE | PersonTitleTxt |
| Phone | 9209265519 | PhoneNum |
| Signature | 2025-11-17 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SSM HEALTH WAUPUN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SUE ANDERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 620 WEST BROWN STREET | AddressLine1Txt |
| City | WAUPUN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53963 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $68,743,572 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/WAUPUN-MEMO | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1949 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF WAUPUN MEMORIAL HOSPITAL 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 | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 53 | TotalVolunteersCnt |
| Total Gross UBI | $24,400 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $60,292 | PYContributionsGrantsAmt |
| CY Contributions Grants | $104,205 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $59,588,022 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $67,382,558 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$4,487 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,292 | CYInvestmentIncomeAmt |
| PY Other Revenue | $343,064 | PYOtherRevenueAmt |
| CY Other Revenue | $1,249,114 | CYOtherRevenueAmt |
| PY Total Revenue | $59,986,891 | PYTotalRevenueAmt |
| CY Total Revenue | $68,737,169 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $65,373 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $54,900 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,224,984 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,436,805 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $25,114,003 | PYOtherExpensesAmt |
| CY Other Expenses | $27,403,295 | CYOtherExpensesAmt |
| PY Total Expenses | $49,404,360 | PYTotalExpensesAmt |
| CY Total Expenses | $52,895,000 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $10,582,531 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $15,842,169 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $93,064,323 | TotalAssetsBOYAmt |
| Total Assets EOY | $102,416,227 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $441,196 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,459,027 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $92,623,127 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $98,957,200 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF WAUPUN MEMORIAL HOSPITAL 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 | $47,166,253 | ExpenseAmt |
| Grant | $54,900 | GrantAmt |
| Revenue | $67,382,558 | RevenueAmt |
| Desc | WAUPUN MEMORIAL HOSPITAL IS A 25-BED CRITICAL ACCESS HOSPITAL LOCATED IN WAUPUN, WISCONSIN, AND PROVIDES A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO WAUPUN AND THE SURROUNDING RURAL AREAS. WAUPUN MEMORIAL HOSPITAL FEATURES A TWO-STORY PROVIDER CLINIC, CONSOLIDATING ALL ITS PROVIDER SERVICES INTO ONE FACILITY WITH A DIRECT CONNECTION TO THE LARGER RESOURCES OF THE HOSPITAL. A STATE-OF-THE-ART SURGERY AREA FEATURES 3 HIGH-TECH OPERATING ROOMS, AN ENDOSCOPY PROCEDURE ROOM, 11 PRE/POSTOPERATIVE PATIENT ROOMS, 4 POST ANESTHESIA RECOVERY ROOMS AND CENTRALIZED STERILE PROCESSING AREA. THE HOSPITAL'S STAFF OF ASSOCIATES AND VOLUNTEERS IS DEDICATED TO PROVIDING SERVICES IN THE AREAS OF LABORATORY, CARDIOPULMONARY, REHABILITATION, RADIOLOGY, ULTRASOUND, MRI, SURGICAL, EMERGENCY, OUTPATIENT DIALYSIS, MEDICAL/SURGICAL SERVICES, INTENSIVE CARE AND OBSTETRICS. | Desc |
| Total Program Service Expenses | $47,166,253 | 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 | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | 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 | 0 | TaxExemptBondsInd |
| 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 | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRADLEY REACH | 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 (18 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 | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| SUE ANDERSON | ||||||||
| DIRECTOR, REGIONAL PRESIDENT | 1.00 | 54.00 | Yes (X) | Yes (X) | $1,377,728 | $0 | $548,240 | |
| WESLEY SPARKMAN | ||||||||
| DIRECTOR, CHAIR | 1.00 | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WAYNE MATZKE | ||||||||
| DIRECTOR, VICE CHAIR | 1.00 | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SR RHEA EMMER | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| PENG HER | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK HOLZMAN | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| JOAN KARSTEN | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| PATTI LEITZEN FYE | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| JENNIFER MASKEL MD | ||||||||
| DIRECTOR, PHYSICIAN AT SSM HEALTH | 1.00 | 54.00 | Yes (X) | $0 | $145,868 | $14,398 | ||
| THEODORE TED MILLER MD | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| OLIVIA OTTE | ||||||||
| DIRECTOR | 1.00 | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW POGODZINSKI MD | ||||||||
| DIRECTOR, PHYSICIAN AT SSM HEALTH | 1.00 | 54.00 | Yes (X) | $0 | $813,233 | $65,767 | ||
| STEVE SMOOT | ||||||||
| VICE PRESIDENT, COO AT SSM HEALTH | 1.00 | 54.00 | Yes (X) | $0 | $2,364,935 | $1,119,698 | ||
| KEVIN SMITH | ||||||||
| TREASURER, CFO AT SSM HEALTH | 1.00 | 54.00 | Yes (X) | $0 | $1,050,477 | $627,081 | ||
| DOUGLAS LONG | ||||||||
| SECRETARY, CLO AT SSM HEALTH | 1.00 | 54.00 | Yes (X) | $0 | $1,587,150 | $700,771 | ||
| THOMAS KIRSCHBAUM | ||||||||
| ASST SEC, REG GENERAL COUNSEL | 1.00 | 54.00 | Yes (X) | $0 | $561,495 | $175,772 | ||
| MATT KINSELLA | ||||||||
| REGIONAL VP FINANCE-WISCONSIN | 1.00 | 54.00 | Yes (X) | $0 | $561,331 | $175,077 | ||
| RANDY COMBS | ||||||||
| FORMER OFFICER | 0.00 | 0.00 | $0 | $1,454,021 | $29,506 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,377,728 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,538,510 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $3,456,310 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | 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 |
|---|---|---|---|---|---|
| TRIMEDX HOLDINGS LLC | |||||
| 5451 LAKEVIEW PARKWAY S DR | INDIANAPOLIS | IN | 46268 | CLINICAL ENGINEERING SERVICES | $267,365 |
| CAREFUSION SERVICES LLC | |||||
| 3750 TORREY VIEW CT | SAN DIEGO | CA | 92130 | HEALTHCARE CONSULTING | $172,135 |
| SHARED MEDICAL SERVICES INC | |||||
| 209 LIMESTONE PASS | COTTAGE GROVE | WI | 53527 | MEDICAL SERVICES | $156,148 |
| OWENS & MINOR DISTRIBUTION INC | |||||
| 9120 LOCKWOOD BOULEVARD | MECHANICSVILLE | VA | 23116 | LOGISTICS AND SUPPLY CHAIN | $129,435 |
| CD SMITH CONSTRUCTION INC | |||||
