ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC (EIN 39-1029998)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-02
- IRS object ID
- 202133069349302083
- Schema version
- 2020v4.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-02T14:31:34-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391029998 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Francis Home of Fond du Lac Wisconsin Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STFR | BusinessNameControlTxt |
| Phone | 9209265519 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 33 Everett Street | AddressLine1Txt |
| City | Fond du Lac | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Randy Combs | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Signature | 2021-11-02 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Randy | PersonFirstNm |
| Person Last | Combs | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | 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 | Chris Thornock | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 33 Everett Street | AddressLine1Txt |
| City | Fond du Lac | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,985,099 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | https://www.ssmhealth.com/locations/location-details/skilled-nursing-st-francis-home | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO ALL WE SERVE. THE ORGANIZATION PROVIDES SKILLED NURSING CARE, INDEPENDENT LIVING AND ASSISTED LIVING FACILITIES. ST. FRANCIS HOME IS THE HEART OF ITS CARE CAMPUS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $65,165 | PYContributionsGrantsAmt |
| CY Contributions Grants | $384,266 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,638,564 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,348,707 | CYProgramServiceRevenueAmt |
| PY Investment Income | $31,343 | PYInvestmentIncomeAmt |
| CY Investment Income | $214,857 | CYInvestmentIncomeAmt |
| PY Other Revenue | $48,427 | PYOtherRevenueAmt |
| CY Other Revenue | $37,136 | CYOtherRevenueAmt |
| PY Total Revenue | $13,783,499 | PYTotalRevenueAmt |
| CY Total Revenue | $13,984,966 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,838,479 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,630,529 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,559,559 | PYOtherExpensesAmt |
| CY Other Expenses | $4,640,202 | CYOtherExpensesAmt |
| PY Total Expenses | $14,398,038 | PYTotalExpensesAmt |
| CY Total Expenses | $15,270,731 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$614,539 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,285,765 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,886,434 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,994,495 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,148,585 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,225,434 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,737,849 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,769,061 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO ALL WE SERVE. THE ORGANIZATION PROVIDES SKILLED NURSING CARE, INDEPENDENT LIVING AND ASSISTED LIVING FACILITIES. ST. FRANCIS HOME IS THE HEART OF ITS CARE CAMPUS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $14,334,333 | ExpenseAmt |
| Revenue | $13,348,707 | RevenueAmt |
| Desc | ST. FRANCIS HOME OF FOND DU LAC, WISCONSIN, INC. OPERATES A NURSING HOME AND RELATED HEALTH CARE FACILITIES PROVIDING VARIOUS PROGRAMS FOR THE CARE OF THE ELDERLY, INJURED, AND SICK. THIS MEDICARE-CERTIFIED SKILLED NURSING FACILITY SPECIALIZES IN LONG-TERM CARE FOR THE ELDERLY. IT PROVIDES THE LATEST IN NURSING HOME CARE, STRESSING A HOME-LIKE ATMOSPHERE FOR RESIDENTS AND OFFERING A SPECIAL UNIT DEDICATED TO THE CARE OF RESIDENTS WITH ALZHEIMER'S DISEASE. ST. CLARE TERRACE OFFERS INDEPENDENT LIVING OPTIONS. THIS SAFE, SECURE COMMUNITY LIVING ENVIRONMENT PROVIDES RESIDENTS A FULFILLING LIFESTYLE IN THEIR RETIREMENT YEARS. ST. FRANCIS TERRACE OFFERS ASSISTED LIVING CARE. THIS IS AN INTERIM CARE OPTION THAT PROVIDES SOME NURSING SUPPORT AND ASSISTANCE, YET ALLOWS PEOPLE TO LIVE INDEPENDENTLY. | Desc |
| Total Program Service Expenses | $14,334,333 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | 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 | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | false | 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 | false | OperateHospitalInd |
| Grants To Organizations | false | 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 | false | UnrelatedBusIncmOverLimitInd |
| 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 | Dennis Bangart | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9209292300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E Division Street | AddressLine1Txt |
| City | Fond du Lac | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| Dave Kusek | |||||||||
| Director, Chairperson | 1.0 | 3.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Douglas Trost | |||||||||
| Director, CEO and President | 1.0 | 46.0 | Yes (X) | Yes (X) | $0 | $309,759 | $84,584 | ||
| Steve Franke | |||||||||
| Director, Secretary/Treasurer | 1.0 | 3.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Barb Senn | |||||||||
| Director, Vice Chairperson | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |||
| Carol Hyland | |||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |||
| Damond Boatwright | |||||||||
| Director, Regional President - WI | 1.0 | 50.0 | Yes (X) | $0 | $1,134,246 | $404,896 | |||
| Jenny Knuth | |||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |||
| Rick Vant Hoff | |||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |||
