AGNESIAN HEALTHCARE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- AGNESIAN HEALTHCARE INC (EIN 39-0807236)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-15
- IRS object ID
- 201311359349307076
- Schema version
- 2011v1.5
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-15T14:50:42-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807236 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AGNESIAN HEALTHCARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AGNE | NameControl |
| Phone | 9209262300 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 EAST DIVISION STREET | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 54935 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BONNIE SCHMITZ | Name |
| Title | VP AND CFO | Title |
| Phone | 9209262300 | Phone |
| Date Signed | 2013-05-14 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | Phone |
| Date Prepared | 2013-05-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVEN LITTLE CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 EAST DIVISION STREET | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 54935 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 375986981 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| All Affiliates Included | 1 | AllAffiliatesIncluded |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AGNESIAN.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1892 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | AGNESIAN HEALTHCARE IS A LOCALLY-BASED, INTEGRATED HEALTHCARE SYSTEM WHICH BEGAN ITS MISSION IN 1892. THE SYSTEM IS COMPRISED OF SEVEN MINISTRIES - ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, RIPON MEDICAL CENTER, ST. FRANCIS HOME, FOND DU LAC REGIONAL CLINIC, CONSULTANTS LABORATORY OF WISCONSIN, AND AGNESIAN HEALTHCARE ENTERPRISES. AGNESIAN PROVIDES A CONTINUUM OF HEALTHCARE SERVICES FROM BIRTH TO END OF LIFE, PREVENTIVE HEALTHCARE DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT SKILL CARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3139 | TotalNbrEmployees |
| Total Nbr Volunteers | 350 | TotalNbrVolunteers |
| Total Gross UBI | 5027249 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 484665 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 292268282 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 303846638 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 6366707 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4671883 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 13030448 | OtherRevenuePriorYear |
| Other Revenue Current Year | 15415062 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 311665437 | TotalRevenuePriorYear |
| Total Revenue Current Year | 323933583 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 118550970 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 131086985 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 169158135 | OtherExpensePriorYear |
| Other Expenses Current Year | 173115111 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 287709105 | TotalExpensesPriorYear |
| Total Expenses Current Year | 304202096 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 23956332 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 19731487 | RevenuesLessExpensesCY |
| Total Assets BOY | 397023480 | TotalAssetsBOY |
| Total Assets EOY | 405106873 | TotalAssetsEOY |
| Total Liabilities BOY | 185535734 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 179598113 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 211487746 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 225508760 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH AS WE CONTINUE THE MISSION OF OUR SPONSOR, THE CONGREGATION OF SISTERS OF ST AGNES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 208459936 | Expense |
| Revenue | 290397234 | Revenue |
| Description | AGNESIAN HEALTHCARE OPERATES ST. AGNES HOSPITAL, A 174-BED GENERAL/SURGICAL ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO RESIDENTS OF FOND DU LAC AND THE SURROUNDING COUNTIES. DURING FISCAL YEAR 2012, ST. AGNES HOSPITAL HAD 6,066 INPATIENT ADMISSIONS, WITH TOTAL PATIENT DAYS OF 26,701. THERE WAS A TOTAL OF 27,841 EMERGENCY ROOM VISITS AND 12,926 SURGERIES PERFORMED IN FY12. IN ADDITION, ST. AGNES HOSPITAL PROVIDED 390,870 PHYSICIAN CLINIC VISITS, 103,838 MEDICAL IMAGING PROCEDURES, AND 1,275,705 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY UNITS. THERE WERE 1,570 CARDIAC CATH LAB VISITS AND 38,613 HOSPICE DAYS. THE HOSPITAL ALSO OPERATES SAMARITAN CLINIC, A FREE CLINIC OFFERING MEDICAL SERVICES TO QUALIFIED INDIVIDUALS. SAMARITAN CLINIC PROVIDED 4,880 VISITS TO PATIENTS, AT A COST OF $642,369 FOR FY12. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY IT PROVIDES TO ITS PATIENTS. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS $3,134,320. IN ADDITION TO QUALITY HEALTH CARE SERVICES, ST. AGNES HOSPITAL PROVIDES ITS COMMUNITIES WITH EDUCATION, SUPPORT GROUPS AND OTHER COMMUNITY BENEFITS. THE NET COST OF THESE COMMUNITY BENEFITS WAS $2,497,034. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 12585882 | Expense |
| Revenue | 14766353 | Revenue |
