WAUPUN MEMORIAL HOSPITAL: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: WAUPUN MEMORIAL HOSPITAL (EIN 39-0806265)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-11-15
IRS object ID: 202243199349315969
Schema version: 2021v4.2
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 O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-11-15T13:40:02-06:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-01-01	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	Randy Combs	PersonNm
Person Title	Treasurer	PersonTitleTxt
Phone	3149947800	PhoneNum
Signature	2022-11-15	SignatureDt

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	Barbara	PersonFirstNm
Person Last	Potts	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DEANN THURMER	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)
Gross Receipts	$57,190,057	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	https://www.ssmhealth.com/locations/waupun-memorial-hospital	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	10	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	0	TotalEmployeeCnt
Total Volunteers	82	TotalVolunteersCnt
Total Gross UBI	$26,381	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$5,010,426	PYContributionsGrantsAmt
CY Contributions Grants	$1,204,455	CYContributionsGrantsAmt
PY Program Service Revenue	$41,223,734	PYProgramServiceRevenueAmt
CY Program Service Revenue	$55,770,519	CYProgramServiceRevenueAmt
PY Investment Income	-$58,775	PYInvestmentIncomeAmt
CY Investment Income	$105	CYInvestmentIncomeAmt
PY Other Revenue	$485,255	PYOtherRevenueAmt
CY Other Revenue	$214,978	CYOtherRevenueAmt
PY Total Revenue	$46,660,640	PYTotalRevenueAmt
CY Total Revenue	$57,190,057	CYTotalRevenueAmt
PY Grants And Similar Paid	$32,705	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$39,266	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$20,684,478	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$21,493,817	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$20,844,359	PYOtherExpensesAmt
CY Other Expenses	$22,677,294	CYOtherExpensesAmt
PY Total Expenses	$41,561,542	PYTotalExpensesAmt
CY Total Expenses	$44,210,377	CYTotalExpensesAmt
PY Revenues Less Expenses	$5,099,098	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$12,979,680	CYRevenuesLessExpensesAmt
Total Assets BOY	$75,719,504	TotalAssetsBOYAmt
Total Assets EOY	$81,200,383	TotalAssetsEOYAmt
Total Liabilities BOY	$15,326,773	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$7,795,228	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$60,392,731	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$73,405,155	NetAssetsOrFundBalancesEOYAmt
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	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$41,131,623	ExpenseAmt
Grant	$39,266	GrantAmt
Revenue	$55,770,519	RevenueAmt
Desc	PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.	Desc
Total Program Service Expenses	$41,131,623	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Donor Rstr Or Quasi Endowments	false	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	Yes (true)	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	false	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	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 (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	false	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	false	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	false	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Jackie Taylor	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6082416949	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1808 W Beltline Hwy	AddressLine1Txt
City	Madison	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53713	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 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
Deann Thurmer
Director, President/CNO-Waupun Memorial Hospital	20.0	20.0	Yes (X)	Yes (X)	$0	$312,782	$122,942
Jan Harmsen
Director, Chair	1.0	0	Yes (X)	Yes (X)	$0	$0	$0
Kathy Duchac
Director, Vice Chair	1.0	0	Yes (X)	Yes (X)	$0	$0	$0
Brittany Page
Director	1.0	0	Yes (X)		$0	$0	$0
David Hopp
Director	1.0	0	Yes (X)		$0	$0	$0
Doug Cronin
Director	1.0	0	Yes (X)		$0	$0	$0
Karen Reynolds
Director	1.0	0	Yes (X)		$0	$0	$0
Kathleen Hendricks
Director	1.0	0	Yes (X)		$0	$0	$0
Robert Nagle
Director	1.0	0	Yes (X)		$0	$0	$0
Roxy Schouten
Pt Yr Director	1.0	0	Yes (X)		$0	$0	$0
Scott Hansfield
Director, Chief of Staff Representative	1.0	0	Yes (X)		$0	$0	$0
Randy Combs
Treasurer, Chief Financial Officer at SSM Health	1.0	66.0		Yes (X)	$0	$1,290,602	$485,851
Kris Zimmer
Former Officer	0.0	0.0			$0	$219,379	$0	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$0	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,822,764	TotReportableCompRltdOrgAmt
Total Other Compensation	$608,793	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	0	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
SHARED MEDICAL SERVICES INC
PO BOX 330	COTTAGE GROVE	WI	53527	IMAGING SERVICES	$386,546
AMN HEALTHCARE INC
12400 HIGH BLUFF DRIVE	SAN DIEGO	CA	92130	STAFFING SERVICES	$228,357
US FOODSERVICE INC
9399 W HIGGINS ROAD	ROSEMONT	IL	60018	DIETARY SERVICES	$128,444
SUPERIOR HEALTH LINENS LLC
5005 S PACKAND AVENUE	CUDAHY	WI	53110	LAUNDRY/LINEN SERVICES	$122,717
FOND DU LAC REGIONAL CLINIC SC
420 E DIVISION ST	FOND DU LAC	WI	54935	PHYSICIAN SERVICES	$113,248

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	5	CntrctRcvdGreaterThan100KCnt
Related Organizations	$8,309	RelatedOrganizationsAmt
Government Grants	$1,196,146	GovernmentGrantsAmt
Total Contributions	$1,204,455	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	Net Patient Service Revenue	Desc
Business	622110	BusinessCd
Total Revenue Column	$55,503,944	TotalRevenueColumnAmt
Related Or Exempt Func Income	$55,503,944	RelatedOrExemptFuncIncomeAmt

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$266,575	TotalRevenueColumnAmt
Related Or Exempt Func Income	$266,575	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$55,770,519	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$105	TotalRevenueColumnAmt
Exclusion	$105	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$50,235	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$50,235	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$50,235	TotalRevenueColumnAmt
Exclusion	$50,235	ExclusionAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$0	OtherAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Cafeteria	722210	$138,362	$138,362
Mobile meals	900099	$26,381		$26,381