| Sr Stephen Bloesl | |||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |||
| Sue Buwalda | |||||||||
| Director | 1.0 | 3.0 | Yes (X) | $0 | $0 | $0 | |||
| Douglas Long | |||||||||
| Secretary, General Counsel at SSM Health | 1.0 | 68.2 | Yes (X) | $0 | $1,201,821 | $399,352 | |||
| Kris Zimmer | |||||||||
| Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health | 1.0 | 67.0 | Yes (X) | $0 | $1,717,045 | $73,075 | |||
| Randy Combs | |||||||||
| Treasurer, Chief Financial Officer at SSM Health | 1.0 | 64.0 | Yes (X) | $0 | $403,263 | $84,602 | |||
| Janel Konkel | |||||||||
| Executive Director | 20.0 | 20.0 | $154,919 | $0 | $33,980 | Yes (X) | |||
| Paula Friedman | |||||||||
| Former Officer | 0.0 | 0.0 | $0 | $507,002 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $154,919 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,273,136 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,080,489 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | 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 (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PRN HOME HEALTH AND THERAPY | |||||
| 1101 E SOUTH RIVER ST | APPLETON | WI | 54915 | THERAPY | $476,081 |
| US FOODSERVICE INC | |||||
| 9399 W Higgins Road | Rosemont | IL | 60018 | DIETARY SERVICES | $476,057 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $67,218 | RelatedOrganizationsAmt |
| Government Grants | $317,048 | GovernmentGrantsAmt |
| Total Contributions | $384,266 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 623110 | BusinessCd |
| Total Revenue Column | $13,348,707 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,348,707 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| 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) |
|---|---|---|
| Total Program Service Revenue | $13,348,707 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $138,795 | TotalRevenueColumnAmt |
| Exclusion | $138,795 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,981 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,981 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,981 | TotalRevenueColumnAmt |
| Exclusion | $3,981 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $38,932 | SecuritiesAmt |
| Other | $37,130 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $38,932 | SecuritiesAmt |
| Other | $37,130 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,062 | TotalRevenueColumnAmt |
| Exclusion | $76,062 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $1,267 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $133 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,134 | TotalRevenueColumnAmt |
| Exclusion | $1,134 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $32,021 | TotalRevenueColumnAmt |
| Exclusion | $32,021 | ExclusionAmt |
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 | $32,021 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,984,966 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,348,707 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $251,993 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,899 | TotalAmt |
| Program Services | $174,190 | ProgramServicesAmt |
| Management And General | $14,709 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,670,137 | TotalAmt |
| Program Services | $7,072,894 | ProgramServicesAmt |
| Management And General | $597,243 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,504 | TotalAmt |
| Program Services | $186,736 | ProgramServicesAmt |
| Management And General | $15,768 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,013,539 | TotalAmt |
| Program Services | $1,856,753 | ProgramServicesAmt |
| Management And General | $156,786 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $555,450 | TotalAmt |
| Program Services | $512,199 | ProgramServicesAmt |
| Management And General | $43,251 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118 | TotalAmt |
| Management And General | $118 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $885,263 | TotalAmt |
| Program Services | $839,822 | ProgramServicesAmt |
| Management And General | $45,441 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $880,500 | TotalAmt |
| Program Services | $819,898 | ProgramServicesAmt |
| Management And General | $60,602 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133 | TotalAmt |
| Program Services | $133 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $527,546 | TotalAmt |
| Program Services | $527,402 | ProgramServicesAmt |
| Management And General | $144 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,457 | TotalAmt |
| Program Services | $3,121 | ProgramServicesAmt |
| Management And General | $2,336 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,295 | TotalAmt |
| Program Services | $1,295 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,859 | TotalAmt |
| Program Services | $174,859 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,419,872 | TotalAmt |
| Program Services | $1,419,872 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,003 | TotalAmt |
| Program Services | $33,003 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical supplies | $492,210 | $492,210 |
| Medicaid Provider Tax | $218,932 | $218,932 |
| Licenses and taxes | $1,014 | $1,014 |
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 | $15,270,731 | TotalAmt |
| Program Services | $14,334,333 | ProgramServicesAmt |
| Management And General | $936,398 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,362 | BOYAmt |
| EOY | $8,165 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,698,940 | BOYAmt |
| EOY | $6,197,849 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $644,031 | BOYAmt |