| Description | AGNESIAN HEALTHCARE OPERATES CONSULTANTS LABORATORY OF WISCONSIN, AN INDEPENDENT REFERENCE LAB SERVING FOND DU LAC, DODGE, OUTAGAMIE, WINNEBAGO AND COLUMBIA COUNTIES. CLW PROVIDED 1,139,485 TESTS DURING FISCAL YEAR 2012. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $310,035. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 7166548 | Expense |
| Revenue | 4929276 | Revenue |
| Description | AGNESIAN HEALTHCARE OPERATES AGNESIAN ENTERPRISES, WHICH IS COMPRISED OF EIGHT PHARMACIES SERVING FOND DU LAC AND SURROUNDING TOWNS, AS WELL AS AGNESIAN HEALTH SHOPPE, WHICH SERVES THE POPULATION WITH HOSPITAL (INPATIENT AND OUTPATIENT), CLINIC AND HOME HEALTH EQUIPMENT. AGNESIAN ENTERPRISES FILLED 437,238 PRESCRIPTIONS DURING FY12. AGNESIAN HEALTH SHOPPE PROVIDES RETAIL SALES OF DURABLE MEDICAL EQUIPMENT, AS WELL AS TELECARE AND HOME OXYGEN SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 228212366 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 263 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 3139 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 1 | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LESLIE STEPHANY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9209264512 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 EAST DIVISION STREET | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 54935 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (31 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| STEVEN N LITTLE | |||||||
| PRESIDENT AND CEO | 50.00 | X | X | 728403 | 0 | 32425 | |
| SR MARY NOEL BROWN | |||||||
| EX-OFFICIO | 1.00 | X | 0 | 0 | 0 | ||
| JAMES R CHATTERTON | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| JOAN KARSTEN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| SR ANN KOERNER | |||||||
| EX-OFFICIO | 1.00 | X | 0 | 0 | 0 | ||
| SR HERTHA LONGO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| M STEPHANIE MARTIN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| STEPHEN MASSICK MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| WAYNE MATZKE | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| PATRICIA MILLER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| H JACK POLLEI | |||||||
| DIRECTOR | 1.00 | X | 11066 | 0 | 0 | ||
| JOSEPH REITEMEIER | |||||||
| VICE CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| JAMES B SIMON | |||||||
| SECRETARY | 1.00 | X | X | 5107 | 0 | 0 | |
| MICHAEL STRINGENZ MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JEFFERY STRONG MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ALLEN MILANI MD | |||||||
| EX-OFFICIO | 1.00 | X | 482838 | 0 | 23868 | ||
| ROBERT A FALE | |||||||
| FORMER PRESIDENT AND CEO | 50.00 | X | 1313324 | 0 | 31971 | ||
| CAROL HYLAND | |||||||
| VP CEO CONSULTANTS LAB | 50.00 | X | 258936 | 0 | 29088 | ||
| DENNIS YUNK | |||||||
| SR VP CLINIC ADMINISTRATOR | 50.00 | X | 283226 | 0 | 26431 | ||
| DOUGLAS TROST | |||||||
| CEO - ST FRANCIS HOME | 50.00 | X | 166128 | 0 | 26964 | ||
| JANE HYDE | |||||||
| FORMER SR VP STRATEGIC DEVELOPMENT | 50.00 | X | 220622 | 0 | 17919 | ||
| JAMES MUGAN | |||||||
| SR VP CLINICAL SERVICES & COO-SAH | 50.00 | X | 261270 | 0 | 35572 | ||
| BONNIE SCHMITZ | |||||||
| CHIEF FINANCIAL OFFICER | 50.00 | X | 221990 | 0 | 17753 | ||
| BARB KNUTZEN | |||||||
| PRES AND CEO-AHE AND PERFORMANCE EXC | 50.00 | X | 192566 | 0 | 23774 | ||
| SR MARY MOLLISON | |||||||
| VP SPIRITUALITY AND CARE TRANSITION | 50.00 | X | 163071 | 0 | 8498 | ||
| JILL STENSON | |||||||
| VP NURSING | 50.00 | X | 162906 | 0 | 15756 | ||
| JOHN CHOI MD | |||||||
| ANESTHESIOLOGIST - PAIN RESOURCE | 50.00 | 971218 | 0 | 29726 | X | ||
| YASIR HATAHET MD | |||||||
| INTENSIVIST | 50.00 | 905433 | 0 | 38113 | X | ||
| PONTUS OSTMAN MD | |||||||
| ANESTHESIOLOGIST - PAIN RESOURCE | 50.00 | 733680 | 0 | 15860 | X | ||
| JAMES GRAF MD | |||||||
| ANESTHESIOLOGIST - PAIN RESOURCE | 50.00 | 553977 | 0 | 34769 | X | ||
| HONG WANG MD | |||||||
| RADIATION ONCOLOGIST | 50.00 | 550445 | 0 | 31971 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 8186206 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 440458 | TotalOtherCompensation |
| Number Individuals GT100 K | 108 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FOND DU LAC REGIONAL CLINIC | |||||
| 420 E DIVISION ST | FOND DU LAC | WI | 54935 | PHYSICIAN SERVICES | 45761663 |
| CERNER CORP | |||||
| 2800 ROCKCREEK PKWY | KANSAS CITY | MO | 64141 | COMPUTER SERVICES | 11894324 |
| IBM CORPORATION | |||||
| 1 NEW ORCHARD RD | ARMONK | NY | 105041722 | COMPUTER SERVICES | 10714511 |
| CD SMITH CONSTRUCTION | |||||
| PO BOX 1066 | FOND DU LAC | WI | 54935 | CONSTRUCTION | 8391302 |
| AMERICAN HEALTHCARE SERVICES | |||||
| PO BOX 945 | TRAVERSE CITY | MI | 49685 | TEMPORARY STAFFING | 1723095 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 49 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SERVICE RE | 621400 | 195902570 | 194359094 | 1543476 |
| MEDICARE/MEDICAID SERV | 621400 | 107944068 | 107944068 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 303846638 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4048938 | TotalRevenueColumn |
| Exclusion | $4,048,938 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 90995 | TotalRevenueColumn |