| 125 CAMELOT DRIVE | FOND DU LAC | WI | 54935 | CONSTRUCTION SERVICES | $125,145 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $91,135 | RelatedOrganizationsAmt |
| Government Grants | $13,070 | GovernmentGrantsAmt |
| Total Contributions | $104,205 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE RE | 622110 | $67,068,024 | $67,068,024 |
| CORPORATE FEES REVENUE | 900099 | $312,982 | $312,982 |
| 340B PHARMACY REVENUE | 456110 | $1,052 | $1,052 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $500 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $500 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $67,382,558 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $329 | TotalRevenueColumnAmt |
| Exclusion | $329 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,095,978 | 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 | $1,095,978 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,095,978 | TotalRevenueColumnAmt |
| Exclusion | $1,095,978 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $963 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $963 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $963 | TotalRevenueColumnAmt |
| Exclusion | $963 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $7,975 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $6,403 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,572 | TotalRevenueColumnAmt |
| Exclusion | $1,572 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $127,164 | $127,164 | |
| MOBILE MEALS | 624200 | $24,400 | $24,400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $151,564 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,737,169 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $67,382,558 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $24,400 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,226,006 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,900 | TotalAmt |
| Program Services | $54,900 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,365,044 | TotalAmt |
| Program Services | $19,867,606 | ProgramServicesAmt |
| Management And General | $497,438 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,036,694 | TotalAmt |
| Program Services | $1,011,372 | ProgramServicesAmt |
| Management And General | $25,322 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,672,747 | TotalAmt |
| Program Services | $2,607,462 | ProgramServicesAmt |
| Management And General | $65,285 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,362,320 | TotalAmt |
| Program Services | $1,329,044 | ProgramServicesAmt |
| Management And General | $33,276 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,495,896 | TotalAmt |
| Program Services | $1,495,896 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $816 | TotalAmt |
| Management And General | $816 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,680,677 | TotalAmt |
| Program Services | $2,673,410 | ProgramServicesAmt |
| Management And General | $7,267 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $532 | TotalAmt |
| Management And General | $532 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $521,484 | TotalAmt |
| Program Services | $515,716 | ProgramServicesAmt |
| Management And General | $5,768 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,482,769 | TotalAmt |
| Program Services | $1,482,769 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,693,849 | TotalAmt |
| Program Services | $1,338,285 | ProgramServicesAmt |
| Management And General | $355,564 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,212 | TotalAmt |
| Program Services | $26,299 | ProgramServicesAmt |
| Management And General | $2,913 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,610 | TotalAmt |
| Program Services | $2,005 | ProgramServicesAmt |
| Management And General | $605 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,584,362 | TotalAmt |
| Program Services | $3,220,345 | ProgramServicesAmt |
| Management And General | $4,364,017 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,766,874 | TotalAmt |
| Program Services | $2,764,201 | ProgramServicesAmt |
| Management And General | $2,673 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,163 | TotalAmt |
| Program Services | $3,651 | ProgramServicesAmt |
| Management And General | $181,512 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & EQUI | $8,695,576 | $8,695,576 | |
| TAXES | $124,616 | $124,616 | |
| LICENSES, DUES & SUBSCR | $101,410 | $40,387 | $61,023 |
| BANK FEES | $403 | $283 | $120 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,046 | TotalAmt |
| Program Services | $37,046 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,895,000 | TotalAmt |
| Program Services | $47,166,253 | ProgramServicesAmt |
| Management And General | $5,728,747 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $355,906 | BOYAmt |
| EOY | $461 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,669,268 | BOYAmt |
| EOY | $10,076,755 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,712 | BOYAmt |
| EOY | $291,323 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10,345 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $56,397,719 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,101,632 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,063,375 | BOYAmt |
| EOY | $35,296,087 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $375,013 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,569,049 | BOYAmt |
| EOY | $56,741,256 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,064,323 | BOYAmt |
| EOY | $102,416,227 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $296,492 | BOYAmt |
| EOY | $1,812,255 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,704 | BOYAmt |
| EOY | $1,646,772 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $441,196 | BOYAmt |
| EOY | $3,459,027 | 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 | $92,248,114 | BOYAmt |
| EOY | $98,957,200 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $375,013 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,623,127 | BOYAmt |
| EOY | $98,957,200 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,064,323 | BOYAmt |
| EOY | $102,416,227 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $15,842,169 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $14,796 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$9,522,892 | 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 | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $4,860 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,860 | 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, STATE AND LOCAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WERE ALLOCATED TO LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $190,000 | OtherCostOrOtherBasisAmt |