| EOY | $729,298 | 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 |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,641 | BOYAmt |
| EOY | $58,641 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,716 | BOYAmt |
| EOY | $29,432 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,622,958 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,152,284 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,479,270 | BOYAmt |
| EOY | $16,470,674 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,427,971 | BOYAmt |
| EOY | $3,905,414 | 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 | $2,453,162 | BOYAmt |
| EOY | $2,517,505 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,341 | BOYAmt |
| EOY | $77,517 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,886,434 | BOYAmt |
| EOY | $29,994,495 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,092,966 | BOYAmt |
| EOY | $808,337 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,821 | BOYAmt |
| EOY | $147,476 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,978,798 | BOYAmt |
| EOY | $10,269,621 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,148,585 | BOYAmt |
| EOY | $11,225,434 | 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 | $17,284,687 | BOYAmt |
| EOY | $16,251,556 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,453,162 | BOYAmt |
| EOY | $2,517,505 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,737,849 | BOYAmt |
| EOY | $18,769,061 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,886,434 | BOYAmt |
| EOY | $29,994,495 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,285,765 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $305,721 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $11,256 | 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,328 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $43,339 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,257 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $65,165 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $384,266 | CurrentTaxYearAmt |
| Total | $525,355 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,174,418 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,152,499 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,573,473 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,638,564 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,348,707 | CurrentTaxYearAmt |
| Total | $61,887,661 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,502 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,485 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $49,212 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $47,484 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $33,288 | CurrentTaxYearAmt |
| Total | $160,971 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,207,248 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,209,323 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,639,942 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,751,213 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,766,261 | CurrentTaxYearAmt |
| Total | $62,573,987 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $62,573,987 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $75,779 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $78,227 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,353 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,318 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $142,776 | CurrentTaxYearAmt |
| Total | $303,453 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $75,779 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $78,227 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,353 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,318 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $142,776 | CurrentTaxYearAmt |
| Total | $303,453 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $0 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $0 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $0 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $0 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $0 | CurrentTaxYearAmt |
| Total | $0 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $14,283,027 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,287,550 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,642,295 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,755,531 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,909,037 | CurrentTaxYearAmt |
| Total | $62,877,440 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.9952 | PublicSupportCY509Pct |
| Public Support PY509 | 0.9964 | PublicSupportPY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
| Investment Income PY | 0.0036 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,340,000 | OtherCostOrOtherBasisAmt |
| Book Value | $1,340,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,495,795 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,597,521 | DepreciationAmt |
| Book Value | $13,898,274 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $266,631 | OtherCostOrOtherBasisAmt |
| Depreciation | $120,768 | DepreciationAmt |
| Book Value | $145,863 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,520,532 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,433,995 | DepreciationAmt |
| Book Value | $1,086,537 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $16,470,674 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial interest in foundation | Desc |
| Book Value | $2,517,505 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $2,517,505 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Allocated tax-exempt debt from SSM Health Care Corporation | $4,317,500 |