| Exclusion | $90,995 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 30975434 | Securities |
| Other | 18185 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 30459404 | Securities |
| Other | 2265 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 516030 | Securities |
| Other | 15920 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 531950 | TotalRevenueColumn |
| Exclusion | $531,950 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 30609061 | GrossSalesOfInventory |
| Cost Of Goods Sold | 21591729 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9017332 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5553547 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 3463785 | UnrelatedBusinessRevenue |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| WORK INJURY - SAH | 592512 | 1282165 | 1282165 | ||
| CAFETERIA SALES | 900099 | 1131715 | 19988 | $1,111,727 | |
| CLINIC REIMBURSEMENT | 621110 | 953989 | 953989 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3029861 | TotalRevenueColumn |
| Exclusion | $3,029,861 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 6397730 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 323933583 | TotalRevenueColumn |
| Related Or Exempt Function Income | 310092863 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 5027249 | UnrelatedBusinessRevenue |
| Exclusion | $8,813,471 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3161464 | Total |
| Program Services | 506706 | ProgramServices |
| Management And General | 2654758 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109169864 | Total |
| Program Services | 87077579 | ProgramServices |
| Management And General | 22092285 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5693187 | Total |
| Program Services | 4176093 | ProgramServices |
| Management And General | 1517094 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5723066 | Total |
| Program Services | 3819774 | ProgramServices |
| Management And General | 1903292 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7339404 | Total |
| Program Services | 5569141 | ProgramServices |
| Management And General | 1770263 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239903 | Total |
| Program Services | 6885 | ProgramServices |
| Management And General | 233018 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129500 | Total |
| Management And General | 129500 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59405896 | Total |
| Program Services | 55394469 | ProgramServices |
| Management And General | 4011427 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 887854 | Total |
| Program Services | 96635 | ProgramServices |
| Management And General | 791219 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40395338 | Total |
| Program Services | 38729475 | ProgramServices |
| Management And General | 1665863 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17638092 | Total |
| Program Services | 61730 | ProgramServices |
| Management And General | 17576362 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10841557 | Total |
| Program Services | 7429400 | ProgramServices |
| Management And General | 3412157 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 577709 | Total |
| Program Services | 472196 | ProgramServices |
| Management And General | 105513 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 642882 | Total |
| Program Services | 426754 | ProgramServices |
| Management And General | 216128 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4007834 | Total |
| Management And General | 4007834 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15748189 | Total |
| Program Services | 5424241 | ProgramServices |
| Management And General | 10323948 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1967984 | Total |
| Program Services | 1102815 | ProgramServices |
| Management And General | 865169 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 12692889 | 12692889 | |
| HOSPITAL ASSESSMENT TAX | 4783756 | 4783756 | |
| INVESTMENT FEES | 556809 | 556809 | |
| LOSS ON DEFEASANCE OF B | 462260 | 462260 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2136659 | Total |
| Program Services | 441828 | ProgramServices |
| Management And General | 1694831 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 304202096 | Total |
| Program Services | 228212366 | ProgramServices |
| Management And General | 75989730 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4836066 | BOY |
| EOY | 5837093 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27011646 | BOY |
| EOY | 8935657 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40185003 | BOY |
| EOY | 44502314 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4707050 | BOY |
| EOY | 4857997 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2254376 | BOY |
| EOY | 2612600 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 281379258 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 144572655 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 119574831 | BOY |
| EOY | 136806603 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 134084567 | BOY |