| Book Value | $190,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,451,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,152,118 | DepreciationAmt |
| Book Value | $26,299,422 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,607,463 | OtherCostOrOtherBasisAmt |
| Depreciation | $687,287 | DepreciationAmt |
| Book Value | $2,920,176 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,121,665 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,262,227 | DepreciationAmt |
| Book Value | $4,859,438 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,027,051 | OtherCostOrOtherBasisAmt |
| Book Value | $1,027,051 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $35,296,087 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATES | $54,769,072 |
| ESTIMATED THIRD PARTY SETTLMENT | $1,230,386 |
| OPERATING RIGHT-OF-USE ASSETS | $741,798 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $56,741,256 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYOR | $763,924 |
| OPERATING RIGH-OF-USE LIABILITIES | $882,848 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,646,772 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | WAUPUN MEMORIAL HOSPITAL'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 2024 OR 2023. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| Most Hospitals Policy | Yes (X) | MostHospitalsPolicyInd |
| 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 | $432,543 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $432,543 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00820 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,755,718 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,323,220 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $666,428 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $719,720 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,854,689 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,042,940 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $432,543 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00820 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $75,100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $75,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $157,407 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $157,407 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $53,884 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $53,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $286,391 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $286,391 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,141,080 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,042,940 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $718,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,968 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,968 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,968 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,968 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,019,932 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $1,017,847 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,101,280 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,083,433 | 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 | WAUPUN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 620 WEST BROWN STREET | AddressLine1Txt |
| City | WAUPUN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53963 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/ | WebsiteAddressTxt |
| State License | 1031 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WAUPUN MEMORIAL 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 24 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSES | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 24 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSES | 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 |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 | SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BIL/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BIL/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BIL/FINANCIAL-ASSISTANCE | 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 |
|---|---|
| WAUPUN MEMORIAL 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. |
| WAUPUN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: SSM HEALTH WAUPUN MEMORIAL HOSPITAL SOUGHT AND RECEIVED INPUT FROM THE FOND DU LAC COUNTY PUBLIC HEALTH DEPARTMENT. THE HOSPITAL ALSO WORKED CLOSELY WITH HEALTHY FOND DU LAC COUNTY STEERING COMMITTEE TO DEVELOP THE 2024-2027 FOND DU LAC COUNTY COMMUNITY HEALTH ASSESSMENT (CHA). COMMUNITY PERSPECTIVES AND DATA GATHERED DURING THIS ENDEAVOR WERE INCORPORATED INTO THE SSM HEALTH WAUPUN MEMORIAL HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT. COMMUNITY PERSPECTIVES WERE GATHERED FROM MULTIPLE ACTIVITIES, INCLUDING A COMMUNITY SURVEY, PUBLIC INPUT SURVEY, KEY INFORMANT INTERVIEWS, AND FOCUS GROUPS (COMMUNITY CONVERSATIONS).IN ADDITION TO A REVIEW OF DEMOGRAPHICS, DATA FROM BROAD SOURCES WAS GATHERED AND RECEIVED TO SET THE INITIAL DIRECTION AND PRIORITIES OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE SECONDARY DATA WAS DERIVED FROM A VARIETY OF UNBIASED SOURCES INCLUDING THE COUNTY HEALTH RANKINGS, YOUTH BEHAVIORAL RISK SURVEY AND THE WISCONSIN DEPARTMENT OF HEALTH SERVICES. |
| WAUPUN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: THE 2024 CHNA WAS COMPLETED COLLABORATIVELY COMPLETED WITH THE FOLLOWING OTHER COMMUNITY PARTNERS:* FOND DU LAC COUNTY HEALTH DEPARTMENT * HEALTHY FOND DU LAC COUNTY STEERING COMMITTEE* DRUG FREE COMMUNITIES OF FOND DU LAC* FOND DU LAC COUNTY MENTAL HEALTH ACTION TEAM* LIVING WELL COALITION OF FOND DU LAC COUNTY |