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$164,743	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$57,190,057	TotalRevenueColumnAmt
Related Or Exempt Func Income	$55,770,519	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$26,381	UnrelatedBusinessRevenueAmt
Exclusion	$188,702	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$39,266	TotalAmt
Program Services	$39,266	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$17,042,471	TotalAmt
Program Services	$16,461,376	ProgramServicesAmt
Management And General	$581,095	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$752,411	TotalAmt
Program Services	$726,756	ProgramServicesAmt
Management And General	$25,655	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,609,298	TotalAmt
Program Services	$2,520,329	ProgramServicesAmt
Management And General	$88,969	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,089,637	TotalAmt
Program Services	$1,052,484	ProgramServicesAmt
Management And General	$37,153	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$1,788	TotalAmt
Management And General	$1,788	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$3,106	TotalAmt
Management And General	$3,106	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$6,514,579	TotalAmt
Program Services	$5,432,787	ProgramServicesAmt
Management And General	$1,081,792	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$277	TotalAmt
Management And General	$277	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,203,792	TotalAmt
Program Services	$1,163,872	ProgramServicesAmt
Management And General	$39,920	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,590,970	TotalAmt
Program Services	$1,590,970	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$989,329	TotalAmt
Program Services	$834,482	ProgramServicesAmt
Management And General	$154,847	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$42,845	TotalAmt
Program Services	$38,336	ProgramServicesAmt
Management And General	$4,509	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$3,445	TotalAmt
Program Services	$2,902	ProgramServicesAmt
Management And General	$543	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,090,878	TotalAmt
Program Services	$3,090,878	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$155,406	TotalAmt
Program Services	$155,406	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical supplies	$7,818,660	$7,818,660
Medicaid Provider Tax	$202,020	$202,020
Internal management fees	$1,059,100		$1,059,100
Licenses and taxes	$1,099	$1,099

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$44,210,377	TotalAmt
Program Services	$41,131,623	ProgramServicesAmt
Management And General	$3,078,754	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$7,816,797	BOYAmt
EOY	$1,864,536	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$12,884,267	BOYAmt
EOY	$5,754,279	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$13,205	BOYAmt
EOY	$9,331	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$118,355	BOYAmt
EOY	$84,767	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$46,590,287	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$12,391,198	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$36,085,791	BOYAmt
EOY	$34,199,089	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$301,357	BOYAmt
EOY	$334,100	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$18,499,732	BOYAmt
EOY	$38,954,281	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$75,719,504	BOYAmt
EOY	$81,200,383	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$2,718,465	BOYAmt
EOY	$5,177,106	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$593,750	BOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$12,014,558	BOYAmt
EOY	$2,618,122	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$15,326,773	BOYAmt
EOY	$7,795,228	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	$60,091,374	BOYAmt
EOY	$73,071,055	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$301,357	BOYAmt
EOY	$334,100	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$60,392,731	BOYAmt
EOY	$73,405,155	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$75,719,504	BOYAmt
EOY	$81,200,383	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$12,979,680	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$32,744	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	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 (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$3,106	OtherActivitiesAmt
Total Lobbying Expenditures	$3,106	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	FormAndLineReferenceDesc
Explanation	THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL & STATE HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES.	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	$36,890,903	OtherCostOrOtherBasisAmt
Depreciation	$7,821,713	DepreciationAmt
Book Value	$29,069,190	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$813,475	OtherCostOrOtherBasisAmt
Depreciation	$411,472	DepreciationAmt
Book Value	$402,003	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$8,463,753	OtherCostOrOtherBasisAmt
Depreciation	$4,158,013	DepreciationAmt
Book Value	$4,305,740	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$232,156	OtherCostOrOtherBasisAmt
Book Value	$232,156	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$34,199,089	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDesc	Book ValueBookValueAmt
Due from affiliates	$38,948,639
OPERATING RIGHT-OF-USE ASSETS	$5,642

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$38,954,281	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
Due to affiliates
Third Party Payor	$2,612,475
OPERATING LEASE OBLIGATIONS	$5,647