| EOY | 146174087 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64369941 | BOY |
| EOY | 55380522 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 397023480 | BOY |
| EOY | 405106873 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30889640 | BOY |
| EOY | 27123150 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127115997 | BOY |
| EOY | 125173728 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27530097 | BOY |
| EOY | 27301235 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185535734 | BOY |
| EOY | 179598113 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 198310924 | BOY |
| EOY | 212398409 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10715610 | BOY |
| EOY | 10649139 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2461212 | BOY |
| EOY | 2461212 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 211487746 | BOY |
| EOY | 225508760 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 397023480 | BOY |
| EOY | 405106873 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 19731487 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -5710473 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $16,793 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 16793 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | OTHER LOBBYING ACTIVITIES: LOBBYING PORTION OF WHA DUES | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 992140 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 15366 | InvestmentEarningsOrLosses |
| Administrative Expenses | 2530 | AdministrativeExpenses |
| End Of Year Balance | 1004976 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 996299 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 48126 | InvestmentEarningsOrLosses |
| Other Expenditures | 50000 | OtherExpenditures |
| Administrative Expenses | 2285 | AdministrativeExpenses |
| End Of Year Balance | 992140 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1020134 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 23156 | InvestmentEarningsOrLosses |
| Other Expenditures | 45000 | OtherExpenditures |
| Administrative Expenses | 1991 | AdministrativeExpenses |
| End Of Year Balance | 996299 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1014822 | BeginningOfYearBalance |
| Contributions | 45000 | Contributions |
| Investment Earnings Or Losses | -37548 | InvestmentEarningsOrLosses |
| Administrative Expenses | 2140 | AdministrativeExpenses |
| End Of Year Balance | 1020134 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6002505 | OtherCostOrOtherBasis |
| Book Value | 6002505 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 136087594 | OtherCostOrOtherBasis |
| Depreciation | 53637465 | Depreciation |
| Book Value | 82450129 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2600257 | OtherCostOrOtherBasis |
| Depreciation | 978567 | Depreciation |
| Book Value | 1621690 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 125344104 | OtherCostOrOtherBasis |
| Depreciation | 89956623 | Depreciation |
| Book Value | 35387481 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11344798 | OtherCostOrOtherBasis |
| Book Value | 11344798 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 136806603 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (10 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| RECEIVABLE FROM AFFILIATED ENTITIES | 4048956 |
| LONG-TERM DEBT FROM AFFILIATED ENTITY | 5000000 |
| INVESTMENT - MERCURY CLINIC | 3005130 |
| INVESTMENT - SAH FOUNDATION | 8686221 |
| OTHER ASSETS | 625163 |
| BOND DEFERRED FINANCING COSTS | 1223251 |
| ASSETS WHOSE USE IS LIMITED - BOND FUNDS | 11898620 |
| ASSETS WHOSE USE IS LIMITED - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN | 19400070 |
| MISCELLANEOUS RECEIVABLES | 670661 |
| RECEIVABLE FROM FOUNDATION | 822450 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 55380522 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE PAYABLE | $4,615,072 |
| PHYSICIANS SUPPLEMENTAL LIFE INSURANCE | $19,400,070 |
| FUND BALANCE SWAP MKT ADJUSTMENT | $3,191,758 |
| DUE TO MEDICARE/MEDICAID | $94,335 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 27301235 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | AGNESIAN HEALTHCARE, INC. HOLDS AN ENDOWMENT FROM THE CONGREGATION OF THE SISTERS OF ST. AGNES. THE ORIGINAL ENDOWMENT OF $1,000,000 IS PERMANENTLY RESTRICTED. INCOME GENERATED FROM THE ENDOWMENT IS UNRESRICTED AND TO BE USED AT THE DISCRETION OF THE CHIEF EXECUTIVE OFFICER TO FUND PROGRAMS SUCH AS DOMESTIC VIOLENCE, CHARITY CARE, ETC. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. AGNESIAN HEALTHCARE, INC. RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. FEDERAL RETURNS FOR THE YEARS ENDED 2009, 2010, AND 2011 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 165.