| WAUPUN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED VARIOUS HEALTH NEEDS IN THE 2024 CHNA. IN ORDER TO MAKE A MEANINGFUL IMPACT, AND TO USE ITS FINANCES MOST EFFECTIVELY AND EFFICIENCY, THE HOSPITAL WILL PLACE PRIMARY FOCUS ON THE FOLLOWING KEY PRIORITIES:* MENTAL HEALTH* SUBSTANCE ABUSE* HEALTH CARE ACCESSMENTAL HEALTHMENTAL HEALTH WAS IDENTIFIED AS THE NUMBER ONE PRIORITY TO ADDRESS AS A RESULT OF THE 2024 CHNA. MENTAL HEALTH NEEDS IN THE GREATER FOND DU LAC AREA, WHICH MAY INCLUDE BUT IS NOT LIMITED TO CHALLENGES, BARRIERS OR NEEDS RELATED TO PROVIDER AVAILABILITY, AFFORDABILITY, TRANSPORTATION, INSURANCE, STIGMA, SUBSTANCE USE, CULTURAL SENSITIVITY AND DIVERSE PROVIDERS AND SERVICES, STRESS, AND SUICIDE. * 15 DEATHS BY SUICIDE REPORTED IN 2024. * 20% OF ADULTS REPORTED TO HAVE A MENTAL HEALTH CONDITION IN THE PAST THREE YEARS. * 49% OF YOUTH REPORTED SIGNIFICANT PROBLEMS WITH FEELINGS (ANXIOUS, NERVOUS, TENSE, ETC.). * 14% OF HOUSEHOLDS REPORTED NOT RECEIVING MENTAL HEALTH CARE AS NEEDED. * 67% OF ADULTS STRONGLY AGREED THAT MENTAL HEALTH CONCERN CAN BE AS SERIOUS AS A PHYSICAL CONCERN.PROGRESS MADE SINCE 2021* ROCK RIVER INTERMEDIATE SCHOOL PARTNERS WITH SSM WAUPUN MEMORIAL HOSPITAL AND CHURCH HEALTH SERVICES TO PROVIDE MENTAL HEALTH SERVICES TO STUDENTS.GOALS & OBJECTIVES INCREASE ACCESS TO BEHAVIORAL/MENTAL HEALTH SERVICES.* PROMOTE VIRTUAL BEHAVIORAL HEALTH INTEGRATION (VBHI) IN PRIMARY CARE AND TELEHEALTH OPTIONS.* SUPPORT, BUILD AND MAINTAIN COMMUNITY SUPPORT GROUPS AND TOOLS (PATHWAYS TO CARE DOCUMENT, NAMI PEER TO PEER GROUPS, LOCAL SUPPORT GROUPS).* PROVIDE SCHWARTZ ROUNDS QUARTERLY IN ALL HOSPITAL SETTINGS. PROVIDE PEER GRIEF SUPPORT GROUPS (I.E. CARE FOR THE CAREGIVERS) AND ZERO SUICIDE.* ENCOURAGE LOCAL EMPLOYERS TO ADOPT A SICK LEAVE POLICY TO INCLUDE MENTAL HEALTH (WORKPLACE MENTAL HEALTH TOOLKIT).DECREASE NUMBER OF DEATHS BY SUICIDE.* HAVE SSM STAFF ATTEND SODRT (SUICIDE OVERDOSE DEATH REVIEW TEAM) AT EVERY MEETING.* HOST AT LEAST FOUR QPR TRAININGS PER YEAR.* PROMOTE ZERO SUICIDE WORK AND EXPAND HEARTMATH EDUCATION AND TRAINING.* ENCOURAGE LOCAL EMPLOYERS TO ADOPT A SICK LEAVE POLICY TO INCLUDE MENTAL HEALTH (WORKPLACE MENTAL HEALTH TOOLKIT).SUBSTANCE ABUSESUBSTANCE USE WAS IDENTIFIED AS THE NUMBER TWO PRIORITY TO ADDRESS IN THE 2025-2027 CHIP. SUBSTANCE USE NEEDS IN THE GREATER FOND DU LAC AREA, WHICH MAY INCLUDE BUT ARE NOT LIMITED TO BARRIERS, CHALLENGES AND NEEDS RELATED TO TOBACCO, VAPING, DRUGS (NARCOTICS, MARIJUANA, ETC.) PRESCRIPTION MEDICATIONS, AND ALCOHOL USE, MENTAL HEALTH AND ACCESS TO CARE. THROUGHOUT THE CHNA, SUBSTANCE USE WAS CONSISTENTLY A TOP-RANKING PRIORITY.* 18 OPIOID RELATED DEATHS IN 2022, COMPARED TO 24 IN 2020. * 16% OF YOUTH REPORTED DRINKING ALCOHOL IN THE PAST MONTH. * 7% OF YOUTH REPORTED BINGE DRINKING IN THE PAST MONTH. * 6% OF YOUTH WHO BOUGHT OR DRANK ALCOHOL AT A COMMUNITY EVENT. * 44% OF YOUTH WHO THIS THE COMMUNITY IS "ACTIVELY DISCOURAGING OR "THINK IT ISN'T OK" UNDERAGE DRINKING. * 33% OF YOUTH WHO REPORT THEY TALKED WITH THEIR PARENTS ABOUT ALCOHOL IN THE PAST MONTH. * 27% OF ADULTS REPORTED *BINGE DRINKING ALCOHOL IN THE PAST MONTH. * 71% OF ADULTS REPORTED DRINKING ALCOHOL IN THE PAST MONTH. * 4% OF YOUTH WHO REPORT USING PRESCRIPTION MEDICATION FOR NON-MEDICAL USE. * 23% OF YOUTH WHO REPORT RELATIVE EASE IN OBTAINING PRESCRIPTION MEDICATION FOR NON-MEDICAL USE. PROGRESS MADE SINCE 2021* WAUPUN MEMORIAL HOSPITAL COLLECTS ON AVERAGE 40 POUNDS OF PRESCRIPTION MEDICATIONS EVERY MONTH IN THE DRUG DROP BOX LOCATED IN THE LOBBY.GOALS & OBJECTIVES DECREASE UNDERAGE DRINKING AND BINGE DRINKING.* PROMOTE ALCOHOL YOUTH PREVENTION PROGRAMS (I.E. FACT AND STAAND).* HOST A SMALL TALKS CAMPAIGN, ANNUALLY. * BUILD A COMMUNITY EVENTS BEST PRACTICE TOOLKIT.* FUND AND PROMOTE ALCOHOL YOUTH PREVENTION WORK.* REQUEST SPONSORSHIP EVENTS TO ADHERE TO COMMUNITY EVENTS BEST PRACTICE TOOLKIT.DECREASE MISUSE OF OPIOIDS AND PRESCRIPTION MEDICATIONS.* PROMOTE DRUG TAKE BACK CAMPAIGNS, ANNUALLY AND REPORT POUNDAGE DISPOSED. * PROMOTE FDL FOR RECOVERY'S MESSAGE.* MONITOR QUARTERLY PDMP AND FOLLOW UP WITH PROVIDERS TO ENSURE BEST PRACTICES ARE BEING FOLLOWED. * REPORT QUARTERLY ON POUNDAGE DISPOSED FROM INTERNAL DRUG DISPOSAL BINS.HEALTH CARE ACCESS FINANCIAL BARRIERS AND LACK OF INSURANCE AND TRANSPORTATION WERE THE MOST SIGNIFICANT BARRIERS TO ACCESSING CARE IDENTIFIED DURING THE CHNA. HEALTH CARE ACCESS IS NOT LIMITED TO THE ABOVE-MENTIONED BARRIERS TO CARE. HOWEVER, DURING THE GOAL SETTING SESSION HEALTH NAVIGATION AND TRANSPORTATION WERE THE MOST MENTIONED THEMES FROM THE GROUP. SINCE HEALTH CARE ACCESS IS A NEW PRIORITY AREA MAJORITY OF THE WORK WILL BE INITIAL AND DATA COLLECTION TO BETTER UNDERSTAND THE NEED. ALSO, A NEW GREATER FOND DU LAC AREA WORKGROUP WILL BE FORMED AND START THE WORK OUTLINED IN THIS CHIP.* 23% OF ADULTS REPORTED DELAYING OR NOT SEEKING MEDICAL CARE BECAUSE OF COST. * 32% OF ADULTS REPORTED SOMEONE IN THEIR HOUSEHOLD DID NOT RECEIVE THE HEALTH CARE NEEDED IN 2023. * 62% (ABOUT 4,200) OF ACUTE CARE PATIENTS AT WAUPUN HOSPITAL SCREENED POSITIVE FOR TRANSPORTATION ACCESS IN 2024. * 5.6% OR 106 CALLS TO 2-1-1 FOR TRANSPORTATION ASSISTANCE (LOW-COST PUBLIC OR LONG-DISTANCE TRAVEL) WERE PLACED IN 2023.PROGRESS MADE SINCE 2021* REACH WAUPUN, A NON-PROFIT ORGANIZATION PROVIDING SERVICES TO WAUPUN YOUTH IDENTIFIED DECREASING BARRIERS TO YOUTH SPORTS BY PROVIDING SPORTS FEES TO THOSE IN NEED. SSM HEALTH PARTNERED WITH REACH WAUPUN TO PROVIDE THE FUNDING FOR THOSE FEES.GOALS & OBJECTIVES INCREASE UTILIZATION OF HEALTH NAVIGATORS IN THE COMMUNITY.* PARTICIPATE IN A NEW ACCESS TO HEALTH CARE WORKGROUP, AT LEAST SIX TIMES ANNUALLY.* CONDUCT AN ENVIRONMENTAL SCAN OF TRANSPORTATION RESOURCES.* BUILD PATHWAYS DOCUMENT FOR PATIENTS TO ACCESS TRANSPORTATION SERVICES.* REEVALUATE CURRENT PATIENT TRANSPORTATION POLICY TO BE USEFUL AND CONCISE.THE CHNA ALSO IDENTIFIED THE FOLLOWING AS TOP HEALTH AREAS THAT WERE NOT SELECTED BY THE COMMUNITY PARTICIPANTS TO BE IN THE TOP THREE PRIORITIES TO ADDRESS:* VIOLENCE AND CRIME* HOUSING * CHILDCARE |
| WAUPUN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13H: SSM HEALTH MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS, INCLUDING BUT NOT LIMITED TO THE HOMELESS POPULATION, WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. IRREGULARLY, IN THE ABSENCE OF USING THE PREDICTIVE ANALYTICAL SOFTWARE, PRESUMPTIVE CHARITY MAY BE AUTHENTICATED BY THE PATIENT CARE TEAM AS REPRESENTED AS CHARITY OR UNINSURED DISCOUNTS TO THE PATIENTS' FINANCIAL OBLIGATION.ADDITIONALLY, PATIENTS MAY BE ELIGIBLE TO RECEIVE A DISCOUNT ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS. |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
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| PART I, LINE 3C: | ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE CONSIDERED FOR THOSE INDIVIDUALS WHO:* HAVE LIMITED OR NO HEALTH INSURANCE;* COOPERATE WITH SSM HEALTH'S POLICIES AND PROCEDURES;* DEMONSTRATE FINANCIAL NEED;* SUPPLY ALL REQUIRED INFORMATION TO PROCESS THE APPLICATION; AND * REIMBURSES THE HOSPITAL FOR ANY MONIES PAID DIRECTLY TO PATIENT BY INSURANCE. PATIENTS WHOSE FAMILY INCOME EXCEED 400% OF THE FEDERAL POVERTY GUIDELINES (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. 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 HEALTH CARE SERVICES*OTHER FINANCIAL OBLIGATIONS AND EXPENSES*GENERALLY, FINANCIAL RESPONSIBILITY WILL BE NO MORE THAN 25% OF GROSS FAMILY INCOME.SSM HEALTH MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS, INCLUDING BUT NOT LIMITED TO THE HOMELESS POPULATION, WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. IRREGULARLY, IN THE ABSENCE OF USING THE PREDICTIVE ANALYTICAL SOFTWARE, PRESUMPTIVE CHARITY MAY BE AUTHENTICATED BY THE PATIENT CARE TEAM AS REPRESENTED AS CHARITY OR UNINSURED DISCOUNTS TO THE PATIENTS' FINANCIAL OBLIGATION. |