Field	Value	IRS element (for citing)
Total Liability	$2,618,122	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	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 2021 OR 2020.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$126,084	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$126,084	NetCommunityBenefitExpnsAmt
Total Expense	0.0029	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,683,033	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,832,321	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$850,712	NetCommunityBenefitExpnsAmt
Total Expense	0.0192	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$314,622	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$567,440	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$5,123,739	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,399,761	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$976,796	NetCommunityBenefitExpnsAmt
Total Expense	0.0221	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$46,768	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$46,768	NetCommunityBenefitExpnsAmt
Total Expense	0.0011	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$130,973	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$130,973	NetCommunityBenefitExpnsAmt
Total Expense	0.0030	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$110,093	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$110,093	NetCommunityBenefitExpnsAmt
Total Expense	0.0025	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$287,834	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$287,834	NetCommunityBenefitExpnsAmt
Total Expense	0.0065	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$5,411,573	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,399,761	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,264,630	NetCommunityBenefitExpnsAmt
Total Expense	0.0286	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,013	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,013	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,000	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,000	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$8,013	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,013	NetCommunityBenefitExpnsAmt
Total Expense	0.0002	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$2,408,479	BadDebtExpenseAmt
Reimbursed By Medicare	$8,432,784	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$8,141,852	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$290,932	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 (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	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	https://www.ssmhealth.com/locations/waupun-memorial-hospital	WebsiteAddressTxt
State License	1031	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Facility Reporting Group	A	FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	A	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	21	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	false	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	https://www.ssmhealth.com/resources/about/community-health/community-health-needs-assessments	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	22	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	https://www.ssmhealth.com/resources/about/community-health/community-health-needs-assessments	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.0	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.0	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/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 (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	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 (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Look Back Medicaid Medcr Prvt	Yes (X)	LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 3E	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.
Schedule H, Part V, Section B, Line 5 Facility A, 1	Facility A, 1 - Waupun Memorial Hospital. The Community Health Needs Assessment is comprised of five different data collection methods to include primary, secondary, qualitative, and quantitative data. Once it was collected, it was organized into five health focus areas. COMMUNITY HEALTH SURVEY The Community Health Survey conducted by JKV Research, LLC., provides primary, quantitative data collected from Fond du Lac County residents. The data provides an overview of behavioral and lifestyle habits as well as prevalence of risk factors and disease conditions existing within the Fond du Lac County adult population. The survey was mailed out to a random sample and 674 adults participated. Aggregate data from six school districts in Fond du Lac County is included in the Community Health Survey report to provide student data when available. PUBLIC INPUT SURVEY The Priority Health Issues Survey was conducted to provide an outlet for the community at large to provide additional input and voice their concerns regarding the most pressing county health issues. The survey was available in hard copy at the health department and online on the health department's website. The survey was available to take in English and Spanish. Residents were encouraged to review key findings from the 2020 Community Health Survey beforehand to provide additional feedback. A total of 284 Fond du Lac County residents completed the survey. The health focus areas ranked most consistently in the top five by respondents were: mental health, alcohol and other drug use, social determinants of health, food security and nutrition and infectious disease. KEY INFORMANT INTERVIEWS A total of 37 Key Informant Interviews were conducted to provide further qualitative data regarding community needs. Key informants identified were considered community experts who can provide valuable insight on pressing health issues in the Fond du Lac County community. The top health focus areas ranked most consistently by key informants were: mental health, alcohol and other drug use, social determinants of health, chronic disease, oral health and food security and nutrition. COMMUNITY CONVERSATIONS New for the 2021 Community Health Assessment was data collected from community conversations These conversations were organized by members of the SSM Health Greater Fond du Lac Region, Fond du Lac County Health Department and other entities that served as host locations for these events. The purpose of these community conversations was to further engage the public and provide an opportunity for various populations to voice their input that may otherwise have not been heard. 16 community conversations were held across the county, providing further information regarding the health needs of residents in Fond du Lac County. Top needs identified from community conversations include: access to resources, mental health, transportation, access to care and racism. Highlights and themes from these conversations can be found throughout the report. SECONDARY DATA Secondary data was collected from local, state, and national health sources to supplement the community health survey and other data collection information listed above. This data helped build a community health profile for Fond du Lac County and allowed this report to be comparable to other counties as well as state and national benchmarks. The secondary data collected is included in throughout the health focus area and the definition of community profiles.
Schedule H, Part V, Section B, Line 6b Facility A, 1	Facility A, 1 - Waupun Memorial Hospital. Waupun Memorial Hospital conducted their CHNA in collaboration with Healthy Fond du Lac County and the Fond du Lac County Health Department.
Schedule H, Part V, Section B, Line 11 Facility A, 1	Facility A, 1 - Waupun Memorial Hospital. The hospital identified various health needs in the 2021 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Mental health - Chronic disease - Substance use Mental health According to the World Health Organization, the definition of health is a "State of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." Mental health is something we all have, and it varies in its degree from time to time. If there is a significant impact on our thinking, feeling and/or behavior, treatment, services or intervention may be required. In general, the sooner one gets treatment, the better the outcome. Having an untreated mental disorder can create serious problems such as increasing the chance of risky behaviors, drug or alcohol addiction, and in extreme cases, death. It also can ruin relationships, cause problems at work, and make it difficult to overcome serious illnesses. Mental Health was identified as the number one priority to address as a result of the 2021 CHNA. Mental health needs in Fond du Lac County may include, but is not limited to challenges, barriers or needs related to provider availability, affordability, transportation, insurance, stigma, substance use, culturally sensitive and diverse providers and services, stress, and suicide. Additionally, statistics show: - 20 deaths by suicide reported in Fond du Lac County in 2020 - 1 in 5 adults reported to have a mental health condition in the past three years - 1 in 5 youth reported they always or nearly always felt sad, blue or depressed - 44% unserved children with mental illness in Fond du Lac County - 79% adults report to have their mental health condition under control (down from 96% in 2017) In order to decrease the number of deaths by suicide in Fond du Lac County, as well as increase access to behavioral health services, the hospital's action plan includes the following initiatives: - Expand trainings for Question, Persuade, Refer (QPR), Mental Health First Aid for Adults (MHFA), Youth Mental Health First Aid (YMHFA). Explore additional trainings and programs for suicide prevention and mental health - Potential new partners and collaborations: Businesses and employers - Increase means for data collection, monitoring and evaluation of mental health needs, with community partners such as DCP, and public safety departments - Research universal and individual screening tools for behavioral and mental health needs across the lifespan and develop a plan to assess and expand SBIRT at the Ripon Community Hospital - increase mental health/behavioral health services and access to them - increase mental health resources and navigation tools - develop more universal approach to safety planning across the country - decrease stigma, campaigns, awareness, TIC, ACEs, build community Chronic disease Chronic diseases are illnesses that last a long time, do not go away on their own, are rarely cured, and often result in disability later in life. Multiple health conditions are classified as chronic diseases such as high blood pressure, high cholesterol, heart disease, obesity, diabetes, asthma and more. Nutrition and physical activity are important to maintain and improve overall health and both play a prominent role in obesity prevention and control. As established in the U.S. Dietary Guidelines, good nutrition includes meeting nutrient recommendations yet keeping calories under control. Physical activity means any bodily activity that enhances or maintains physical fitness and overall health. Obesity is one of the most critical health issues of our time and is a complex health issue resulting from many interacting causes and factors in our society, behavior, and genetics. Obesity is also associated with poorer mental health outcomes and reduces quality of life. The burden of obesity and other diet-related chronic diseases are vast, and rates continue to rise. Changes at the community level, such as policies, systems, and environment, are more likely to be effective, although they may be more difficult to achieve. According to Fond du Lac community members responses throughout the assessment, common barriers and challenges to chronic diseases and related health behaviors included, but not limited to, access and affordability to healthy foods, awareness of nutritious food and cooking healthy meals, access to indoor and outdoor recreation, access and affordability of healthcare services. insurance, stigma, transportation, and cultural competencies. Additionally, statistics show: - Heart diseases is the number one cause of death among adults - 75% (3 in 4) adults were classified as at least overweight - About 1 in 3 youth were classified as at least overweight - 52% of adults reported meeting aerobic physical activity guidelines - 23% of adults reported eating the recommended servings of fruit per day - 17% of youth reported eating the recommended servings of fruit per day - 4,920 (6%) households reported they went hungry because they couldn't afford enough food In order to improve residents' weight, physical activity, nutrition, and increase breastfeeding, the hospital has implemented the following action items: - Research and identify chronic disease prevention and self-management classes - increase trail usage, enhance bike and pedestrian master plans - implement a physical activity campaign - increase schools participating in safe routes to school - identify existing efforts and assess impact - increase SNAP usage - increase access to and affordability of fruits and vegetables - assess current food forests or community/shared gardens and increase value/impact - increase health promotion programs offered to low-income housing residents - Increase number of childcare centers and business centers who have adopted the Ten Steps to Breastfeeding-Friendly Toolkit (Promote support for breastfeeding mothers in the workplace, early childhood education settings, and throughout the community Substance use Alcohol and other drug use means any use of a substance that result in negative consequences. This includes a broad array of mood-altering substances such as alcohol, tobacco, prescription substances, and illegal substances like methamphetamine and heroin. Negative consequences or unhealthy uses include but are not limited to, operating a motor vehicle while intoxicated, drinking while pregnant, alcohol dependence, fetal alcohol spectrum disorder, alcohol-related hospitalizations, and more. Substance use was identified as the number three priority to address in the 2022-2024 CHIP. Substance use needs in Fond du Lac County may include, but is not limited to barriers, challenges and needs related tobacco, vaping, drugs (narcotics, marijuana, etc.), prescription medications, and alcohol use, mental health and access to care. Throughout the Community Health Needs Assessment, substance use was consistently ranked as a top priority. Additionally, statistics show: - 25 opioid related deaths in Fond du Lac County in 2020, over double the deaths from 2019 - 74% of adults reported drinking alcohol in the past month - 22% of youth reported drinking alcohol in the past month - 37% of adults reported binge drinking alcohol in the past month - 37% of adults reported binge drinking alcohol in the past month The hospital's action plan includes the following initiatives to decrease underage drinking and binge drinking, and decrease misuse of opioids/prescription medication: - Increase festivals evaluated annually using the Community Events Best Practices Toolkit - Increase number of law enforcement agencies completing annual compliance checks - Decrease Alcohol Outlet density - Awareness and education campaign - Increase number of Narcan trainings and kits distributed - Syringe services program - Prescription medication prescribing practices and pain management - Prescription medication disposal The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs.
Schedule H, Part V, Section B, Line 13 Facility A, 1	Facility A, 1 - Waupun Memorial Hospital. Patients and their guarantor's income is used in determining income level for free or discounted care.