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3134320 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3134320 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01080 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12525002 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12525002 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04300 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15659322 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 15659322 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05380 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1264530 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 129944 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1134586 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 405140 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 405140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 658422 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 658422 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 608921 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 608921 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2937013 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 129944 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2807069 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00970 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18596335 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 129944 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 18466391 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06350 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 138270 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 138270 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 138270 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 138270 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $12,692,889 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 92082790 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 131944857 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -39862067 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST AGNES HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E DIVISION STREET | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 54935 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST AGNES HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 165.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| FOND DU LAC REGIONAL CLINIC | ||||
| 420 E DIVISION STREET | FOND DU LAC | WI | 54935 | OUTPATIENT PHYSICIAN CLINIC |
| CONSULTANTS LAB OF WISCONSIN LLC | ||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | LABORATORY AND TESTING |
| AGNESIAN HEALTHCARE ENTERPRISES LLC | ||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | PHARMACEUTICALS, HOME HEALTH, MEDICAL SUPPLIES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 6A: AN ANNUAL COMMUNITY BENEFIT REPORT IS COMPLETED BY THE FINANCE DEPARTMENT AND DISTRIBUTED TO THE PUBLIC THROUGH THE PUBLIC RELATIONS OFFICE OF AGNESIAN HEALTHCARE, INC. | ||
| PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST OF COMMUNITY BENEFIT SERVICES. OVERALL COSTS LESS TAXES WERE DIVISIBLE BY TOTAL CHARGES. | ||
| PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDES SAMARITAN CLINIC, A CLINIC OFFERING FREE MEDICAL SERVICES TO QUALIFIED INDIVIDUALS, AND COUNSELING SERVICES THROUGH BEHAVIORAL HEALTH SERVICES. SAMARITAN CLINIC COSTS WERE $642,369 FOR FY12. THE SAMARITAN HEALTH CLINIC PROVIDES PATIENTS WITH IMPORTANT BASIC HEALTH SERVICES, MEDICATIONS AND URGENT DENTAL NEEDS AT NO CHARGE TO THE PATIENT. | ||
| PART I, L7 COL(F): BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX, LINE 24 WAS $12,692,889 AND WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS. | ||
| PART II, LINE 8: WORKFORCE DEVELOPMENT INCLUDES JOB SHADOWING, CAREERS CAMP, AND THE HEALTHCARE YOUTH APPRENTICE PROGRAM. THESE PROGRAMS ALLOW STUDENTS AND OTHERS TO LEARN ABOUT DIFFERENT OCCUPATIONS IN THE HEALTHCARE INDUSTRY BY BECOMING CERTIFIED AND GAINING ACTUAL WORK EXPERIENCE. THE PROGRAMS ALSO PROMOTE THESE STUDENTS TO BRING VALUABLE HEALTHCARE KNOWLEDGE BACK TO THEIR FAMILIES AND THE COMMUNITY. | ||
| PART III, LINE 4: THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO CONTRACTUAL ADJUSTMENTS AND A CREDIT TO THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY FOR DETERMINING BAD DEBTS IS A COST TO CHARGE RATIO. | ||
| PART III, LINE 8: MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES, THE TOTAL EXPENSES LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE. | ||
| PART III, LINE 8: WE HAVEN'T REPORTED THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. HOWEVER, IT SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE IT PROMOTES ACCESS TO HEALTHCARE TO THE UNDERSERVED ELDERLY POPULATION, WHO WOULD NOT HAVE ACCESS TO LOCAL CARE IF WE WERE NOT ABLE TO SERVE THEM. ALTHOUGH OUR HOSPITAL IS EFFICIENTLY OPERATED, THE CALCULATIONS USED FOR MEDICARE REIMBURSEMENT DO NOT ALLOW FOR PAYMENTS THAT COVER COSTS OF NECESSARY SERVICES. | ||
| PART III, LINE 9A: AGNESIAN HEALTHCARE, INC. HAS A WRITTEN DEBT COLLECTION POLICY. PAYMENT IS DUE WITHIN 30 DAYS OF RECEIPT OF A STATEMENT. IF PATIENTS DO NOT SET UP ACCEPTABLE PAYMENT ARRANGEMENTS, BILLS WILL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY. FINANCIAL COUNSELORS WORK WITH ALL PATIENTS ON AN INDIVIDUAL BASIS AND MAY OFFER EXTENDED MONTHLY PAYMENTS WITHOUT INTEREST BASED ON DOLLAR AMOUNT, PRIVATE PAY DISCOUNTS (INDIVIDUALS WHO DO NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE BILLED AT REDUCED RATE), OR GUARANTEED BANK LOANS. | ||