| PART I, LINE 6A: | SSM HEALTH CARE CORPORATION FILES A COMBINED COMMUNITY BENEFIT REPORT FOR ALL ITS AFFILIATES. THE COMMUNITY BENEFIT REPORT CAN BE FOUND ON SSM'S WEBSITE AT: HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH. |
| 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 7I ARE REPORTED AT COST AS REPORTED. THE CALCULATION OF FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F UTILIZES FORM 990, PART IX, LINE 25, COLUMN A, WHICH DOES NOT INCLUDE BAD DEBT EXPENSE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | SSM HEALTH WAUPUN MEMORIAL HOSPITAL PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN SCHEDULE H, PART II WAUPUN MEMORIAL HOSPITAL INCLUDE THE FOLLOWING:* ENVIRONMENTAL IMPROVEMENTS SHARPS HOME COLLECTION DISPOSAL |
| 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 INCLUDE 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: | WAUPUN MEMORIAL HOSPITAL, 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, 2024 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 COSTS 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 HEALTH 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: | THE HOSPITALS HAVE 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, THE HOSPITAL EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH IT PARTICIPATES BY ESTABLISHING SOUND BUSINESS PRACTICES. THE HOSPITALS' 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 STATEMENT2. 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 THE HOSPITAL'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 HEALTH 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 THEFOLLOWING 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 DATATO SELECT TOP HEALTH PRIORITIES; AND COMPLETE WRITTEN CHNA.*DEVELOP, ADOPT, AND IMPLEMENT STRATEGIES TO ADDRESS TOP-HEALTH PRIORITIES: ESTABLISH STRATEGIES TO ADDRESS PRIORITIES; COMPLETE STRATEGIC IMPLEMENTATION PLAN; OBTAIN REGIONAL/DIVISIONAL 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 HEALTH PRIORITIES: COLLECT DATA AND EVALUATE PROGRESS; REPORT TO REGIONAL/DIVISIONAL BOARD EVERY SIX MONTHS AND SYSTEM BOARD EVERY YEAR; SHARE FINDINGS WITH COMMUNITYSTAKEHOLDERS; 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 HEALTH ISSUES IN THE COMMUNITY. ALL HOSPITAL CHNAS ARE COMPLETED, APPROVED, AND INTEGRATED INTO THE ORGANIZATION'S STRATEGIC PLAN. WE CONTINUE TO MONITOR AND ASSESS THEPROGRESS 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 COUNSELING THE 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: | SSM HEALTH WAUPUN MEMORIAL HOSPITAL DEFINES ITS COMMUNITY AS AN AREA SIMILAR TO ITS PRIMARY SERVICE DELIVERY AREA. THE PRIMARY SERVICE AREA FOR THE HOSPITAL INCLUDES PART OF WAUPUN AND THE BRANDON AREA IN FOND DU LAC COUNTY, AND PART OF WAUPUN AND FOX LAKE AREA IN DODGE COUNTY. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES THE RIPON AREA, PART OF FOND DU LAC COUNTY, AND COMMUNITIES IN DODGE AND GREEN LAKE COUNTIES, SUCH AS MAYVILLE, BEAVER DAM, RANDOLPH AND MARQUETTE, AND A SMALL PORTION OF COLOMBIA COUNTY. WAUPUN MEMORIAL HOSPITAL IS IN WAUPUN, WISCONSIN. THE CITY OF WAUPUN, COINED "THE CITY OF SCULPTURE," HAS ONE OF THE COUNTRY'S LARGEST COLLECTION OF OUTDOOR SCULPTURES DONATED BY CLARENCE SHALER. WAUPUN IS HOME TO THE WILD GOOSE STATE TRAIL AND IS NESTLED ALONG THE SOUTHERN BRANCH OF THE ROCK RIVER NEAR THE NORTHERN ACCESS POINTS OF THE HORICON NATIONAL WILDLIFE REFUGE. THE SURROUNDING AREAS OFFERS AN ABUNDANCE OF OUTDOOR RECREATION. THE WAUPUN AREA ALSO HAS A LARGE BLUE-COLLAR WORKFORCE WITH FACTORY WORKERS AND TWO PRISONS SYSTEMS. WAUPUN CORRECTIONAL INSTITUTION, AND DODGE CORRECTION INSTITUTION. RURAL FARMLANDS SURROUND WAUPUN.WHEN COMPARED TO WISCONSIN AND THE UNITED STATES, FOND DU LAC COUNTY'S POPULATION IS SLIGHTLY OLDER AND LESS DIVERSE WITH 87.7% OF THE POPULATION BEING WHITE. ADDITIONAL ETHNICITIES THAT MAKE UP THE POPULATION IN FOND DU LAC COUNTY INCLUDE, 6.4% HISPANIC/LATINX, 2.3% BLACK/AFRICAN AMERICAN AND 1.2% ASIAN. FOND DU LAC COUNTY'S POPULATION IS 50.4% FEMALE AND 49.6% MALE.THE PERCENTAGE OF FOND DU LAC COUNTY ADULTS WITH A HIGH SCHOOL EDUCATION IS 51% COMPARED TO THE STATE PERCENTAGE OF 42%. FOND DU LAC COUNTY HAS A SIGNIFICANTLY LOWER POPULATION WITH A COLLEGE EDUCATION AT 15% COMPARED TO THE STATE AT 23%. THE PERCENTAGE OF PERSONS LIVING IN POVERTY IS COMPARABLE IN FOND DU LAC COUNTY AT 9.6% AND THE STATE AT 10.7%. FOND DU LAC COUNTY AND THE SSM HEALTH WAUPUN MEMORIAL HOSPITAL SERVICE AREA INCLUDE PEOPLE WHO ARE HIGH RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE DUE TO BEING UNINSURED/UNDERINSURED, ARE EXPERIENCING HEALTH DISPARITIES, OR FACING BARRIERS RELATED TO GEOGRAPHY, LANGUAGE, FINANCIAL CIRCUMSTANCES, TRANSPORTATION, STIGMA, ACCESSIBILITY TO TECHNOLOGY OR KNOWLEDGE OF TECHNOLOGY, MEDICATION COMPLIANCE DUE TO COST OR COVERAGE, ACCESS TO HEALTHY FOODS, AND LOW-INCOME HOUSING. POTENTIALLY MEDICALLY UNDERSERVED POPULATIONS INCLUDE THE RURAL, POOR, AND OLDER ADULTS WHO MAY BE WITHOUT ADEQUATE TRANSPORTATION; BLACK, INDIGENOUS AND OTHER PERSONS OF COLOR (BIPOC) INDIVIDUALS WHO MAY BE EXPERIENCING DISCRIMINATION AND RACIAL OR ETHNIC HEALTH DISPARITIES; NON-ENGLISH (PRIMARILY SPANISH) SPEAKING INDIVIDUALS WHO MAY ALSO BE UNDOCUMENTED; LOW SOCIO-ECONOMIC STATUS (SES) AND HOMELESS INDIVIDUALS; LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER (LGBTQ+) RESIDENTS; AND INCARCERATED INDIVIDUALS OR PEOPLE IN THE CRIMINAL JUSTICE SYSTEM. |
| PART VI, LINE 5: | SSM HEALTH AND ITS AFFILIATES PARTICIPATE IN A WIDE ARRAY OF COMMUNITY PROGRAMS THROUGHOUT THE AREA TO FURTHER ITS EXEMPT PURPOSE OF PROMOTING THE HEALTH 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.SSM HEALTH AND ITS AFFILIATES PROMOTE GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE COMMUNITY HEALTH.THE HOSPITALS ALSO FURTHER THEIR 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. |