Field	Value	IRS element (for citing)
Facility	0	FacilityNum

Supplemental Information Detail SupplementalInformationDetail (18 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 3c Discounted Care Exceptions	Patients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called "presumptive eligibility."
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	SSM Health Care Corporation, 46-6029223
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	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 in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.
Schedule H, Part II Community Building Activities	RIPON MEDICAL CENTER PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: ENVIRONMENTAL IMPROVEMENTS: Sharps containers are supplied to our patients and customers throughout the community free of charge, with full containers able to be dropped off at all facility sites for disposal; LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: Donation to support the development of the Dr. Richard and Leslie Ridenour Science Center.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	FOR FINANCIAL STATEMENT PURPOSES, SSM Health HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THE AMOUNT REPORTED ON PART III, LINE 3 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER NORTON HOSPITAL'S FINANCIAL ASSISTANCE POLICY ON A GROSS BASIS.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	Waupun Memorial Hospital 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, 2021 consolidated audit is contained on page 13, 14 and 15 of the attached financial statements.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE 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.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	Waupun Memorial Hospital has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable. Waupun Memorial Hospital embraces its responsibility to serve the communities in which it participates by establishing sound business practices. Waupun Memorial Hospital's billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after 120 days. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSM prior to engaging in ECAs. SSM will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make "reasonable efforts" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with Waupun Memorial Hospital's collection and financial assistance policies.
Schedule H, Part V, Section B, Line 16a FAP website	A - Waupun Memorial Hospital: Line 16a URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website	A - Waupun Memorial Hospital: Line 16b URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	A - Waupun Memorial Hospital: Line 16c URL: https://www.ssmhealth.com/resources/patients-visitors/pay-my-bill/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessment	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 SSM'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, SSM's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-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 community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical 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 the progress of our local efforts in the spirit of caring for others and improving community health.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	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.
Schedule H, Part VI, Line 4 Community information	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, Markesan and Marquette, and a small portion of Colombia county. Approximately 75% of the hospital's patient population comes from the primary service area, and another 15% from the secondary service area. Waupun Memorial Hospital is located in Waupun, Wisconsin. The Waupun Memorial Hospital service area includes portions of Dodge and Green Lake counties. Green Lake County has a population of 18,913 people. Dodge County has a population of 87,715 people. Both counties include vast rural communities, support a large industrial workforce, and compared to Fond du Lac County have more individuals living in poverty. Some of the large factories employ a considerable Hispanic and Spanish speaking population, are also more persons in poverty in Dodge and Green Lake counties compared to Fond du Lac County. Waupun is also home to three prison systems, Waupun Correctional Institution, Dodge Correctional Institution and John C Burke Correctional Center. Dodge Correctional Institution's operational capacity is 1,165 people, and for the year 2020 saw 5,821 people in their facility. Waupun Correctional Institution has an operational capacity of 1,290 people.
Schedule H, Part VI, Line 5 Promotion of community health	Waupun Memorial Hospital participates 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. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. In response to the global coronavirus pandemic, Waupun Memorial Hospital worked relentlessly to respond to community needs by developing and implementing strategies to address social needs of those served, providing screening & testing services, personal protective equipment and education throughout the community, as well as treatment for those who presented with COVID-19. Waupun Memorial Hospital promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote community health. Waupun Memorial Hospital also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.
Schedule H, Part VI, Line 6 Affiliated health care system	Waupun Memorial Hospital is a 501(c)(3) organization and is a member of the integrated health care system know as SSM Health.
Schedule H, Part VI, Line 7 State filing of community benefit report	WI