| PART III LINE 9B: A ZERO DOLLAR AMOUNT WAS ESTIMATED FOR THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. IF PATIENTS QUALIFY, THEIR EXPENSES ARE RECLASSIFIED AS CHARITY CARE. PATIENTS WHO RECEIVED A COLLECTION NOTICE COULD APPLY FOR CHARITY CARE. IF THEIR APPLICATION IS APPROVED, THIS WOULD TRIGGER A TRANSFER OF EXPENSE FROM BAD DEBT TO CHARITY CARE. | ||
| PART V, LINE 12: FINANCIAL COUNSELORS AT AGNESIAN HEALTHCARE ASSIST PATIENTS WITH APPLICATION TO COMMUNITY CARE. PATIENTS CAN BE REFERRED TO COMMUNITY CARE BY CLERGY, DEPARTMENTS OF AGNESIAN HEALTHCARE, SISTERS OF ST. AGNES, AREA SOCIAL AND HEALTH AGENCIES, FAMILY OR SELF. THE APPLICATION IS COMPLETED BY THE PATIENT WITH ASSISTNACE FROM THE FINANCIAL COUNSELOR IF NEEDED. THE FINANCIAL COUNSELOR WILL COMMUNICATE TO THE PATIENT WHAT PROGRAMS THEY WILL BE ELIGIBLE FOR, AS WELL AS PROVIDE NOTIFICATION OF APPROVAL OR DENIAL OF THEIR APPLICATION IN A TIMELY MANNER. | ||
| PART V, SECTION B, LINE 19D: UNINSURED PATIENTS AUTOMATICALLY RECEIVE A 15% DISCOUNT OFF GROSS CHARGES. PATIENTS WHO HAVE INSURANCE BUT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CHARGED THE FULL AMOUNT OF THEIR RESPONSIBILITY FOR COINSURANCE AND DEDUCTIBLE PER THE EOB FROM THEIR INSURANCE COMPANY. | ST. AGNES HOSPITAL | |
| PART VI, LINE 2: AGNESIAN HEALTHCARE SENIOR LEADERS MEET REGULARLY WITH COMMUNITY LEADERS TO GATHER INPUT FROM AND RESPOND TO PATIENT AND CUSTOMER NEEDS. SENIOR LEADERS AND MEMBERS OF THE WORKFORCE PARTICIPATE IN A VARIETY OF ORGANIZATIONS IN SUPPORT OF AGNESIAN HEALTHCARE'S KEY COMMUNITIES. THROUGH AGNESIAN'S PARTICIPATION IN THESE ACTIVITIES, COMMUNITY MEMBERS LEARN OF AGNESIAN'S COMMITTMENT TO COMMUNITY-WIDE HEALTHCARE AND PROVIDE AGNESIAN WITH INSIGHT INTO COMMUNITY HEALTH NEEDS AND DESIRES. IN ADDITION, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS INITIATED DURING FISCAL YEAR 2011, AND THE RESULTS WILL BE AVAILABLE DURING FISCAL YEAR 2012. THE ASSESSMENT WAS CONDUCTED IN CONJUNCTION WITH THE FOND DU LAC COUNTY HEALTH DEPARTMENT. THE ASSESSMENT DETERMINES PRIORITY HEALTH CONCERNS THROUGH AN EXAMINATION OF DATA FROM THE COUNTY AND STATE ON DISEASE INCIDENCE, DEATHS AND BIRTHS, DEMOGRAPHICS, ECONOMIC FACTORS, INJURY AND HEALTH BEHAVIOR, THE ENVIRONMENT AND COMMUNITY PERCEPTIONS. IT ALSO INCLUDES AN ASSESSMENT OF COMMUNITY RESOURCES CURRENTLY IN PLACE. RESULTS OF THE ASSESSMENT WILL BE WIDELY DISTRIBUTED THROUGHOUT THE COMMUNITY VIA MEDIA OUTLETS AND HOSPITAL AND COUNTY WEBSITES. | ||
| PART VI, LINE 3: FINANCIAL COUNSELORS AT AGNESIAN HEALTHCARE ASSIST PATIENTS WITH APPLICATION TO COMMUNITY CARE. PATIENTS CAN BE REFERRED TO COMMUNITY CARE BY CLERGY, DEPARTMENTS OF AGNESIAN HEALTHCARE, SISTERS OF ST. AGNES, AREA SOCIAL AND HEALTH AGENCIES, FAMILY OR SELF. THE APPLICATION IS COMPLETED BY THE PATIENT WITH ASSISTANCE FROM THE FINANCIAL COUNSELOR IF NEEDED. THE FINANCIAL COUNSELOR WILL COMMUNICATE TO THE PATIENT WHAT PROGRAMS THEY WILL BE ELIGIBLE FOR, AS WELL AS PROVIDE NOTIFICATION OF APPROVAL OR DENIAL OF THEIR APPLICATION IN A TIMELY MANNER. | ||
| PART VI, LINE 4: COMMUNITY CARE APPLICATIONS ARE ACCEPTED ONLY FROM PATIENTS OF AGNESIAN HEALTHCARE WHO RESIDE IN THE COUNTIES OF CALUMET, DODGE, FOND DU LAC, GREEN LAKE, MARQUETTE, WAUSHARA OR WINNEBAGO. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THOSE AREAS FOR A MINIMUM OF THREE MONTHS AND PROVIDE SUPPORTING DOCUMENTATION. ON OCCASION, INDIVIDUALS ARE NOT COMMUNITY MEMBERS BUT MAY NEED ASSISTANCE; THOSE APPLICATIONS ARE CONSIDERED ON A CASE-BY-CASE BASIS. THE SAMARITAN CLINIC SERVICES PATIENTS FROM DODGE AND FOND DU LAC COUNTIES. | ||
| PART VI, LINE 5: AGNESIAN HEALTHCARE LEADERS DEVELOP GRANT APPLICATIONS IN SUPPORT OF PROGRAMS AND SERVICES SERVING THE GREATER NEEDS OF THE COMMUNITY, INCLUDING HOSPICE HOPE, DOMESTIC VIOLENCE PROGRAMS, CARDIAC CARE, AND PREVENTIVE HEALTH SCREENINGS AND SERVICES. PROVIDING THESE SERVICES LOCALLY IS A FOCUS OF OUR COMMUNITY BENEFIT PROGRAMS. | ||
| PART VI, LINE 5: AGNESIAN HEALTHCARE OFFERS PROGRAMS TO THE COMMUNITY THAT ALLOW STUDENTS AND OTHERS TO LEARN ABOUT DIFFERENT OCCUPATIONS IN THE HEALTHCARE INDUSTRY BY BECOMING CERTIFIED AND GAINING ACTUAL WORK EXPERIENCE. THE DIFFERENT PROGRAMS PROVIDE HANDS-ON OPPORTUNITIES AND ALLOW JOB SHADOWING SO THE FUTURE OF THE PROFESSION CAN GAIN CONFIDENCE AND SKILLS. IN ADDITION, AGNESIAN HEALTHCARE SHARES ITS PROFESSIONAL STAFF EXPERTISE TO OFFER HEALTH EDUCATION CLASSES, HEALTH SCREENINGS, SUPPORT GROUPS, AND OTHER HEALTH PROMOTION ACTIVITIES THROUGHOUT THE YEAR. OTHER COMMUNITY ACTIVITIES INCLUDE SUPPORT AND TRAINING FOR THE DODGE CORRECTIONAL INSTITUTIONAL HOSPICE PROGRAM, SHARPS DISPOSAL SERVICES, ADOPT-A-FAMILY, DONATIONS TO FOOD PANTRIES, AND LEADERSHIP PARTICIPATION IN COMMUNITY NONPROFIT ORGANIZATIONS. | ||
| PART VI, LINE 6: AGNESIAN HEALTHCARE, INC. IS AN INTEGRATED, COMPREHENSIVE NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM COMPRISED OF SEVEN MINISTRIES: AGNESIAN HEALTHCARE ENTERPRISES, LLC, CONSULTANTS LAB OF WI, LLC, FOND DU LAC REGIONAL CLINIC, ST. AGNES HOSPITAL, ST. FRANCIS HOME, WAUPUN MEMORIAL HOSPITAL AND RIPON MEDICAL CENTER. AGNESIAN PROVIDES A CONTINUUM OF HEALTHCARE SERVICES FROM BIRTH TO END OF LIFE, PREVENTIVE HEALTHCARE, DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT AND SKILL CARE SERVICES. AGNESIAN HEALTHCARE IS COMMITTED TO ENSURING THAT INDIVIDUALS NEEDING VITAL HEALTHCARE SERVICES GET THE HELP THEY NEED AND DESERVE. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVEN N LITTLE | |||||||||||||