| PART VI, LINE 6: | SSM HEALTH WAUPUN MEMORIAL HOSPITAL IS A 501(C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. SSM HEALTH CARE CORPORATION (SSMHCC), A MISSOURI NONPROFIT CORPORATION, IS THE ULTIMATE PARENT ENTITY OF A FULLY INTEGRATED HEALTH SYSTEM WITH ITS HEADQUARTERS BASED IN ST. LOUIS, MISSOURI. SSMHCC AND ITS CONSOLIDATED SUBSIDIARIES (DOING BUSINESS AS SSM HEALTH (SSMH) OWNS AND OPERATES 23 ACUTE CARE HOSPITALS, ONE OF WHICH SPECIALIZES IN PEDIATRICS, TWELVE POST-ACUTE CARE FACILITIES, A NATIONAL PHARMACY BENEFIT MANAGEMENT COMPANY (PBM), AN EXTENSIVE NETWORK OF PHYSICIAN PRACTICE OPERATIONS, OTHER HEALTH CARE BUSINESSES AND SEVERAL FOUNDATIONS. 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, A MINISTERIAL JURIDIC PERSON, WHICH IS CURRENTLY COMPOSED OF ONE FRANCISCAN SISTER OF MARY (FSM), ONE SISTER OF ST. AGNES, ONE JESUIT PRIEST, ONE FRANCISCAN PRIEST, AND FOUR 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 | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| CHURCH HEALTH SERVICES INC | ||||||||
| 115 N CENTER ST | BEAVER DAM | WI | 53916 | 391759669 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| HOLY FAMILY CONGREGATION GREEN LAKE COUNTY WI INC | ||||||||
| PO BOX 370 | MARKESAN | WI | 53946 | 371590601 | 501(C)(3) | $10,000 | $0 | GENERAL SUPPORT |
| WAUPUN AREA FOOD PANTRY INC | ||||||||
| 520 MCKINLEY ST | WAUPUN | WI | 53963 | 300219941 | 501(C)(3) | $8,500 | $0 | GENERAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE PROCEDURES USED TO MONITOR THE USE OF GRANT FUNDING VARIES BASED ON THE GRANT RECIPIENT. GRANTS TO RELATED ENTITIES ARE MONITORED DIRECTLY BY THE ORGANIZATION WHEREBY THE RECIPIENT REPORTS ON THE SPECIFIC USE OF THE FUNDING. FOR GRANTS TO UNRELATED ENTITIES, THE ORGANIZATION UTILIZES THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) TO TRACK, STORE AND REPORT A WIDE RANGE OF INFORMATION RELATED TO GRANTS AND OVERALL COMMUNITY IMPACT. | ExplanationTxt |
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 |
| 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVE SMOOT | ||||||||||||||
| VICE PRESIDENT, COO AT SSM HEALTH | $0 | $1,305,272 | $0 | $895,103 | $0 | $164,560 | $0 | $1,075,677 | $0 | $44,021 | $0 | $3,484,633 | $0 | $1,036,001 |
| DOUGLAS LONG | ||||||||||||||
| SECRETARY, CLO AT SSM HEALTH | $0 | $813,979 | $0 | $583,198 | $0 | $189,973 | $0 | $676,547 | $0 | $24,224 | $0 | $2,287,921 | $0 | $583,198 |
| SUE ANDERSON | ||||||||||||||
| DIRECTOR, REGIONAL PRESIDENT | $787,210 | $0 | $422,941 | $0 | $167,577 | $0 | $527,309 | $0 | $20,931 | $0 | $1,925,968 | $0 | $480,783 | $0 |
| KEVIN SMITH | ||||||||||||||
| TREASURER, CFO AT SSM HEALTH | $0 | $1,034,519 | $0 | $0 | $0 | $15,958 | $0 | $586,407 | $0 | $40,674 | $0 | $1,677,558 | $0 | $0 |
| RANDY COMBS | ||||||||||||||
| FORMER OFFICER | $0 | $323,766 | $0 | $923,306 | $0 | $206,949 | $0 | $13,881 | $0 | $15,625 | $0 | $1,483,527 | $0 | $923,306 |
| MATTHEW POGODZINSKI MD | ||||||||||||||
| DIRECTOR, PHYSICIAN AT SSM HEALTH | $0 | $735,611 | $0 | $75,000 | $0 | $2,622 | $0 | $19,513 | $0 | $46,254 | $0 | $879,000 | $0 | $0 |
| THOMAS KIRSCHBAUM | ||||||||||||||
| ASST SEC, REG GENERAL COUNSEL | $0 | $400,165 | $0 | $115,798 | $0 | $45,532 | $0 | $136,607 | $0 | $39,165 | $0 | $737,267 | $0 | $115,798 |
| MATT KINSELLA | ||||||||||||||
| REGIONAL VP FINANCE-WISCONSIN | $0 | $417,285 | $0 | $101,437 | $0 | $42,609 | $0 | $132,986 | $0 | $42,091 | $0 | $736,408 | $0 | $121,251 |
| JENNIFER MASKEL MD | ||||||||||||||
| DIRECTOR, PHYSICIAN AT SSM HEALTH | $0 | $145,211 | $0 | $0 | $0 | $657 | $0 | $10,712 | $0 | $3,686 | $0 | $160,266 | $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 TAX INDEMNIFICATION/GROSS UP PAYMENTS IN 2024, WHICH 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; 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 2024. 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 DISTRIBUTIONS FROM THIS PLAN IN 2024. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. STEVE SMOOT - $159,608 MATTHEW KINSELLA - $41,165 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CD SMITH CONSTRUCTION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER OF ORGANIZATION IS A BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $125,145 | TransactionAmt |
| Transaction | WAYNE MATZKE, BOARD MEMBER OF WAUPUN MEMORIAL HOSPITAL, IS A BOARD MEMBER OF CD SMITH CONSTRUCTION, INC. CD SMITH CONSTRUCTION, INC. PROVIDES CONSTRUCTION SERVICES TO WAUPUN MEMORIAL HOSPITAL IN THE NORMAL COURSE OF BUSINESS. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART V, LINE 1A: | ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY A RELATED ORGANIZATION SSM HEALTH CARE CORPORATION, EIN 46-6029223. |
| FORM 990, PART VI, SECTION A, LINE 4 | IN 2024, WAUPUN MEMORIAL HOSPITAL UPATED ITS BYLAWS FOR THE FOLLOWING CHANGES: - CHANGE TO THE SIZE OF THE BOARD OF DIRECTORS AND NUMBER OF EX OFFICIO DIRECTORS - CHANGE TO TERMS AND TERM LIMITS FOR BOARD OF DIRECTORS MEMBERS - CHANGE TO OFFICER POSITIONS AND METHOD FOR APPOINTMENT - CHANGE TO THE COMMITTEES FOR THE HOSPITAL OPERATING ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS AGNESIAN HEALTHCARE INC. AGNESIAN HEALTHCARE INC IS A NONPROFIT 501 (C)(3) ORGANIZATION. BOTH WAUPUN MEMORIAL HOSPITAL AND AGNESIAN HEALTHCARE 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 FOLLOWING POWERS ARE RESERVED FOR SSM HEALTH CARE CORPORATION (SSMHCC), THE ULTIMATE PARENT OF WAUPUN MEMORIAL HOSPITAL AND ITS SOLE MEMBER AGNESIAN HEALTHCARE INC.: A. 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 CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION; D. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN; E. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; F. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; G. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; H. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; I. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; J. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY; K. 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; L. TO APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; M. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION; N. 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; O. 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; P. 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 SSMHCC APPROVAL; AND Q. 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 | THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY THAT 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 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 FINANCIAL 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 MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN TEMPORARY NET ASSETS - SPECIAL PURPOSE -375,013. TRANSFERS TO CONSOLIDATED ENTITIES -9,147,879. |
Schedule R IRS990ScheduleR
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM HEALTH MINISTRIES | |||||||||||
| 3221 MCKELVEY ROAD SUITE 107 | BRIDGETON | MO | 63044 | 431012492 | RELIGIOUS ORGANIZATION | MO | 501(C)(3) | LINE 1 | N/A | 0 | |