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
Fond du Lac County School District
72 W 9th St	Fond du Lac	WI	54935	391411371	Government	$7,562	Student health education programs
Society of St Vincent DePaul
818 W Sunset Dr	Waukesha	WI	53189	390909537	501(c)(3)	$10,000	General support
Fond du Lac County Health Department
160 S Macy St	Fond du Lac	WI	54935	396005696	Government	$10,000	Save A Smile Dental program

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	Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	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)
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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
Deann Thurmer
Director, President/CNO-Waupun Memorial Hospital	$0	$273,587	$0	$36,585	$0	$2,610	$0	$96,967	$0	$25,975	$0	$435,724	$0	$31,054
Kris Zimmer
Former Officer	$0	$0	$0	$219,008	$0	$372	$0	$0	$0	$0	$0	$219,379	$0	$372
Randy Combs
Treasurer, Chief Financial Officer at SSM Health	$0	$940,014	$0	$182,693	$0	$167,895	$0	$478,907	$0	$6,945	$0	$1,776,454	$0	$82,693

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation

The organization's top management official, president, is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee;

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan

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 2021. Capital Accumulation Plan: SSMH provides this supplemental nonqualified retirement plan to executive level employees. The organization contributed a percentage of the employee's base salary into their choice of a select list of investments. The deposits and earnings of the plan are owned by SSMH and are tax-deferred until a distribution is made to the employee. In addition, the plan has special safeguards in place to protect the funds from contingencies, other than insolvency. For contributions made to the plan in 2014 or after, the distribution will occur after the completion of four plan years for all executives that are still actively employed on the distribution date. Any active participant 65 years or older will receive the contribution in the current year. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2021: Deann Thurmer $25,370 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2021. All distributions received from the plan in the current year were included in the individual's taxable compensation. Kris Zimmer $372