| Due to affiliates | $4,371,380 |
| Other liabilities | $1,021,500 |
| Third party payor | $559,241 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,269,621 | 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 | ST. FRANCIS HOME OF FOND DU LAC WISCONSIN, INC.'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2020 OR 2019. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Douglas Trost | ||||||||||||||
| Director, CEO and President | $0 | $269,976 | $0 | $37,162 | $0 | $2,621 | $0 | $44,544 | $0 | $40,040 | $0 | $394,343 | $0 | $37,162 |
| Damond Boatwright | ||||||||||||||
| Director, Regional President - WI | $0 | $665,011 | $0 | $362,963 | $0 | $106,272 | $0 | $398,144 | $0 | $6,752 | $0 | $1,539,142 | $0 | $467,525 |
| Paula Friedman | ||||||||||||||
| Former Officer | $0 | $0 | $0 | $249,317 | $0 | $257,685 | $0 | $0 | $0 | $0 | $0 | $507,002 | $0 | $258,551 |
| Kris Zimmer | ||||||||||||||
| Pt Yr Treasurer, Pt Yr Chief Financial Officer at SSM Health | $0 | $370,664 | $0 | $803,048 | $0 | $543,333 | $0 | $56,137 | $0 | $16,938 | $0 | $1,790,120 | $0 | $1,162,526 |
| Douglas Long | ||||||||||||||
| Secretary, General Counsel at SSM Health | $0 | $645,435 | $0 | $469,242 | $0 | $87,144 | $0 | $374,673 | $0 | $24,679 | $0 | $1,601,173 | $0 | $547,438 |
| Randy Combs | ||||||||||||||
| Treasurer, Chief Financial Officer at SSM Health | $0 | $216,927 | $0 | $100,000 | $0 | $86,336 | $0 | $82,693 | $0 | $1,909 | $0 | $487,865 | $0 | $84,600 |
| Janel Konkel | ||||||||||||||
| Executive Director | $135,441 | $0 | $9,139 | $0 | $10,339 | $0 | $10,003 | $0 | $23,977 | $0 | $188,899 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 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 (CEO and 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 4a Severance or change-of-control payment | SSM Health has adopted a severance policy to provide a financial transition in the event of involuntary termination without cause for executive level positions. The amount of the compensation is based on the position held and length of service with SSMH. The following individuals listed in Part VII of the Form 990 received payments under the plan in the current year: Paula Friedman $257,685 |
| 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 2020. 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 2020: Douglas Trost $11,000 Damond Boatwright $77,160 Kris Zimmer $54,000 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2020. All distributions received from the plan in the current year were included in the individual's taxable compensation. Damond Boatwright $104,562 Kris Zimmer $493,428 Randy Combs $84,600 Douglas Long $78,000 During 2020, the following individuals participated in a nonqualified retirement plan from the organization or a related organization. The amounts reported below represent the change in accrued benefit for each individual and also include amounts accrued under the pension restoration plan: Kris Zimmer $26,226 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1a | ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY A RELATED ORGANIZATION, SSM HEALTH CARE CORPORATION, 46-6029223. |
| 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 St. Francis Home of Fond du Lac Wisconsin, Inc. 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 following powers are reserved for the member: 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 ยง501(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 | A written conflict of interest and insider transaction policy exists which requires each director, principal officer, trustee or committee member to disclose on a annual basis to the designated authority a conflict of interest disclosure statement. The designated authority ensures that all statements are completed, reviews them for conflicts, and submits to the board for review any conflict of interest disclosure statements that disclose actual or potential conflicts. |
| Form 990, Part VI, 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 Wisconsin Secretary of State's website. Copies of the Form 990 and the conflict of interest policy are available to the public upon request. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in beneficial interest in foundation - 11256; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (50 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 |
| Waupun Memorial Hospital Inc | ||||||||||
| 620 West Brown Street | Waupun | WI | 53963 | 390806265 | Health Care | WI | 501(c)(3) | 3 | 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 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (16 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 Holdings LLC | ||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 800968174 | Pharmacy Benefits | WI | NA | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (19 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 | 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 | ||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 030310431 | Insurance | NA | C Corporation | false | 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 | |
| Dane County Cytology Center Inc | ||||||||||
| 2000 Engel Street Suite 201 | Madison | WI | 53713 | 391414219 | Medical Services | WI | NA | C Corporation | false | |
| SSM Health Insurance Company | ||||||||||
| 1277 Deming Way | Madison | WI | 53717 | 834718249 | Insurance | MO | 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 | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | 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 |