| SSM HEALTH CARE CORPORATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 466029223 | HEALTH CARE | MO | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH MINISTRIES | |
| SSMHC LIABILITY TRUST I | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 436331003 | INSURANCE | MO | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH CARE CORPORATION | |
| SSM CONSOLIDATED HEALTH SERVICES | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431473657 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | 0 | SSM HEALTH CARE CORPORATION | |
| SSM POLICY INSTITUTE | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431788151 | HEALTH CARE | MO | 501(C)(4) | 0 | SSM HEALTH CARE CORPORATION | ||
| SSM HEALTH CARE PORTFOLIO MANAGEMENT CO | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431825256 | MANAGEMENT | MO | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH CARE CORPORATION | |
| SSM HEALTH FOUNDATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 874109859 | FUNDRAISING | MO | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH CARE CORPORATION | |
| SSM HEALTH CARE ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431343281 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE CORPORATION | |
| SSM-SLUH INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 474196634 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE ST LOUIS | |
| SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430738490 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE ST LOUIS | |
| CARDINAL GLENNON CHILDREN'S FOUNDATION | |||||||||||
| 3800 PARK AVE | ST LOUIS | MO | 63110 | 431754347 | FUNDRAISING | MO | 501(C)(3) | LINE 7 | 0 | SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | |
| SSM HEALTH CARDINAL GLENNON TRANSPORT | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 863519607 | HEALTH CARE | MO | 501(C)(3) | LINE 12A, I | 0 | SSM CARDINAL GLENNON CHILDREN'S HOSPITAL | |
| SSM HEALTH CARE GROUP | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 880988603 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | 0 | SSM HEALTH CARE ST LOUIS | |
| SSM HEALTH FOUNDATION - ST LOUIS | |||||||||||
| 12312 OLIVE BLVD STE 100 | ST LOUIS | MO | 63141 | 431552945 | FUNDRAISING | MO | 501(C)(3) | LINE 7 | 0 | SSM HEALTH CARE ST LOUIS | |
| SSM HEALTH CARE OF OKLAHOMA INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 730657693 | HEALTH CARE | OK | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE CORPORATION | |
| LEE DEWEY CORPORATION | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 731279603 | MOB | OK | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH CARE OF OKLAHOMA INC | |
| ST ANTHONY SHAWNEE HOSPITAL INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 455055149 | HEALTH CARE | OK | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE OF OKLAHOMA INC | |
| THE ST ANTHONY HOSPITAL FOUNDATION INC | |||||||||||
| 601 NW 11TH STREET | OKLAHOMA CITY | OK | 73101 | 736104300 | FUNDRAISING | OK | 501(C)(3) | LINE 7 | 0 | SSM HEALTH CARE OF OKLAHOMA INC | |
| SSM HEALTH CARE OF WISCONSIN INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430688874 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE CORPORATION | |
| DELLS MEDICAL BUILDING INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 391613292 | MOB | WI | 501(C)(2) | 0 | SSM HEALTH CARE OF WISCONSIN INC | ||
| ST MARY'S FOUNDATION INC | |||||||||||
| 700 SOUTH PARK STREET | MADISON | WI | 53715 | 431940686 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| ST CLARE HEALTH CARE FOUNDATION INC | |||||||||||
| 707 14TH STREET | BARABOO | WI | 53913 | 431940683 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| ST MARY'S JANESVILLE FOUNDATION INC | |||||||||||
| 3400 E RACINE ST | JANESVILLE | WI | 53546 | 273439133 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| AGNESIAN HEALTHCARE FOUNDATION INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 391684956 | FUNDRAISING | WI | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| MONROE CLINIC AND HOSPITAL FOUNDATION INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 205769038 | FUNDRAISING | WI | 501(C)(3) | LINE 7 | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| SHARED MAGNETIC RESONANCE IMAGING FACILITY INC | |||||||||||
| 1104 JOHN NOLEN DRIVE | MADISON | WI | 53713 | 391534744 | HEALTH CARE | WI | 501(C)(3) | LINE 12A, I | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| AGNESIAN HEALTHCARE INC | |||||||||||
| 430 E DIVISION ST | FOND DU LAC | WI | 54935 | 390807236 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| RIPON MEDICAL CENTER INC | |||||||||||
| 845 PARKSIDE STREET | RIPON | WI | 54971 | 391101287 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | 0 | AGNESIAN HEALTHCARE INC | |
| WAUPUN MEMORIAL HOSPITAL INC | |||||||||||
| 620 WEST BROWN STREET | WAUPUN | WI | 53963 | 390806265 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | 0 | AGNESIAN HEALTHCARE INC | |
| 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 | 0 | AGNESIAN HEALTHCARE INC | |
| SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO | |||||||||||
| N8114 COUNTY WW | MOUNT CALVARY | WI | 53057 | 391022770 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | 0 | AGNESIAN HEALTHCARE INC | |
| VILLA ROSA INC | |||||||||||
| N8120 COUNTY WW | MOUNT CALVARY | WI | 53057 | 421670962 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | 0 | AGNESIAN HEALTHCARE INC | |
| THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED | |||||||||||
| 452 FOX LAKE ROAD | WAUPUN | WI | 53963 | 390884514 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | 0 | AGNESIAN HEALTHCARE INC | |
| THE MONROE CLINIC INC | |||||||||||
| 515 22ND AVENUE | MONROE | WI | 53566 | 390808509 | HEALTH CARE | WI | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE OF WISCONSIN INC | |
| SSM HEALTH AT HOME FOUNDATION OF WISCONSIN INC | |||||||||||
| 4639 HAMMERSLEY ROAD | MADISON | WI | 53711 | 391839309 | FUNDRAISING | WI | 501(C)(3) | LINE 12A, I | 0 | HOME HEALTH UNITED INC | |
| SSM REGIONAL HEALTH SERVICES | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 440579850 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | 0 | SSM HEALTH CARE CORPORATION | |
| ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION | |||||||||||
| 2505 MISSION DRIVE | JEFFERSON CITY | MO | 65109 | 431575307 | FUNDRAISING | MO | 501(C)(3) | LINE 12A, I | 0 | SSM REGIONAL HEALTH SERVICES | |
| ST MARY'S HOSPITAL AUXILIARY | |||||||||||
| 2505 MISSION DRIVE | JEFFERSON CITY | MO | 65109 | 436049878 | FUNDRAISING | MO | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| SSM AUDRAIN HEALTH CARE INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431550298 | HEALTH CARE | MO | 501(C)(3) | LINE 3 | 0 | SSM REGIONAL HEALTH SERVICES | |