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part III, Line 4a Program Service Accomplishments	Briefly describe the organization's mission: Since it was founded in 1872 by Catholic sisters, SSM Health (SSMH) has existed to meet the health needs of the communities it serves. SSMH is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through one of the largest integrated delivery systems in the nation. With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSMH includes 23 acute care hospitals, one children's hospital, more than 300 physician offices and other outpatient and virtual care services, 10 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company, and an Accountable Care Organization. The health system employs nearly 40,000 people and is affiliated with 11,000 physicians making it one of the largest employers in every community it serves. In the tradition of its founding sisters, SSMH strives to fulfill its mission by providing exceptional health care to everyone who comes to its hospitals, regardless of their ability to pay. About Waupun Memorial Hospital: Waupun Memorial Hospital is a 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 three high-tech operating rooms, an endoscopy procedure room, 11 pre/postoperative patient rooms, four 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. In 2018, Waupun Memorial Hospital received certification of its Cardiac Rehab program by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). WMH was recognized for its commitment to improving the quality of life by enhancing standards of care. AACVPR Program Certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other professional societies. Each program is reviewed by the AACVPR Program Certification Committee and Certification is awarded by the AACVPR Board of Directors. AACVPR-certified programs are recognized as leaders in the field of cardiovascular and pulmonary rehabilitation because they offer the most advanced practices available. Waupun Memorial Hospital also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay * Has an open medical staff with privileges available to all qualified physicians in the area * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system Quantifiable Uncompensated Care: This section includes a list of the types of programs and services that could be quantified as uncompensated care: Traditional Charity Care $ 126,084 Unpaid Cost of Medicaid $ 850,712 Total Quantifiable Uncompensated Care $ 976,796
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 V, Line 2a	ALL APPLICABLE W-2 AND W-3 IRS TAX FORMS ARE REPORTED AND FILED BY A RELATED ORGANIZATION, AGNESIAN HEALTHCARE INC, EIN 39-0807236.
Form 990, Part VI, Line 15a Process for determining compensation	A related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 15b Process for determining compensation	A related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 6 Classes of members or stockholders	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, Line 7a Members or stockholders electing members of governing body	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, Line 7b Decisions requiring approval by members or stockholders	The member has the following powers: A. to establish and change the mission, philosophy and values of the Corporation; B. to appoint additional, successor or replacement Members; C. to appoint and remove the Directors; D. to appoint and remove the President of the Corporation and the chief executive officer of any operating division of the Corporation; E. to approve amendments to the Articles of Incorporation of the Corporation as provided therein; F. to approve amendments to the Bylaws of the Corporation; G. to approve the merger, consolidation or dissolution of the Corporation; H. to approve the formation of a Controlled Subsidiary or a Remotely Controlled Subsidiary; I. to approve the sale of all or substantially all of the assets of the Corporation; J. to approve the acquisition or disposition by the Corporation of another legal entity or an interest in another legal entity; K. to authorize or approve the acquisition or disposition by the Corporation of real property or any interest in real property; L. to establish centralized employee benefit, insurance, investment, financing, corporate responsibility, performance assessment and improvement and other operational and support programs; to require the participation of the Corporation in such programs; and to authorize the opening and closing of bank accounts and investment accounts in the name of the Corporation in connection with such programs; M. to approve the strategic, financial and human resources plan of the Corporation; N. to appoint the auditor and corporate counsel for the Corporation; O. to authorize and approve borrowing money and entering into financial guaranties by the Corporation, including actions relating to the formation, joining, operation, withdrawal from and termination of a credit group or an obligated group and the granting of security interests in the property of the Corporation; P. to require the Corporation to transfer assets, including but not limited to cash, to SSMHCC or to any other entity exempt from federal income tax as an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, or the corresponding provision of any future United States Internal Revenue Law, which is controlled by SSMHCC, to the extent necessary to accomplish the mission, goals and objectives of SSMHCC as determined by SSMHCC; Q. to approve the transfer of assets by the Corporation to any entity other than SSMHCC, other than transfers made in the ordinary course of operations of the Corporation which will not require Member approval; and R. to determine the extent to which and the manner in which the powers described in this section which are reserved to SSMHCC with respect to the Corporation are to be included in the governing documents of any Controlled Subsidiary, Remotely Controlled Subsidiary or Non-Controlled Subsidiary and exercised with respect to any Controlled Subsidiary, any Remotely Controlled Subsidiary or any Non-Controlled Subsidiary.
Form 990, Part VI, Line 11b Review of form 990 by governing body	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, Line 12c Conflict of interest policy	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, Line 19 Required documents available to the public	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 VIII, Line 2f Other Program Service Revenue	ALL OTHER PROGRAM SERVICE REVENUE - Total Revenue: 266575, Related or Exempt Function Revenue: 266575, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees	Medical and other professional services - Total Expense: 6514579, Program Service Expense: 5432787, Management and General Expenses: 1081792, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN BENEFICIAL INTEREST IN FOUNDATION - 32744;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (52 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
SSM Health Care Corporation
10101 Woodfield Lane	St Louis	MO	63132	466029223	Health Care	MO	501(c)(3)	Type I	SSM Health Ministries	false
SSMHC Liability Trust I