| 372708 | 0 | 46395 | 0 | 309300 | 0 | 0 | 0 | 32425 | 0 | 760828 | 0 | 0 | 0 |
| ALLEN MILANI MD | |||||||||||||
| 482838 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 23868 | 0 | 506706 | 0 | 0 | 0 |
| ROBERT A FALE | |||||||||||||
| 612871 | 0 | 131225 | 0 | 569228 | 0 | 0 | 0 | 31971 | 0 | 1345295 | 0 | 0 | 0 |
| CAROL HYLAND | |||||||||||||
| 229806 | 0 | 29130 | 0 | 0 | 0 | 0 | 0 | 29088 | 0 | 288024 | 0 | 0 | 0 |
| DENNIS YUNK | |||||||||||||
| 227426 | 0 | 25800 | 0 | 30000 | 0 | 0 | 0 | 26431 | 0 | 309657 | 0 | 0 | 0 |
| DOUGLAS TROST | |||||||||||||
| 147579 | 0 | 18549 | 0 | 0 | 0 | 0 | 0 | 26964 | 0 | 193092 | 0 | 0 | 0 |
| JANE HYDE | |||||||||||||
| 192872 | 0 | 27750 | 0 | 0 | 0 | 0 | 0 | 17919 | 0 | 238541 | 0 | 0 | 0 |
| JAMES MUGAN | |||||||||||||
| 232149 | 0 | 29121 | 0 | 0 | 0 | 0 | 0 | 35572 | 0 | 296842 | 0 | 0 | 0 |
| BONNIE SCHMITZ | |||||||||||||
| 202100 | 0 | 19890 | 0 | 0 | 0 | 0 | 0 | 17753 | 0 | 239743 | 0 | 0 | 0 |
| BARB KNUTZEN | |||||||||||||
| 169973 | 0 | 22593 | 0 | 0 | 0 | 0 | 0 | 23774 | 0 | 216340 | 0 | 0 | 0 |
| SR MARY MOLLISON | |||||||||||||
| 143526 | 0 | 19545 | 0 | 0 | 0 | 0 | 0 | 8498 | 0 | 171569 | 0 | 0 | 0 |
| JILL STENSON | |||||||||||||
| 142539 | 0 | 20367 | 0 | 0 | 0 | 0 | 0 | 15756 | 0 | 178662 | 0 | 0 | 0 |
| JOHN CHOI MD | |||||||||||||
| 532665 | 0 | 438553 | 0 | 0 | 0 | 0 | 0 | 29726 | 0 | 1000944 | 0 | 0 | 0 |
| YASIR HATAHET MD | |||||||||||||
| 511339 | 0 | 394094 | 0 | 0 | 0 | 0 | 0 | 38113 | 0 | 943546 | 0 | 0 | 0 |
| PONTUS OSTMAN MD | |||||||||||||
| 733680 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15860 | 0 | 749540 | 0 | 0 | 0 |
| JAMES GRAF MD | |||||||||||||
| 553977 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34769 | 0 | 588746 | 0 | 0 | 0 |
| HONG WANG MD | |||||||||||||
| 550445 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 31971 | 0 | 582416 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | ALL GROSSUP PAYMENTS AND SOCIAL CLUB DUES ARE INCLUDED ON FORM 1099. THESE PAYMENTS ARE MADE FOR TWO MEMBERS OF THE BOARD OF DIRECTORS. |
| PART I, LINE 4B | ALL EXECUTIVES EXCEPT CEO PARTICIPATE IN A 457(B) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. |
| PART I, LINE 5 | COMPENSATION FOR SOME EMPLOYED PHYSICIANS IS BASED ON A PERCENTAGE OF GROSS BILLINGS. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| WI HEALTH AND EDUC FACILITIES AUTHORITY | |||||||
| 391337855 | 97710BGG1 | 2008-12-11 | 49330000 | REFUNDING OF 2005 ISSUE | 0 | 0 | 0 |
| WI HEALTH AND EDUC FACILITIES AUTHORITY | |||||||
| 391337855 | 97710BYW6 | 2010-12-01 | 57260000 | REFUNDING OF 2001 ISSUE, PRIVATE ROOM PROJECT | 0 | 0 | 0 |
| WI HEALTH AND EDUC FACILITIES AUTHORITY | |||||||
| 391337855 | NONEAVAIL | 2011-12-15 | 10020000 | PARTIAL REFUNDING OF 1998 ISSUE | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount In Reserve FundAmountInReserveFund | Other Spent ProceedsOtherSpentProceeds | Amount UnspentAmountUnspent |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1000000 | 49330000 | 430000 | 48900000 | 2005 | 1 | 0 | 1 | 1 | |||
| 1730000 | 57260000 | 767686 | 18012751 | 1 | 0 | 0 | 1 | 4518399 | 1574279 | 2661885 | |
| 908000 | 10020000 | 90000 | 2011 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.01470 | 0.01470 | 1 |
| 0 | 0 | 0 | 0 | 1 | ||
| 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Term Of HedgeTermOfHedge | Superintegrated HedgeSuperintegratedHedge | Hedge TerminatedHedgeTerminated | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|---|---|---|
| PIPER JAFFRAY | ||||||||
| 0 | 1 | 1 | 28.000000000000 | 0 | 0 | 0 | 0 | 0 |
| (no name) | ||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | |||
| (no name) | ||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fed Tax Requirements Compliance | X | FedTaxRequirementsCompliance |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JOSEPH REITEMEIER | |||
| DIRECTOR | 306593 | JOSEPH REITEMEIER IS PRESIDENT OF FOND DU LAC ASSOCIATION OF COMMERCE. AGNESIAN HEALTHCARE, INC. PROVIDED OCCUPATIONAL HEALTH SERVICES TO THE ASSOCIATION OF COMMERCE, BILLING $453 FOR THESE SERVICES IN FISCAL YEAR 2012. IN ADDITION, AGNESIAN HEALTHCARE, INC. PURCHASED SERVICES TOTALING $306,140 FROM THE ASSOCIATION OF COMMERCE DURING FISCAL YEAR 2012. | 0 |
| JOSEPH REITEMEIER | |||