| ST MARY'S - GOOD SAMARITAN INC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 364170833 | HEALTH CARE | IL | 501(C)(3) | LINE 12A, I | 0 | SSM REGIONAL HEALTH SERVICES | |
| ST MARY'S HOSPITAL FOUNDATION | |||||||||||
| 400 N PLEASANT | CENTRALIA | IL | 62801 | 364636691 | FUNDRAISING | IL | 501(C)(3) | LINE 7 | 0 | ST MARY'S-GOOD SAMARITAN INC | |
| ST MARY'S HOSPITAL AUXILIARY | |||||||||||
| 400 N PLEASANT | CENTRALIA | IL | 62801 | 237126345 | FUNDRAISING | IL | 501(C)(3) | LINE 10 | 0 | ST MARY'S HOSPITAL FOUNDATION | |
| GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION | |||||||||||
| 1 GOOD SAMARITAN WAY | MOUNT VERNON | IL | 62864 | 262884795 | FUNDRAISING | IL | 501(C)(3) | LINE 7 | 0 | ST MARY'S-GOOD SAMARITAN INC | |
| GOOD SAMARITAN HOSPITAL AUXILIARY | |||||||||||
| 1 GOOD SAMARITAN WAY | MOUNT VERNON | IL | 62864 | 237049599 | FUNDRAISING | IL | 501(C)(3) | LINE 12C, III-FI | N/A | 0 | |
| GOOD SAMARITAN REGIONAL HEALTH CENTER | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430653587 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | SSM REGIONAL HEALTH SERVICES | |
| ST MARY'S HOSPITAL CENTRALIA ILLINOIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 370662580 | HEALTH CARE | IL | 501(C)(3) | LINE 3 | 0 | SSM REGIONAL HEALTH SERVICES | |
| CENTRALIA MEDICAL SERVICES BLDG ASSOC | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 237408025 | MOB | IL | 501(C)(3) | LINE 12A, I | 0 | SSM REGIONAL HEALTH SERVICES | |
| SSM HEALTH BUSINESSES | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431333488 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | 0 | SSM HEALTH CARE CORPORATION | |
| THE SARAH COMMUNITY | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 431784657 | HEALTH CARE | MO | 501(C)(3) | LINE 10 | 0 | SSM HEALTH BUSINESSES | |
| VISITING NURSE ASSOCIATION OF GREATER ST LOUIS | |||||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 430567000 | HEALTH CARE | MO | 501(C)(3) | LINE 7 | 0 | SSM HEALTH BUSINESSES | |
| HOME HEALTH UNITED INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391539827 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | 0 | SSM HEALTH BUSINESSES | |
| HHU XTRA CARE INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391705111 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | 0 | SSM HEALTH BUSINESSES | |
| HOME CARE UNITED INC | |||||||||||
| 2802 WALTON COMMONS LANE | MADISON | WI | 53718 | 391776340 | HEALTH CARE | WI | 501(C)(3) | LINE 10 | 0 | SSM HEALTH BUSINESSES | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (19 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 | Yes (1) |
| ST LOUIS HEALTHCARE SUPPORT SERVICES LLC | |||||||||
| 4901 FOREST PARK AVENUE STE 1140 | ST LOUIS | MO | 63108 | 372121486 | LAUNDRY SERVICES | MO | N/A | 0 | Yes (1) |
| 1110 N CLASSEN BLVD LLC | |||||||||
| 1110 N CLASSEN BOULEVARD | OKLAHOMA CITY | OK | 73106 | 731158158 | MOB | OK | N/A | 0 | Yes (1) |
| MT VERNON RADIATION THERAPY CENTER LLC | |||||||||
| 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | 201382620 | RADIATION THERAPY | IL | N/A | 0 | Yes (1) |
| 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 |
| 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 |
| 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 |
| ST CLARE IMAGING SERVICES LLC | |||||||||
| 707 14TH STREET SUITE A | BARABOO | WI | 53913 | 200122365 | DIAG. SERVICES | WI | N/A | 0 | Yes (1) |
| NAVITUS HEALTH SOLUTIONS LLC | |||||||||
| 361 INTEGRITY DRIVE | MADISON | WI | 53717 | 043608530 | PHARMACY BENEFIT MANAGEMENT | WI | 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 |
| M&C REALTY LLC | |||||||||
| 343 DUENKE RD | FORISTELL | MO | 63348 | 621851447 | MOB | MO | N/A | 0 | Yes (1) |
| 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 (18 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSMHC INSURANCE COMPANY | |||||||||||||
| PO BOX 1051 GT | GRAND CAYMAN | CJ | 030310431 | INSURANCE | CJ | N/A | C | 0 | |||||
| OMNINHEALTH HOLDINGS | |||||||||||||
| 884144276 | HEALTH CARE CONSULTING | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | DE | ||||
| SSM MANAGED CARE ORGANIZATION LLC | |||||||||||||
| 431708511 | HEALTH PROMOTION | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| ST MARY'S HOSPITAL CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC | |||||||||||||
| 000000000 | CONDO ASSOCIATION | N/A | C | 0 | 707 SOUTH MILLS STREET | MADISON | WI | 53715 | WI | ||||
| PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC | |||||||||||||
| 364161526 | HEALTH CARE | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | IL | ||||
| FPP INC & SUBS | |||||||||||||
| 431465174 | HEALTH CARE | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| SSM MEDICAL GROUP INC | |||||||||||||
| 431664107 | PHYSICIAN OFFICES | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| SSM HEALTH PHARMACY LLC | |||||||||||||
| 264031708 | PHARMACY | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| SSMHC LIABILITY TRUST II | |||||||||||||
| 816128118 | INSURANCE | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| HEALTHFIRST PHYSICIAN MANAGEMENT SERVICES | |||||||||||||
| 731534336 | MEDICAL SERVICES | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | OK | ||||
| DIVERSIFIED HEALTH SERVICES CORP | |||||||||||||
| 431369305 | MEDICAL EQUIPMENT | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| SSM PROPERTIES INC | |||||||||||||
| 431462486 | PROPERTY SERVICES | N/A | C | 0 | 12800 CORPORATE HILL DRIVE | ST LOUIS | MO | 63131 | MO | ||||
| DEAN HEALTH SYSTEMS INC | |||||||||||||
| 391128616 | PHYSICIAN OFFICES | N/A | C | 0 | 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | WI | ||||
| DEAN RETAIL SERVICES INC | |||||||||||||
| 391717636 | PROPERTY SERVICES | N/A | C | 0 | 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | WI | ||||
| NAVITUS HOLDINGS LLC | |||||||||||||
| 800968174 | PHARMACY | N/A | C | 0 | 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | WI | ||||
| SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC | |||||||||||||
| 832038674 | CONDO ASSOCIATION | N/A | C | 0 | 1808 WEST BELTLINE HIGHWAY | MADISON | WI | 53713 | WI | ||||
| QUALITY DRUG CORPORATION | |||||||||||||
| 330644268 | PHARMACY BENEFITS | N/A | C | 0 | 239 BROADWAY | LAGUNA BEACH | CA | 92651 | CA | ||||
| PARTNERS GROUP PMC PRIVATE CREDIT LP | |||||||||||||
| C/O MAPLES CORPORATE SERVICES LTD | GRAND CAYMAN | CJ | 981439264 | INVESTMENT | CJ | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | 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 |
Comments