10101 Woodfield Lane	St Louis	MO	63132	436331003	Insurance	MO	501(c)(3)	Type I	SSM Health Care Corporation	false
SSM Consolidated Health Services
10101 Woodfield Lane	St Louis	MO	63132	431473657	Health Care	MO	501(c)(3)	10	SSM Health Care Corporation	false
SSM Policy Institute
10101 Woodfield Lane	St Louis	MO	63132	431788151	Health Care	MO	501(c)(4)		SSM Health Care Corporation	false
SSM Health Care Portfolio Management Co
10101 Woodfield Lane	St Louis	MO	63132	431825256	Management	MO	501(c)(3)	Type I	SSM Health Care Corporation	false
SSM Cardinal Glennon Children's Hospital
10101 Woodfield Lane	St Louis	MO	63132	430738490	Health Care	MO	501(c)(3)	3	SSM Health Care St Louis	false
Cardinal Glennon Children's Foundation
10101 Woodfield Lane	St Louis	MO	63132	431754347	Fundraising	MO	501(c)(3)	7	SSM Cardinal Glennon Children's Hospital	false
SSM Health Foundation - St Louis
10101 Woodfield Lane	St Louis	MO	63132	431552945	Fundraising	MO	501(c)(3)	7	SSM Health Care St Louis	false
SSM Health Care of Oklahoma Inc
10101 Woodfield Lane	St Louis	MO	63132	730657693	Health Care	OK	501(c)(3)	3	SSM Health Care Corporation	false
The St Anthony Hospital Foundation Inc
10101 Woodfield Lane	St Louis	MO	63132	736104300	Fundraising	OK	501(c)(3)	7	SSM Health Care of Oklahoma	false
SSM Health Care of Wisconsin Inc
10101 Woodfield Lane	St Louis	MO	63132	430688874	Health Care	WI	501(c)(3)	3	SSM Health Care Corporation	false
Dells Medical Building Inc
10101 Woodfield Lane	St Louis	MO	63132	391613292	MOB	WI	501(c)(2)		SSM Health Care of Wisconsin	false
St Mary's Foundation Inc
10101 Woodfield Lane	St Louis	MO	63132	431940686	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin	false
St Clare Health Care Foundation Inc
10101 Woodfield Lane	St Louis	MO	63132	431940683	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin	false
Home Health United Inc
2802 Walton Commons Lane	Madison	WI	53718	391539827	Health Care	WI	501(c)(3)	10	SSM Health Care of Wisconsin	false
Home Care United Inc
2802 Walton Commons Lane	Madison	WI	53718	391776340	Health Care	WI	501(c)(3)	10	SSM Health Care of Wisconsin	false
HHU Xtra Care Inc
2802 Walton Commons Lane	Madison	WI	53718	391705111	Health Care	WI	501(c)(3)	10	SSM Health Care of Wisconsin	false
SSM Health at Home Foundation of Wisconsin Inc
2802 Walton Commons Lane	Madison	WI	53718	391839309	Fundraising	WI	501(c)(3)	Type I	Home Health United Inc	false
SSM Regional Health Services
10101 Woodfield Lane	St Louis	MO	63132	440579850	Health Care	MO	501(c)(3)	3	SSM Health Care Corporation	false
St Mary's Health Center Jefferson City Missouri Foundation
10101 Woodfield Lane	St Louis	MO	63132	431575307	Fundraising	MO	501(c)(3)	Type I	SSM Regional Health Services	false
Good Samaritan Regional Health Center
10101 Woodfield Lane	St Louis	MO	63132	430653587	Health Care	IL	501(c)(3)	3	SSM Regional Health Services	false
St Mary's Hospital Centralia Illinois
10101 Woodfield Lane	St Louis	MO	63132	370662580	Health Care	IL	501(c)(3)	3	SSM Regional Health Services	false
St Mary's - Good Samaritan Inc
10101 Woodfield Lane	St Louis	MO	63132	364170833	Health Care	IL	501(c)(3)	Type I	SSM Regional Health Services	false
Good Samaritan Regional Health Center Foundation
10101 Woodfield Lane	St Louis	MO	63132	262884795	Fundraising	IL	501(c)(3)	7	St Mary's-Good Samaritan Inc	false
St Mary's Hospital Foundation
10101 Woodfield Lane	St Louis	MO	63132	364636691	Fundraising	IL	501(c)(3)	7	St Mary's-Good Samaritan Inc	false
St Mary's Hospital Auxiliary
400 N Pleasant	Centralia	IL	62801	237126345	Fundraising	IL	501(c)(3)	10	St Mary's Hospital Foundation	false
SSM Health Businesses
10101 Woodfield Lane	St Louis	MO	63132	431333488	Health Care	MO	501(c)(3)	10	SSM Health Care Corporation	false
SSM Health Care St Louis
10101 Woodfield Lane	St Louis	MO	63132	431343281	Health Care	MO	501(c)(3)	3	SSM Health Care Corporation	false
Centralia Medical Services Bldg Assoc
10101 Woodfield Lane	St Louis	MO	63132	237408025	MOB	IL	501(c)(3)	Type I	SSM Regional Health Services	false
St Mary's Janesville Foundation Inc
10101 Woodfield Lane	St Louis	MO	63132	273439133	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin	false
SSM Health Ministries
3221 McKelvey Road Suite 107	Bridgeton	MO	63044	431012492	Religious Organization	MO	501(c)(3)	1	NA	false
Lee Dewey Corporation
10101 Woodfield Lane	St Louis	MO	63132	731279603	MOB	OK	501(c)(3)	Type I	SSM Health Care of Oklahoma	false
SSM Hospice & Home Care Foundation
10101 Woodfield Lane	St Louis	MO	63132	300012246	Fundraising	MO	501(c)(3)	7	SSM Health Businesses	false
St Mary's Hospital Auxiliary
100 St Marys Medical Plaza	Jefferson City	MO	65101	436049878	Fundraising	MO	501(c)(3)	Type II	NA	false
Good Samaritan Hospital Auxiliary
1 Good Samaritan Way	Mount Vernon	IL	62864	237049599	Fundraising	IL	501(c)(3)	Type III-FI	NA	false
St Anthony Shawnee Hospital Inc
1000 N Lee Ave	Oklahoma City	OK	73102	455055149	Health Care	OK	501(c)(3)	3	SSM Health Care of Oklahoma	false
SSM Audrain Health Care Inc
10101 Woodfield Lane	St Louis	MO	63132	431550298	Health Care	MO	501(c)(3)	3	SSM Regional Health Services	false
Audrain Medical Center Foundation Inc
620 E Monroe St	Mexico	MO	65265	431265060	Fundraising	MO	501(c)(3)	Type I	NA	false
SSM-SLUH Inc
10101 Woodfield Lane	St Louis	MO	63132	474196634	Health Care	MO	501(c)(3)	3	SSM Health Care St Louis	false
SSM Health Plan
1277 Deming Way	Madison	WI	53717	831979548	Insurance	MO	501(c)(4)		SSM Health Businesses	false
Agnesian Healthcare Inc
430 E Division St	Fond du Lac	WI	54935	390807236	Health Care	WI	501(c)(3)	3	SSM Health Care of Wisconsin	false
Ripon Medical Center Inc
845 Parkside Street	Ripon	WI	54971	391101287	Health Care	WI	501(c)(3)	3	Agnesian Healthcare Inc	false
St Francis Home of Fond du Lac Wisconsin Inc
33 Everett Street	Fond du Lac	WI	54935	391029998	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	false
Sister Servants of Christ the King Villa Loretto
N8114 County WW	Mount Calvary	WI	53057	391022770	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	false
Villa Rosa Inc
N8120 County WW	Mount Calvary	WI	53057	421670962	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	false
The Christian Home and Rehabilitation Center Incorporated
331 Bly Street	Waupun	WI	53963	390884514	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	false
The Monroe Clinic Inc
515 22nd Avenue	Monroe	WI	53566	390808509	Health Care	WI	501(c)(3)	3	SSM Health Care of Wisconsin	false
Monroe Clinic and Hospital Foundation Inc
515 22nd Avenue	Monroe	WI	53566	205769038	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin	false
Agnesian Healthcare Foundation Inc
430 E Division St	Fond du Lac	WI	54935	391684956	Fundraising	WI	501(c)(3)	Type I	SSM Health Care of Wisconsin	false
Shared Magnetic Resonance Imaging Facility Inc
1104 John Nolen Drive	Madison	WI	53713	391534744	Health Care	WI	501(c)(3)	Type I	SSM Health Care of Wisconsin	false
SSM Health Cardinal Glennon Transport
10101 Woodfield Lane	St Louis	MO	63132	863519607	Health Care	MO	501(c)(3)	Type I	SSM Cardinal Glennon Children's Hospital	false
SSM Health Foundation
10101 Woodfield Lane	St Louis	MO	63132	874109859	Fundraising	MO	501(c)(3)	Type I	SSM Health Care Corporation	false