| DIRECTOR | 51461 | JOSEPH REITEMEIER IS PRESIDENT OF FOND DU LAC ASSOCIATION OF COMMERCE. HIS DAUGHTER-IN-LAW, JENNIFER REITEMEIER, IS EMPLOYED AS AN RN AT AGNESIAN HEALTHCARE, EARNING AN ANNUAL SALARY OF $51,461. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS TWO CLASSES OF MEMBERS - CLASS A MEMBERS WHO ARE MEMBERS OF THE CONGREGATION OF THE SISTERS OF ST. AGNES AND CLASS B MEMBERS WHO CONTITUTE THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CLASS A MEMBERS, WHO ARE MEMBERS OF THE CONGREGATION OF THE SISTERS OF ST. AGNES, HAVE THE POWER TO ELECT OR APPOINT THE CLASS B MEMBERS. THE CLASS B MEMBERS CONSTITUTE THE BOARD OF DIRECTORS. THE CLASS B MEMBERS HAVE THE POWER TO SUBMIT RECOMMENDATIONS REGARDING THE SELECTION AND RETENTION OF THE CEO TO THE MEMBERS OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE CONGREGATION OF THE SISTERS OF ST AGNES SPONSORED MINISTRIES IS A CLASS B MEMBER WHO IS RESPONSIBLE FOR APPROVING CERTAIN ACTIVITIES OF THE CORPORATION. THE CONGREGATION OF THE SISTERS OF ST AGNES IS A CLASS A MEMBER WHO HAS THE SAME RESERVE POWERS AS THE CLASS B MEMBER. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FINANCE DEPARTMENT PREPARES THE FORM 990 AND THE RETURN IS REVIEWED BY THE DIRECTOR OF FINANCE AND CFO. A FINAL COPY OF THE 2011 FORM 990 IS PROVIDED TO THE BOARD EXECUTIVE COMMITTEE FOR REVIEW AND APPROVAL TO THE AGNESIAN HEALTHCARE BOARD BEFORE THE RETURN IS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | WE HAVE A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY THAT REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON AN 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 | DETERMINATION OF COMPENSATION OF THE CEO AND OFFICERS INCLUDES ANALYSIS OF COMPARABLE COMPENSATION SURVEYS BY AN INDEPENDENT COMPENSATION CONSULTANT, WHO RECOMMENDS RANGES OF APPROPRIATE COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVES THE COMPENSATION PACKAGE FOR OFFICERS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION IS INCLUDED IN THE BOARD MINUTES. THE FINAL AGREEMENT IS DOCUMENTED WITH A WRITTEN CONTRACT, WHICH IS SIGNED BY BOTH PARTIES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | AGNESIAN HEALTHCARE'S POLICY AND PROCEDURE FIN1069 DEFINES THE PROCEDURE FOR MAKING ANNUAL INFORMATION RETURNS AVAILABLE FOR PUBLIC INSPECTION. INDIVIDUALS REQUESTING INSPECTION ARE REFERRED TO THE ADMINISTRATION OFFICE, WHERE THEY ARE PROVIDED WITH THE DOCUMENTS AND A CONFERENCE ROOM FOR INSPECTING DOCUMENTS. PHOTOCOPIES WILL BE PROVIDED TO THE REQUESTOR. ANYONE MAY INSPECT THE RETURNS UPON DEMAND, WITHOUT AN APPOINTMENT OR ANY FOREWARNING, DURING AGNESIAN HEALTHCARE INC'S NORMAL BUSINESS HOURS. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION, BUT CAN BE MADE AVAILABLE IF THE REQUESTING PARTY HAS A BONAFIDE REASON. ALL FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH A POSTING ON A PUBLIC WEBSITE. | |
| FORM 990, PART XI, LINE 5: | CHANGE IN UNREALIZED GAINS/LOSSES -4,550,665. CAPITAL CONTRIBUTION - FOUNDATION 542,172. CAPITAL CONTRIBUTION - OTHER 11,846. CHANGE IN SWAP FUND BALANCE -1,617,853. CHANGE IN FUND BALANCE - SAH FOUNDATION -98,083. CHANGE IN ERROR/SUSPENSE ACCOUNT 2,110. TOTAL TO FORM 990, PART XI, LINE 5: -5,710,473. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2B | THE CONSOLIDATED FINANCIAL STATEMENTS OF AGNESIAN HEALTHCARE SYSTEM WERE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM, WIPFLI, LLP. THREE RELATED ENTITIES IN THE AGNESIAN HEALTHCARE SYSTEM, WAUPUN MEMORIAL HOSPITAL, ST. FRANCIS HOME, AND RIPON MEDICAL CENTER, FILE SEPARATE FORMS 990. REMAINING ENTITIES ARE REPRESENTED BY THE AGNESIAN HEALTHCARE TAX RETURN. | |
| FORM 990, PART XII, LINE 2C | THE AUDIT COMMITTEE OF AGNESIAN HEALTHCARE, INC IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT BY THE INDEPENDENT ACCOUNTING FIRM. THE PROCESS FOR THE OVERSIGHT AND SELECTION PROCESS DID NOT CHANGE DURING THE FISCAL YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| CONSULTANTS LABORATORY OF WISCONSIN LLC | |||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 391528550 | LAB SERVICES | WI | 16364249 | 13053315 | N/A |
| AGNESIAN HEALTHCARE ENTERPRISES LLC | |||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 392038757 | RETAIL PHARMACY | WI | 8392710 | 8750785 | N/A |
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| ST FRANCIS HOME OF FOND DU LAC | ||||||||||
| 33 EVERETT STREET | FOND DU LAC | WI | 54935 | 391029998 | NURSING HOME | WI | 501(C)(3) | 9 | N/A | 0 |
| CONGREGATION OF SISTERS OF ST AGNES | ||||||||||
| 320 COUNTY ROAD K | FOND DU LAC | WI | 54935 | 390806217 | CONVENT | WI | 501(C)(3) | 1 | N/A | 0 |
| AGNESIAN HEALTHCARE FOUNDATION | ||||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 391684956 | FOUNDATION | WI | 501(C)(3) | 11 | N/A | 0 |
| WAUPUN MEMORIAL HOSPITAL | ||||||||||
| 620 WEST BROWN STREET | WAUPUN | WI | 53963 | 390806265 | HOSPITAL | WI | 501(C)(3) | 3 | N/A | 0 |
| RIPON MEDICAL CENTER | ||||||||||
| 933 NEWBURY STREET | RIPON | WI | 54971 | 391101287 | HOSPITAL | WI | 501(C)(3) | 3 | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| AGNESIAN HEALTHCARE FOUNDATION INC | ||
| C | 712163 | CASH RECEIPTS |
| ST FRANCIS HOME | ||
| D | 5000000 | BOND VALUE |
| ST FRANCIS HOME | ||
| L | 66143 | CASH PAYMENTS |
| CONGREGATION OF SISTERS OF ST AGNES | ||
| L | 278047 | CASH PAYMENTS |
| CONGREGATION OF SISTERS OF ST AGNES | ||
| N | 489504 | CASH PAYMENTS |
| WAUPUN MEMORIAL HOSPITAL | ||
| O | 414097 | CASH TRANSFER |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART V, LINE 2: | ReturnReference |
| Explanation | NAME: RIPON MEDICAL CENTER, TRANSACTION TYPE O, AMOUNT $3,487, METHOD: CASH TRANSFER | Explanation |
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