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (18 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt
SSM St Joseph Endoscopy Center LLC
10101 Woodfield Lane	St Louis	MO	63132	270046559	Surgery Services	MO	NA	N/A
St Clare Imaging Services LLC
707 14th Street Suite A	Baraboo	WI	53913	200122365	Diag. Services	WI	NA	N/A
Mt Vernon Radiation Therapy Center LLC
10101 Woodfield Lane	St Louis	MO	63132	201382620	Radiation Therapy	IL	NA	N/A
Sleep & Neurology Center of Southern Illinois LLC
10101 Woodfield Lane	St Louis	MO	63132	208468195	Diag. Services	IL	NA	N/A
CHOWSMGSI Office Building LLC
10101 Woodfield Lane	St Louis	MO	63132	371383861	MOB	IL	NA	N/A
Oza Cancer Center LLC
10101 Woodfield Lane	St Louis	MO	63132	201382727	MOB	IL	NA	N/A
Shawnee Real Estate Holdings LLC
1000 N Lee Ave	Oklahoma City	OK	73102	455458304	MOB	OK	NA	N/A
Dean Clinic & St Mary's Hospital Accountable Care Organization LLC
1808 West Beltline Highway	Madison	WI	53713	452995500	Accountable Care Organization	WI	NA	N/A
Wisconsin Integrated Information Technology and Telemedicine Systems LLC
1808 West Beltline Highway	Madison	WI	53713	392016715	Information Technology Services	WI	NA	N/A
Dean Health Holdings LLC
1277 Deming Way	Madison	WI	53717	261594709	Support Services	WI	NA	N/A
Wingra Building Group
1808 West Beltline Highway	Madison	WI	53713	390237060	MOB	WI	NA	N/A
Janesville Riverview Clinic Building Partnership
1808 West Beltline Highway	Madison	WI	53713	396220698	MOB	WI	NA	N/A
1110 N Classen Blvd LLC
1110 N Classen Boulevard	Oklahoma City	OK	73106	731158158	MOB	OK	NA	N/A
SSM St Clare Surgical Center LLC
10101 Woodfield Lane	St Louis	MO	63132	261439695	Surgery Services	MO	NA	N/A
Windmill LLP
50 Village View Lane	Chesterfield	MO	63017	431804651	Investments	MO	NA	N/A
Navitus Health Solutions LLC
361 Integrity Drive	Madison	WI	53717	043608530	Pharmacy Benefits	WI	NA	N/A
SSM Select Rehab St Louis LLC
4714 Gettysburg Road	Mechanicsburg	PA	17055	263694972	Health Care	DE	NA	N/A
Epiphany Rx LLC
361 Integrity Drive	Madison	WI	53717	364855405	Pharmacy Benefits	DE	NA	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (21 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	Province Or StateForeignAddress/ProvinceOrStateNm	CountryForeignAddress/CountryCd	Foreign PostalForeignAddress/ForeignPostalCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
SSM Managed Care Organization LLC
10101 Woodfield Lane	St Louis	MO	63132	431708511	Health Promotion	MO	NA	C Corporation	false
FPP INC & Subs
10101 Woodfield Lane	St Louis	MO	63132	431465174	Health Care	MO	NA	C Corporation	false
Diversified Health Services Corp
10101 Woodfield Lane	St Louis	MO	63132	431369305	Medical Equipment	MO	NA	C Corporation	false
SSM Properties Inc
10101 Woodfield Lane	St Louis	MO	63132	431462486	Property Services	MO	NA	C Corporation	false
HealthFirst Physician Management Services
10101 Woodfield Lane	St Louis	MO	63132	731534336	Medical Services	OK	NA	C Corporation	false
SSMHC Liability Trust II
10101 Woodfield Lane	St Louis	MO	63132	816128118	Insurance	MO	NA	C Corporation	false
SSM Medical Group Inc
10101 Woodfield Lane	St Louis	MO	63132	431664107	Physician Offices	MO	NA	C Corporation	false
SSMHC Insurance Company
				030310431	Insurance		NA	C Corporation	false	PO Box 1051 GT	Grand Cayman	CJ	KY11102	CJ
Physicians Services Corp of Southern Illinois Inc
10101 Woodfield Lane	St Louis	MO	63132	364161526	Health Care	IL	NA	C Corporation	false
Dean Health Systems Inc
1808 West Beltline Highway	Madison	WI	53713	391128616	Physician Offices	WI	NA	C Corporation	false
Dean Health Insurance Inc
PO Box 56099	Madison	WI	53705	391830837	Insurance	WI	NA	C Corporation	false
Dean Health Plan Inc
PO Box 56099	Madison	WI	53705	391535024	Insurance	WI	NA	C Corporation	false
Dean Retail Services Inc
1808 West Beltline Highway	Madison	WI	53713	391717636	Property Services	WI	NA	C Corporation	false
Oza Oncology Inc
4117 Veterans Memorial Drive	Mt Vernon	IL	62804	371343746	Physician Offices	IL	NA	S Corporation	false
SSM Health Janesville Campus Condominium Association Inc
1808 West Beltline Highway	Madison	WI	53713	832038674	Condo association	WI	NA	C Corporation	false
SSM Health Pharmacy LLC
10101 Woodfield Lane	St Louis	MO	63132	264031708	Pharmacy	MO	NA	C Corporation	false
SSM Health Insurance Company
1277 Deming Way	Madison	WI	53717	834718249	Insurance	MO	NA	C Corporation	false
Navitus Holdings LLC
1808 West Beltline Highway	Madison	WI	53713	800968174	Pharmacy	WI	NA	C Corporation	false
MS Community JV LLC
401 Carlson Parkway CP330	Minnetonka	MN	55305	873240022	Insurance	DE	NA	C Corporation	false
Quality Drug Corporation
239 Broadway	Laguna Beach	CA	92651	330644268	Pharmacy benefits	CA	NA	C Corporation	false
St Mary's Hospital Campus Condominium Owners Association Inc
707 South Mills Street	Madison	WI	53715	000000000	Condo association	WI	NA	C Corporation	false

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	false	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	false	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd