AGNESIAN HEALTHCARE INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- AGNESIAN HEALTHCARE INC (EIN 39-0807236)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-04
- IRS object ID
- 202013099349302501
- Schema version
- 2019v5.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-04T15:30:24-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807236 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Agnesian Healthcare Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AGNE | BusinessNameControlTxt |
| Phone | 9209265519 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E Division St | AddressLine1Txt |
| City | Fond du Lac | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Doug Long | PersonNm |
| Person Title | Secretary | PersonTitleTxt |
| Signature | 2020-11-04 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Katherine Vergos | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E Division St | AddressLine1Txt |
| City | Fond du Lac | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54935 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $467,636,366 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | https://www.agnesian.com/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1892 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 2313 | TotalEmployeeCnt |
| Total Volunteers | 402 | TotalVolunteersCnt |
| Total Gross UBI | $3,972,663 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $427,564 | PYContributionsGrantsAmt |
| CY Contributions Grants | $568,781 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $195,999,850 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $403,484,831 | CYProgramServiceRevenueAmt |
| PY Investment Income | $192,582 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,275,923 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,623,015 | PYOtherRevenueAmt |
| CY Other Revenue | $27,328,663 | CYOtherRevenueAmt |
| PY Total Revenue | $209,243,011 | PYTotalRevenueAmt |
| CY Total Revenue | $438,658,198 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $83,162 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $575,203 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $99,801,256 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $202,779,057 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $228,402 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $101,622,402 | PYOtherExpensesAmt |
| CY Other Expenses | $228,296,154 | CYOtherExpensesAmt |
| PY Total Expenses | $201,506,820 | PYTotalExpensesAmt |
| CY Total Expenses | $431,650,414 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,736,191 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,007,784 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $654,431,153 | TotalAssetsBOYAmt |
| Total Assets EOY | $776,804,116 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $197,327,913 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $292,818,515 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $457,103,240 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $483,985,601 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $356,402,104 | ExpenseAmt |
| Grant | $575,203 | GrantAmt |
| Revenue | $418,854,515 | RevenueAmt |
| Desc | Please see Schedule O for a complete description of program service accomplishments. | Desc |
| Total Program Service Expenses | $356,402,104 | 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 | Yes (true) | 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 | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | Yes (true) | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| 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 | Yes (true) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| 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 | 292 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 2313 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | Yes (true) | ForeignFinancialAccountInd |
| Foreign Country | CJ | ForeignCountryCd |
| 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 | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | 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 | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| 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 (32 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Paula Friedman | ||||||||||
| Pt Yr Director/Vice President, Pt Yr Senior VP-Strategic Development SSM Health | 1.0 | 58.0 | Yes (X) | Yes (X) | $0 | $1,384,920 | $282,580 | |||
| Steven Little | ||||||||||
| Pt Yr Director, Pt Yr Regional Chief Operating Officer, Wisconsin | 1.0 | 45.0 | Yes (X) | Yes (X) | $0 | $1,395,599 | $9,512 | |||
| Thor Gilbertson | ||||||||||
| Director, Vice Chairperson | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Wayne Matzke | ||||||||||
| Director, Chairperson | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Mark Thompson | ||||||||||
| Director, Regional Chief Medical Officer | 1.0 | 43.0 | Yes (X) | $0 | $575,194 | $219,571 | Yes (X) | |||
| Dr Doug Fownes | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Dr Jeffery Strong | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Dr Judith Westphal | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Dr Ted Miller | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Dr Toni Stanley | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Joan Karsten | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Marysue Michels | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Sr Hertha Longo | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Sr Marie Scott | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Sr Susan Stucki | ||||||||||
| Director | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||||
| Stephen Peterson | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas Schneider | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas Schuessler | ||||||||||
| Director | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||||
| Doug Long | ||||||||||
| Secretary, General Counsel at SSM Health | 1.0 | 65.2 | Yes (X) | $0 | $229,550 | $471,986 | ||||
| Katherine Vergos | ||||||||||
| President - St. Agnes Hospital | 40.0 | 0.0 | Yes (X) | $465,436 | $0 | $128,135 | ||||
| Kris Zimmer | ||||||||||
| Treasurer, Chief Financial Officer at SSM Health | 1.0 | 67.0 | Yes (X) | $0 | $1,365,634 | $813,620 | ||||
| Barbara Knutzen | ||||||||||
| President - AHE, CLW and Performance | 40.0 | 0 | $189,646 | $0 | $31,634 | Yes (X) | ||||
| James Mugan | ||||||||||
| Sr VP - Medical Group and Medical Affairs | 40.0 | 0 | $339,080 | $0 | $54,660 | Yes (X) | ||||
| Michael Degere | ||||||||||
| VP - Population Health Management | 40.0 | 0 | $362,739 | $0 | $63,025 | Yes (X) | ||||
| Michael Drees | ||||||||||
| COO - Fond du Lac Regional Clinic | 40.0 | 0 | $304,815 | $0 | $60,752 | Yes (X) | ||||
| Jacob Waidelich | ||||||||||
| Physician | 40.0 | 0 | $565,464 | $0 | $11,388 | Yes (X) | ||||
| John Choi | ||||||||||
| Physician | 40.0 | 0 | $686,071 | $0 | $52,288 | Yes (X) | ||||
| Michael Vander Kooy | ||||||||||
| Radiation Oncologist | 40.0 | 0 | $707,472 | $0 | $61,757 | Yes (X) | ||||
| Steven Flurry | ||||||||||
| Anesthesiologist | 40.0 | 0 | $671,433 | $0 | $53,072 | Yes (X) | ||||
| Yasir Hatahet | ||||||||||
| Intensivist/Pulmonologist | 40.0 | 0 | $552,375 | $0 | $58,671 | Yes (X) | ||||
| Bonnie Schmitz | ||||||||||
| Former Key Employee | 0.0 | 0 | $604,554 | $0 | $269 | Yes (X) | ||||
| Nancy Birschbach | ||||||||||
| Former Key Employee | 0.0 | 40.0 | $0 | $356,040 | $118,475 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,449,084 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,306,938 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,491,394 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 183 | 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 | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| FOND DU LAC REGIONAL CLINIC SC | ||||||
| 420 E DIVISION ST | FOND DU LAC | WI | 54935 | PHYSICIAN SERVICES | $52,613,459 | |
| CD SMITH CONSTRUCTION | ||||||
| PO BOX 1066 | FOND DU LAC | WI | 54935 | CONSTRUCTION SERVICES | $5,272,351 | |
| CERNER CORP | ||||||
| 2800 ROCKCREEK PKWY | KANSAS CITY | MO | 64141 | COMPUTER SERVICES | $4,276,904 | |
| WILLIAMS MONTGOMERY & JOHN LTD | ||||||
| 233 S WACKER DR | CHICAGO | IL | 60606 | LEGAL SERVICES | $2,128,667 | 6800 |
| MEDICAL COLLEGE OF WI | ||||||
| 8701 WATERTOWN PLANK RD | WAUWATOSA | WI | 53226 | PHYSICIAN SERVICES | $1,822,101 | PO BOX 26 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 73 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $568,781 | RelatedOrganizationsAmt |
| Total Contributions | $568,781 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net patient service revenue | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $403,484,831 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $403,484,831 | 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 | $403,484,831 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,669,444 | TotalRevenueColumnAmt |
| Exclusion | $4,669,444 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $269,445 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $269,445 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $269,445 | TotalRevenueColumnAmt |
| Exclusion | $269,445 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,437,555 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $831,076 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,437,555 | SecuritiesAmt |
| Other | -$831,076 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,606,479 | TotalRevenueColumnAmt |
| Exclusion | $2,606,479 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $37,729,122 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $28,147,092 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,582,030 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $3,071,729 | UnrelatedBusinessRevenueAmt |
| Exclusion | $6,510,301 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Laboratory | 621500 | $16,270,618 | $15,369,684 | $900,934 | |
| Cafeteria | 722210 | $1,206,570 | $1,206,570 |
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 | $17,477,188 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $438,658,198 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $418,854,515 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $3,972,663 | UnrelatedBusinessRevenueAmt |
| Exclusion | $15,262,239 | 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 | $575,203 | TotalAmt |
| Program Services | $575,203 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,999,923 | TotalAmt |
| Program Services | $1,887,335 | ProgramServicesAmt |
| Management And General | $110,520 | ManagementAndGeneralAmt |
| Fundraising | $2,068 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,707,639 | TotalAmt |
| Program Services | $145,054,526 | ProgramServicesAmt |
| Management And General | $8,494,209 | ManagementAndGeneralAmt |
| Fundraising | $158,904 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,027,996 | TotalAmt |
| Program Services | $7,576,053 | ProgramServicesAmt |
| Management And General | $443,644 | ManagementAndGeneralAmt |
| Fundraising | $8,299 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,563,712 | TotalAmt |
| Program Services | $26,955,692 | ProgramServicesAmt |
| Management And General | $1,578,491 | ManagementAndGeneralAmt |
| Fundraising | $29,529 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,479,787 | TotalAmt |
| Program Services | $9,889,818 | ProgramServicesAmt |
| Management And General | $579,135 | ManagementAndGeneralAmt |
| Fundraising | $10,834 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,729,180 | TotalAmt |
| Management And General | $17,729,180 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,800 | TotalAmt |
| Management And General | $54,800 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,380 | TotalAmt |
| Management And General | $10,380 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,500,630 | TotalAmt |
| Program Services | $37,913,012 | ProgramServicesAmt |
| Management And General | $41,586,822 | ManagementAndGeneralAmt |
| Fundraising | $796 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $782,901 | TotalAmt |
| Management And General | $782,901 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,440,070 | TotalAmt |
| Program Services | $16,695,059 | ProgramServicesAmt |
| Management And General | $1,737,185 | ManagementAndGeneralAmt |
| Fundraising | $7,826 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,114 | TotalAmt |
| Program Services | $10,114 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,364,344 | TotalAmt |
| Program Services | $5,751,405 | ProgramServicesAmt |
| Management And General | $1,612,939 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,169,101 | TotalAmt |
| Program Services | $983,802 | ProgramServicesAmt |
| Management And General | $175,582 | ManagementAndGeneralAmt |
| Fundraising | $9,717 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $582,452 | TotalAmt |
| Program Services | $457,903 | ProgramServicesAmt |
| Management And General | $124,120 | ManagementAndGeneralAmt |
| Fundraising | $429 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,889,810 | TotalAmt |
| Program Services | $4,889,810 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,734,637 | TotalAmt |
| Program Services | $21,734,637 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,528,457 | TotalAmt |
| Program Services | $1,528,457 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical supplies | $63,864,783 | $63,864,783 |
| Medicaid Provider Tax | $5,112,788 | $5,112,788 |
| Licenses and taxes | $5,521,707 | $5,521,707 |
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 | $431,650,414 | TotalAmt |
| Program Services | $356,402,104 | ProgramServicesAmt |
| Management And General | $75,019,908 | ManagementAndGeneralAmt |
| Fundraising | $228,402 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,673,154 | BOYAmt |
| EOY | $39,259,155 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,581,521 | BOYAmt |
| EOY | $5,707,220 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,225,369 | BOYAmt |
| EOY | $74,846,607 | 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) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,792,318 | BOYAmt |
| EOY | $3,797,416 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,841,068 | BOYAmt |
| EOY | $3,055,737 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $287,523,014 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $40,534,389 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $253,767,003 | BOYAmt |
| EOY | $246,988,625 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,658,875 | BOYAmt |
| EOY | $262,830,962 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,288,458 | BOYAmt |
| EOY | $16,627,456 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,603,387 | BOYAmt |
| EOY | $123,690,938 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $654,431,153 | BOYAmt |
| EOY | $776,804,116 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,540,950 | BOYAmt |
| EOY | $51,359,055 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $283,578 | BOYAmt |
| EOY | $308,869 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
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) |
|---|---|---|
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,503,385 | BOYAmt |
| EOY | $241,150,591 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $197,327,913 | BOYAmt |
| EOY | $292,818,515 | 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 | $451,305,858 | BOYAmt |
| EOY | $477,760,012 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,797,382 | BOYAmt |
| EOY | $6,225,589 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $457,103,240 | BOYAmt |
| EOY | $483,985,601 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $654,431,153 | BOYAmt |
| EOY | $776,804,116 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,007,784 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $25,271,058 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,396,481 | 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 | $10,380 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,380 | 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 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 | $14,684,350 | OtherCostOrOtherBasisAmt |
| Book Value | $14,684,350 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $193,819,603 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,505,194 | DepreciationAmt |
| Book Value | $177,314,409 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,977,894 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,579,480 | DepreciationAmt |
| Book Value | $4,398,414 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,163,105 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,449,715 | DepreciationAmt |
| Book Value | $35,713,390 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,878,062 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $14,878,062 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $246,988,625 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SSM COMPREHENSIVE INVESTMENT PROGRAM | Desc |
| Book Value | $262,830,962 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $262,830,962 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from affiliates | $117,831,938 |
| OPERATING RIGHT-OF-USE ASSETS | $5,859,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $123,690,938 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| Third Party Payor | $2,155,000 |
| Capital Lease Obligations | $1,968,062 |
| Allocated tax-exempt debt: SSM Health Care Corporation | $117,430,192 |
| Due to affiliates | $113,735,819 |
| OPERATING LEASE OBLIGATIONS | $5,861,518 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $241,150,591 | 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 | AGNESIAN HEALTHCARE 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 2019 OR 2018. | 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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 165 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | $1,223,547 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,223,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0028 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,590,433 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,247,656 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $23,342,777 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0541 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $82,057 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $243,564 | 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 | $45,896,037 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,491,220 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,566,324 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0569 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,748,481 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $424,347 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,324,134 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0031 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,180 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $63,180 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $216,781 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $35,896 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $180,885 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0004 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,980 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,980 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $114,664 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $114,664 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0003 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,150,086 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $460,243 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,689,843 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0039 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $48,046,123 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,951,463 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $26,256,167 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0608 | 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) |
|---|---|---|
| Total Community Benefit Expns | $15,169 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,169 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $686 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $686 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,902 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,902 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | 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) |
|---|---|---|
| Total Community Benefit Expns | $44,790 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,790 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | 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 | $64,547 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $64,547 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $24,059,789 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $36,979,964 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $44,732,780 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,752,816 | 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 | St Agnes Hospital | BusinessNameLine1Txt |
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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://www.agnesian.com/locations/st-agnes-hospital | WebsiteAddressTxt |
| State License | 120 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| 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 | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | 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.agnesian.com/locations/st-agnes-hospital | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | https://www.ssmhealth.com/about/chna | OtherWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.ssmhealth.com/about/chna | 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 | 165.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.0 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.agnesian.com/page/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.agnesian.com/page/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.agnesian.com/page/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 Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 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 - St. Agnes Hospital. The hospital facility took into account input from persons who represent the broad interests of the community served through the following process: key informants in Fond du Lac County were identified by the Community Health Assessment Task Force members and interviewed by the Fond du Lac County Health Department. Interviews were completed in-person and electronically via questionnaires in February and March 2018, and interviewees were asked to rank twelve health focus areas from highest to lowest priority, with number one being the top priority health issue to address in Fond du Lac County based on the population served. |
| Schedule H, Part V, Section B, Line 6a Facility A, 1 | Facility A, 1 - St. Agnes Hospital. Hospitals included in the CHNA were Agnesian Healthcare (St. Agnes Hospital), Waupun Memorial Hospital, and Ripon Medical Center. |
| Schedule H, Part V, Section B, Line 6b Facility A, 1 | Facility A, 1 - St. Agnes Hospital. St. Agnes Hospital collaborated extensively with the Fond du Lac County Health Department. |
| Schedule H, Part V, Section B, Line 11 Facility A, 1 | Facility A, 1 - St. Agnes Hospital. The hospital identified various health needs in the 2018 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: - Nutrition and physical activity - Mental health - Alcohol and other drug abuse Nutrition and physical activity The hospital has identified nutrition and physical activity as a community health priority. The hospital aims to increase the number of Fond du Lac County residents living at healthy weight for their height through eating healthier and being more active. Additionally, statistics show: - Almost 3 in 4 adults in the area classify as being overweight or obese - Only 1 in 4 adults reported eating the recommended servings of vegetables per day - About half of adults reported eating the recommended servings of fruit per day - Only 1 in 4 met the recommended amount of physical activity and strength training - For youth, 1 in 4 are overweight or obese - Less than half of youth report eating the recommended servings of fruits and vegetables - Only 1 in 5 youth meet the recommended amount of physical activity and strength training The hospital's action plan includes the following initiatives to improve nutrition and physical activity in the community served: - Improve physical activity through the following: - Increase trail usage by 10% from 1496 (2016) total bike/pedestrian counts over a weeklong period to 1646 - Implement one community-wide physical activity campaign - Increase the number of teachers in the FDL School District implementing wearable technology with students from 19 to 21 - Increase the number of schools participating in safe routes to school from 23 to 27 - Improve fruit and vegetable consumption through the following: - Increase SNAP usage at the Wednesday Downtown FDL Farmers Market by 25% from $278 (2018 YTD) to $348 - Increase SNAP usage at the Saturday Downtown FDL Farmers Market by 10% from $5,000 (2018 YTD) to $5,500 - Increase the number of food forests planted from 4 (2018) to 5 - Increase the number of pounds of produce donated at the FDL farmers market by 10% from 3,500 lbs (2018 YTD) to 3,850 lbs - Increase the health promotion programs offered to low-income housing residents from zero to 9 - Improve breastfeeding rates through the following: - Increase the number of childcare centers and business centers who have adopted the Ten Steps to Breastfeeding-Friendly Toolkit from 7 (2017) to 15 - Increase the attendance at the annual Breastfeeding Celebration from 85 (2018) to 125 Mental Health The hospital has identified mental health as a top community health priority. The facility is striving to reduce the stigma around mental health and suicide, increase access to behavioral health services at any age and for those in high-risk groups, and decrease the number of deaths by suicide. Additionally, statistics show: - About 1 in 5 Fond du Lac County residents reported a mental health condition - 5 percent of adults reported to having considered suicide in the last year - 15 percent of high school students reported to having considered suicide in the last year - The number of suicides in Fond du Lac County has nearly doubled from 2013 to 2017 The hospital's action plan includes the following initiatives to address mental health in the community served: - Decrease number of deaths by suicide through earlier identification of mental distress through the following: - Increasing number of those who live and work in Fond du Lac County who are trained as gatekeepers in Question, Persuade, Refer (QPR), Mental Health First Aid for Adults (MHFA), and Youth Mental Health First Aid (YMHFA) - Promoting use of universal and targeted screening across the lifespan in both clinical and non-clinical settings - Reduce stigma around mental health and suicide which can limit help-seeking behaviors with the following: - Education & Awareness activities: Coordinated messaging campaign (via radio, website, newspaper, etc.), including the facts related to mental health conditions, their occurrence in the general population, and the effectiveness of treatment - Promoting positive mental health and resiliency - Partner with individuals who have lived experience to share their stories and inform efforts - Increase access to behavioral health services across the lifespan, and for those in high-risk groups through the following: - Develop a Pathways to Care Mental Health Navigation Tool for Fond du Lac County adults - Develop a more universal approach to safety planning across the county, which includes creating a document with a common language and format that can be used across populations and settings Alcohol and Other Drug Abuse The hospital has identified alcohol and other drug abuse as a key priority to address within the community. The hospital facility with community groups to reduce availability of alcohol and illicit drugs, binge drinking, and to improve procedures to manage and address opioid abuse. Additionally, statistics show: - 1 in 5 adults and youth have reported binge drinking - 1 in 3 youth report very or fairly easy access to prescription medications for misuse - About 1 in 10 youth reported electronic vapor product use over a 30-day period - In 2017, there were 7 opioid overdose deaths in Fond du Lac County The hospital's action plan includes the following initiatives to improve alcohol and other drug abuse in the community served: - Reduce underage drinking and adult binge drinking through the following: - Increase the number of festivals evaluated annually throughout Fond du Lac County from 7 (2017) to 12 - Increase the number of law enforcement agencies completing annual compliance checks from 2 (2017) to 4 - Reduce misuse and abuse of drugs, particularly opioids through the following: - Increase the number Narcan kits distributed annually through community Narcan Trainings from 54 (2017) to 75 - Increase number of providers using the evidence-informed screening tool SBIRT for early intervention and referral for treatment from 0 (2017) to 4 or more The hospital has no plans to discontinue other community benefit efforts addressing additional community needs within its efforts. The following community needs were identified and will be addressed as resources allow (additional descriptions available in the 2018 CHIP): - Trauma-informed care - Social determinants of health |
| Schedule H, Part V, Section B, Line 11 Facility A, 2 | Facility A, 2 - St. Agnes Hospital (Continued). During 2019, the following activities were performed to help address the issues identified in the CHNA: Nutrition and Physical Activity: * Fond du Lac County's Living Well Coalition. In 2019, Dr. Heather Schmidt, Nicole Wiegert, Terri St. Lawrence and Joel Mason from Agnesian Healthcare, a Member of SSM Health, were members of the Living Well Coalition. The Living Well Coalition's focus is on the Nutrition/Physical activity pillar for Healthy Fond du Lac 2020. * POWER Program. Healthy Lifestyle/weight loss program for patients preparing for surgery which incorporates healthy eating/physical activity. Dr. Schmidt sees the program participant and incorporates a dietitian from Agnesian along with a physical activity component. In the Ripon Area, the Ripon Wellness Center assists participants. * Summer of Fun program. Summer program for children living in poverty. Program was offered approximately 3 days/week. Two days/week the Fond du Lac Recreation Department and area volunteers provided outdoor physical activities for the children to participate in. Children were also provided lunch and a healthy snack/water each day. * Healthy Living with diabetes. This is a 6 week workshop designed for adults with type 2 diabetes or pre-diabetes and their caregivers. It Teaches participants skills to effectively manage diabetes or delay the onset of diabetes. Topics include healthy eating and physical activity. This program is a community collaboration. We had 3 SSM associates trained to facilitate the class. * Letter of support. Letter of support was drafted to UW-Extension Education, Agriculture and Recreation Committee all to use local trails (Wild Goose Trail) to be physically active; opposing winter ATV use on the trails. * Fruit tree donation. Donated 2 fruit trees to the community garden at Hamilton Park. * Referrals to Livestrong, Healthy Living program at YMCA. Agnesian HealthCare continues to collaborate with the YMCA to refer patients to free programs that promote healthy living, nutrition and physical activity. In 2019, Care Management referred at least 293 patients to the YMCA for the above listed programs. * Health Resource Center Programming. Offered various cooking demos and physical activity options (i.e. yoga) for our community through our health resource center in 2019. Mental Health: * Healthy Fond du Lac 2020's Mental Health Priority Team. In 2019, Dr. Matthew Doll of Agnesian Healthcare served on Healthy Fond du Lac 2020 Mental Health Priority Team. * Suicide Prevention - Yscreen. In 2019, Agnesian Healthcare rolled out the Columbia Screening tool in partnership with YScreen as part of a broad and community-wide suicide prevention program. As part of the effort, Agnesian Healthcare provided training and process improvement to the community health coalition and community partners. YScreen, a mental health screening tool for all 9th graders, was utilized throughout the county. * Suicide Prevention - Clinician Training. As part of a community-wide suicide prevention program, Agnesian Healthcare also hosted and training clinicians on motivation interviewing for potentially suicidal individuals. * Suicide Prevention - Safety Plans, Zero Suicide, QPR, TIC and ACEs. As part of a broader effort to reduce and prevent suicides in Fond du Lac County, Agnesian Healthcare piloted the Stanley Brown safety plan tool for all providers to use. Agnesian also provided training and process improvement activities for the Zero Suicide effort as well as additional training on QPR, trauma informed care (TIC) and adverse childhood experiences (ACEs). Alcohol and Other Drug Abuse: * Drug Free Communities. As part of efforts to address Healthy Fond du Lac 2020's Alcohol and Other Drug Abuse priority area, members of Agnesian Healthcare, a unit of SSM Health, participated in Fond du Lac County's Drug Free Communities program. |
| Schedule H, Part V, Section B, Line 13 Facility A, 1 | Facility A, 1 - St. Agnes Hospital. Patients and their guarantor's income is used in determining income level for free or discounted care. |
| Schedule H, Part V, Section B, Line 13 Facility A, 1 | Facility A, 1 - St. Agnes Hospital. Uninsured patients are automatically given a discount ranging in percentage based on the total amount due. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Fond du Lac Regional Clinic | ||||
| 420 E Division Street | Fond du lac | WI | 54935 | Outpatient physician clinic |
| Consultants Lab of Wisconsin LLC | ||||
| 430 E Division Street | Fond du lac | WI | 54935 | Laboratory and testing |
| Agnesian Healthcare Enterprises LLC | ||||
| 430 E Division Street | Fond du lac | WI | 54935 | Pharmaceuticals, home health, and medical supplies |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 | AGNESIAN HEALTHCARE INC 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: COMMUNITY SUPPORT: VARIOUS COMMUNITY EDUCATIONAL EVENTS AND SUPPORT GROUPS, ENVIRONMENTAL IMPROVEMENTS: MANAGEMENT OF THE SHARPS HOME COLLECTION AND DISPOSAL PROGRAM, COALITION BUILDING: INVOLVEMENT WITH SCHOOL DISTRICTS AND BOARDS, AND PUBLIC HEALTH DEPARTMENTS TO IMPROVE COMMUNITY HEALTH MEASURES, WORKFORCE DEVELOPMENT: JOB SHADOWING, AND CLINICAL WORK EXPERIENCE PROGRAMS (IN PARTNERSHIP WITH COLLEGES AND OTHER HEALTH CARE ORGANIZATIONS). |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS AT CHARGES AS RECORDED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ALLOWANCE FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | Agnesian Healthcare Inc is part of the SSM Health consolidated audit. The footnote that references the treatment of uncollectible accounts and implicit price concessions in the December 31, 2019 consolidated audit is contained on page 11 and 12 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 | ST. AGNES HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. PAYMENT IS DUE WITHIN 30 DAYS OF RECEIPT OF A STATEMENT. IF PATIENTS DO NOT SET UP ACCEPTABLE PAYMENT ARRANGEMENTS, BILLS WILL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY. FINANCIAL COUNSELORS WORK WITH ALL PATIENTS ON AN INDIVIDUAL BASIS AND MAY OFFER EXTENDED MONTHLY PAYMENTS WITHOUT INTEREST BASED ON DOLLAR AMOUNT, PRIVATE PAY DISCOUNTS (INDIVIDUALS WHO DO NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE BILLED AT A REDUCED RATE), OR GUARANTEED BANK LOANS. IF PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE, THEIR EXPENSES ARE RECLASSIFIED AS CHARITY CARE. PATIENTS WHO RECEIVED A COLLECTION NOTICE COULD APPLY FOR CHARITY CARE. IF THEIR APPLICATION IS APPROVED, THIS WOULD TRIGGER A TRANSFER OF EXPENSES FROM BAD DEBT TO CHARITY CARE. |
| Schedule H, Part V, Section B, Line 16a FAP website | A - St. Agnes Hospital: Line 16a URL: https://www.agnesian.com/page/financial-assistance; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | A - St. Agnes Hospital: Line 16b URL: https://www.agnesian.com/page/financial-assistance; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | A - St. Agnes Hospital: Line 16c URL: https://www.agnesian.com/page/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 | St. Agnes Hospital is located in Fond du Lac, Wisconsin, and defines its primary service area as Fond du Lac County, Wisconsin. In 2015, the population of the county was estimated at 102,793 adults. Approximately 17.5% of the population is age 65 or older, and 21.9% have obtained a Bachelor's degree or higher. Over one-third of the population lives in a rural area. The area of Fond du Lac County has a poverty rate of 7.7%, significantly lower than the state of Wisconsin and U.S. as a whole. Median household incomes for the county are also slightly above state and national amounts. Additional demographic and statistical data on Fond du Lac County's residents and their health can be found beginning on page 94 of the 2018 CHNA. |
| Schedule H, Part VI, Line 5 Promotion of community health | Agnesian Healthcare Inc 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. Focusing on a broad definition of health, Agnesian Healthcare Inc's clinics and programs provide medical and mental health services, health education, health management, prevention, referrals, insurance enrollment and in-home primary care services and support, while fostering collaboration and incorporating Community Benefit strategies. Agnesian Healthcare Inc promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote community health. Agnesian Healthcare Inc 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 | Agnesian Healthcare Inc 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 (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Arc of Fond du Lac | |||||||
| 500 N Park Avenue | Fond du Lac | WI | 54935 | 391034161 | 501(c)(3) | $50,000 | General support |
| Moraine Park Technical College | |||||||
| 235 N National Ave | Fond du Lac | WI | 54936 | 391088212 | Government | $50,000 | General support |
| Marian University | |||||||
| 45 South National Avenue | Fond du Lac | WI | 54935 | 391024723 | 501(c)(3) | $62,500 | General support |
| Ripon Area School District | |||||||
| 1120 Metomen Street | Ripon | WI | 54971 | 396004200 | Government | $8,903 | General support |
| Boys & Girls Club of FDL | |||||||
| 76 W 2nd Street | Fond du Lac | WI | 54935 | 391896496 | 501(c)(3) | $60,000 | General support |
| ASTOP Inc | |||||||
| 21 S Marr St | Fond du Lac | WI | 54935 | 391707358 | 501(c)(3) | $22,000 | General support |
| Envision Greater FDL Inc | |||||||
| 23 S Main Street No 101 | Fond du Lac | WI | 54935 | 390284470 | 501(c)(6) | $80,000 | General support |
| Fond du Lac County Health Department | |||||||
| 160 S Macy St | Fond du Lac | WI | 54935 | 396005696 | Government | $100,000 | General support |
| Children's Museum of FDL | |||||||
| 75 West Scott St | Fond du Lac | WI | 54935 | 562471187 | 501(c)(3) | $11,000 | General support |
| Fond du Lac Soccer Association | |||||||
| PO Box 1292 | Fond du Lac | WI | 54935 | 391369383 | 501(c)(3) | $30,000 | General support |
| Solutions Center | |||||||
| 39 N Sophia Street | Fond du Lac | WI | 54935 | 391452956 | 501(c)(3) | $15,000 | General support |
| Fond du Lac Area YMCA | |||||||
| 90 W Second St | Fond du Lac | WI | 54935 | 390806436 | 501(c)(3) | $15,000 | General support |
| Fond du Lac Food Pantry | |||||||
| 573 W Rolling Meadows Dr | Fond du Lac | WI | 54936 | 510156435 | 501(c)(3) | $26,800 | General support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 12 | Total501c3OrgCnt |
| Total Other Org | 1 | 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) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (17 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Paula Friedman | ||||||||||||||
| Pt Yr Director/Vice President, Pt Yr Senior VP-Strategic Development SSM Health | $0 | $270,134 | $0 | $189,852 | $0 | $924,934 | $0 | $278,843 | $0 | $3,736 | $0 | $1,667,500 | $0 | $618,871 |
| Steven Little | ||||||||||||||
| Pt Yr Director, Pt Yr Regional Chief Operating Officer, Wisconsin | $0 | $119,395 | $0 | $274,864 | $0 | $1,001,341 | $0 | $5,133 | $0 | $4,379 | $0 | $1,405,111 | $0 | $112,832 |
| Mark Thompson | ||||||||||||||
| Director, Regional Chief Medical Officer | $0 | $494,318 | $0 | $76,618 | $0 | $4,259 | $0 | $188,808 | $0 | $30,763 | $0 | $794,765 | $0 | $76,618 |
| Kris Zimmer | ||||||||||||||
| Treasurer, Chief Financial Officer at SSM Health | $0 | $887,868 | $0 | $230,489 | $0 | $247,277 | $0 | $797,538 | $0 | $16,082 | $0 | $2,179,255 | $0 | $340,596 |
| Doug Long | ||||||||||||||
| Secretary, General Counsel at SSM Health | $0 | $149,400 | $0 | $0 | $0 | $80,150 | $0 | $469,438 | $0 | $2,548 | $0 | $701,536 | $0 | $0 |
| Katherine Vergos | ||||||||||||||
| President - St. Agnes Hospital | $359,780 | $0 | $99,450 | $0 | $6,206 | $0 | $125,305 | $0 | $2,830 | $0 | $593,571 | $0 | $0 | $0 |
| Nancy Birschbach | ||||||||||||||
| Former Key Employee | $0 | $282,526 | $0 | $72,043 | $0 | $1,472 | $0 | $93,377 | $0 | $25,098 | $0 | $474,515 | $0 | $22,043 |
| Bonnie Schmitz | ||||||||||||||
| Former Key Employee | $9,272 | $0 | $130,715 | $0 | $464,567 | $0 | $269 | $0 | $0 | $0 | $604,824 | $0 | $0 | $0 |
| James Mugan | ||||||||||||||
| Sr VP - Medical Group and Medical Affairs | $301,869 | $0 | $21,157 | $0 | $16,054 | $0 | $23,625 | $0 | $31,035 | $0 | $393,740 | $0 | $0 | $0 |
| Barbara Knutzen | ||||||||||||||
| President - AHE, CLW and Performance | $132,400 | $0 | $17,551 | $0 | $39,695 | $0 | $16,496 | $0 | $15,137 | $0 | $221,279 | $0 | $0 | $0 |
| Michael Degere | ||||||||||||||
| VP - Population Health Management | $331,658 | $0 | $23,331 | $0 | $7,750 | $0 | $23,625 | $0 | $39,400 | $0 | $425,764 | $0 | $0 | $0 |
| Michael Drees | ||||||||||||||
| COO - Fond du Lac Regional Clinic | $266,880 | $0 | $18,912 | $0 | $19,023 | $0 | $22,773 | $0 | $37,979 | $0 | $365,567 | $0 | $0 | $0 |
| Yasir Hatahet | ||||||||||||||
| Intensivist/Pulmonologist | $493,094 | $0 | $36,508 | $0 | $22,772 | $0 | $20,001 | $0 | $38,670 | $0 | $611,046 | $0 | $0 | $0 |
| Michael Vander Kooy | ||||||||||||||
| Radiation Oncologist | $655,404 | $0 | $0 | $0 | $52,068 | $0 | $23,625 | $0 | $38,132 | $0 | $769,229 | $0 | $0 | $0 |
| John Choi | ||||||||||||||
| Physician | $531,286 | $0 | $151,181 | $0 | $3,604 | $0 | $23,625 | $0 | $28,663 | $0 | $738,359 | $0 | $0 | $0 |
| Steven Flurry | ||||||||||||||
| Anesthesiologist | $627,105 | $0 | $0 | $0 | $44,328 | $0 | $23,625 | $0 | $29,447 | $0 | $724,505 | $0 | $0 | $0 |
| Jacob Waidelich | ||||||||||||||
| Physician | $563,714 | $0 | $0 | $0 | $1,750 | $0 | $0 | $0 | $11,388 | $0 | $576,852 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: Steven Little $928,541 Paula Friedman $470,555 Bonnie Schmitz $401,794 |
| 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 2019. 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 2019: Mark Thompson $38,000 Kris Zimmer $105,240 Katherine Vergos $28,428 Nancy Birschbach $22,550 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2019. All distributions received from the plan in the current year were included in the individual's taxable compensation. Steven Little $56,667 Paula Friedman $429,019 Kris Zimmer $111,962 During 2019, 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: Paula Friedman $9,691 Kris Zimmer $66,609 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wisconsin Health and Educational Facilities Authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| CUSIP | 97712DXT8 | CUSIPNum |
| Bond Issued | 2017-08-10 | BondIssuedDt |
| Issue Price | $62,792,652 | IssuePriceAmt |
| Purpose | Finance capital improvements and refund 2010 and 2012 bonds | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,320,000 | RetiredAmt |
| Total Proceeds | $63,093,975 | TotalProceedsAmt |
| Refunding Escrow | $24,742,759 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $656,999 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $23,199,248 | CapitalExpendituresAmt |
| Other Spent Proceeds | $14,541,303 | OtherSpentProceedsAmt |
| Unspent | $102,004 | UnspentAmt |
| Refunding Tax Exempt Bonds | Yes (true) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | Yes (true) | RefundingTaxableBondsInd |
| Final Allocation Made | false | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.0 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.0 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.0 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | Yes (true) | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| CD Smith Construction | |||
| WAYNE E MATZKE, DIRECTOR/OFFICER, IS ON BOARD OF DIRECTORS OF INTERESTED PERSON | $5,272,351 | Construction services | false |
| FOND DU LAC REGIONAL CLINIC SC | |||
| DIRECTORS ARE EMPLOYEE-OWNERS OF INTERESTED PERSON | $52,613,459 | Physician services | false |
| HOLIDAY AUTO | |||
| ENTITY OWNED BY THOR H GILBERTSON, DIRECTOR/OFFICER | $64,423 | SALES AND SERVICE TO VEHICLES | false |
| Cynthia Schneider | |||
| FAMILY MEMBER OF THOMAS SCHNEIDER, DIRECTOR | $29,632 | EMPLOYMENT | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part IV, Column (b) FOND DU LAC REGIONAL CLINIC SC OWNERS | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING DIRECTORS LISTED ON FORM 990, PART VII, ARE EMPLOYEE-OWNERS OF THE FOND DU LAC REGIONAL CLINIC: DR DOUG FOWNES, DR JEFFERY STRONG, DR TONI STANLEY, AND DR TED MILLER. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 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 Agnesian Healthcare Inc: Agnesian Healthcare Inc, operating as St. Agnes Hospital, has been providing healing care for almost 125 years. The hospital has grown into both an inpatient and outpatient facility providing innovative community and regional healthcare services to the greater Fond du Lac area. As a nonprofit Catholic institution, St. Agnes Hospital serves people of all faiths and beliefs. It is a leader in providing quality state-of-the-art healthcare services, whether it is cancer treatment; comprehensive heart care through the Dale Michels Center for Heart Care, including angioplasty and open-heart surgery; home or hospice care; maternity services; laser surgery; sports medicine; behavioral health services; women's health services; occupational health services; rehabilitation services and 24-hour emergency care. In 2018, St. Agnes Hospital received the American Heart Association's Get With The Guidelines - Heart Failure Silver Plus Quality Achievement Award. The award recognizes the hospital's commitment to ensuring heart failure patients receive the most appropriate treatment according to nationally recognized, research-based guidelines founded in the latest scientific evidence. St. Agnes Hospital earned the award by meeting specific quality achievement measures for the diagnosis and treatment of heart failure patients at a set level for a designated period. St. Agnes also earned The Joint Commission's Gold Seal of Approval and the American Heart Association/American Stroke Association's Heart-Check mark for advanced certification and quality for primary stroke centers. The hospital was also one of the 250 recipients of Healthgrades' 2018 Distinguished Hospital Award for Clinical Excellence. Agnesian Healthcare Inc 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 $ 1,223,547 Unpaid Cost of Medicaid $ 23,342,777 Unpaid Cost of Medicare $ 7,752,816 Total Quantifiable Uncompensated Care $ 32,319,140 |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | DR DOUG FOWNES, DR JEFFERY STRONG, DR TONI STANLEY, AND DR TED MILLER - Business relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The sole member of the corporation is SSM Health Care of Wisconsin, Inc. SSM Health Care of Wisconsin, Inc, is a nonprofit 501(C)(3) organization. Both Agnesian Healthcare Inc and SSM Health Care of Wisconsin, 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 §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 | 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 15a Process to establish compensation of top management official | Determination of compensation of the CEO and officers includes analysis of comparable compensation to the board of directors. The board of directors, who are independent, review and approve the compensation package for officers, and contemporaneous substantiation of the deliberation and decision is included in the board minutes. The final agreement is documented with a written contract, which is signed by both parties. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | An annual survey is performed by an outside company. |
| 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 IX, Line 11g Other Fees | Medical and other professional fees - Total Expense: 79500630, Program Service Expense: 37913012, Management and General Expenses: 41586822, Fundraising Expenses: 796; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in beneficial interest in foundation - 3031277; Fund balance transfers - -8427758; |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| Consultants Laboratory of Wisconsin LLC | |||||||||
| 430 E Division Street | Fond du lac | WI | 54935 | 391528550 | Lab services | WI | $28,858,377 | $14,651,523 | Agnesian Healthcare Inc |
| Agnesian Healthcare Enterprises LLC | |||||||||
| 430 E Division Street | Fond du lac | WI | 54935 | 392038757 | Retail pharmacy | WI | $9,568,369 | $7,751,222 | Agnesian Healthcare Inc |
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 | |
| Ripon Medical Center Inc | ||||||||||
| 845 Parkside Street | Ripon | WI | 54971 | 391101287 | Health Care | WI | 501(c)(3) | 3 | Agnesian Healthcare Inc | Yes (true) |
| Waupun Memorial Hospital Inc | ||||||||||
| 620 West Brown Street | Waupun | WI | 53963 | 390806265 | Health Care | WI | 501(c)(3) | 3 | Agnesian Healthcare Inc | Yes (true) |
| 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 | Yes (true) |
| 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 | Yes (true) |
| Villa Rosa Inc | ||||||||||
| N8120 County WW | Mount Calvary | WI | 53057 | 421670962 | Health Care | WI | 501(c)(3) | 10 | Agnesian Healthcare Inc | Yes (true) |
| The Christian Home and Rehabilitation Center Incorporated | ||||||||||
| 331 Bly Street | Waupun | WI | 53963 | 390884514 | Health Care | WI | 501(c)(3) | 10 | Agnesian Healthcare Inc | Yes (true) |
| 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 (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | UBI Code VUBICodeVAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM St Joseph Endoscopy Center LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 270046559 | Surgery Services | MO | NA | N/A | $0 | $0 | $0 | 0 |
| St Clare Imaging Services LLC | ||||||||||||
| 707 14th Street Suite A | Baraboo | WI | 53913 | 200122365 | Diag. Services | WI | NA | N/A | $0 | $0 | $0 | 0 |
| Mt Vernon Radiation Therapy Center LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 201382620 | Radiation Therapy | IL | NA | N/A | $0 | $0 | $0 | 0 |
| Sleep & Neurology Center of Southern Illinois LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 208468195 | Diag. Services | IL | NA | N/A | $0 | $0 | $0 | 0 |
| CHOWSMGSI Office Building LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 371383861 | MOB | IL | NA | N/A | $0 | $0 | $0 | 0 |
| Oza Cancer Center LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 201382727 | MOB | IL | NA | N/A | $0 | $0 | $0 | 0 |
| Shawnee Real Estate Holdings LLC | ||||||||||||
| 1000 N Lee Ave | Oklahoma City | OK | 73102 | 455458304 | MOB | OK | NA | N/A | $0 | $0 | $0 | 0 |
| 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 | $0 | $0 | $0 | 0 |
| Wisconsin Integrated Information Technology and Telemedicine Systems LLC | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 392016715 | Information Technology Services | WI | NA | N/A | $0 | $0 | $0 | 0 |
| Dean Health Holdings LLC | ||||||||||||
| 1277 Deming Way | Madison | WI | 53717 | 261594709 | Support Services | WI | NA | N/A | $0 | $0 | $0 | 0 |
| Wingra Building Group | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 390237060 | MOB | WI | NA | N/A | $0 | $0 | $0 | 0 |
| Janesville Riverview Clinic Building Partnership | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 396220698 | MOB | WI | NA | N/A | $0 | $0 | $0 | 0 |
| 1110 N Classen Blvd LLC | ||||||||||||
| 1110 N Classen Boulevard | Oklahoma City | OK | 73106 | 731158158 | MOB | OK | NA | N/A | $0 | $0 | $0 | 0 |
| SSM St Clare Surgical Center LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 261439695 | Surgery Services | MO | NA | N/A | $0 | $0 | $0 | 0 |
| Windmill LLP | ||||||||||||
| 50 Village View Lane | Chesterfield | MO | 63017 | 431804651 | Investments | MO | NA | N/A | $0 | $0 | $0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SSM Managed Care Organization LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431708511 | Health Promotion | MO | NA | C Corporation | $0 | $0 | 0 | false |
| FPP INC & Subs | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431465174 | Health Care | MO | NA | C Corporation | $0 | $0 | 0 | false |
| Diversified Health Services Corp | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431369305 | Medical Equipment | MO | NA | C Corporation | $0 | $0 | 0 | false |
| SSM Properties Inc | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431462486 | Property Services | MO | NA | C Corporation | $0 | $0 | 0 | false |
| HealthFirst Physician Management Services | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 731534336 | Medical Services | OK | NA | C Corporation | $0 | $0 | 0 | false |
| SSMHC Liability Trust II | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 816128118 | Insurance | MO | NA | C Corporation | $0 | $0 | 0 | false |
| SSM Medical Group Inc | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 431664107 | Physician Offices | MO | NA | C Corporation | $0 | $0 | 0 | false |
| SSMHC Insurance Company | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 030310431 | Insurance | NA | C Corporation | $0 | $0 | 0 | false | |
| Physicians Services Corp of Southern Illinois Inc | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 364161526 | Health Care | IL | NA | C Corporation | $0 | $0 | 0 | false |
| Dean Health Systems Inc | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 391128616 | Physician Offices | WI | NA | C Corporation | $0 | $0 | 0 | false |
| Dean Health Insurance Inc | ||||||||||||
| PO Box 56099 | Madison | WI | 53705 | 391830837 | Insurance | WI | NA | C Corporation | $0 | $0 | 0 | false |
| Dean Health Plan Inc | ||||||||||||
| PO Box 56099 | Madison | WI | 53705 | 391535024 | Insurance | WI | NA | C Corporation | $0 | $0 | 0 | false |
| SMDV Office Building | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 391628491 | Physician Offices | WI | NA | C Corporation | $0 | $0 | 0 | false |
| Dean Retail Services Inc | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 391717636 | Property Services | WI | NA | C Corporation | $0 | $0 | 0 | false |
| Navitus Holdings LLC | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 800968174 | Pharmacy Benefits | WI | NA | C Corporation | $0 | $0 | 0 | false |
| Oza Oncology Inc | ||||||||||||
| 4117 Veterans Memorial Drive | Mt Vernon | IL | 62804 | 371343746 | Physician Offices | IL | NA | S Corporation | $0 | $0 | 0 | false |
| SSM Health Janesville Campus Condominium Association Inc | ||||||||||||
| 1808 West Beltline Highway | Madison | WI | 53713 | 832038674 | Condo association | WI | NA | C Corporation | $0 | $0 | 0 | false |
| SSM Health Pharmacy LLC | ||||||||||||
| 10101 Woodfield Lane | St Louis | MO | 63132 | 264031708 | Pharmacy | MO | NA | C Corporation | $0 | $0 | 0 | false |
| Dane County Cytology Center Inc | ||||||||||||
| 2000 Engel Street Suite 201 | Madison | WI | 53713 | 391414219 | Medical Services | WI | NA | C Corporation | $0 | $0 | 0 | false |
| SSM Health Insurance Company | ||||||||||||
| 1277 Deming Way | Madison | WI | 53717 | 834718249 | Insurance | MO | NA | C Corporation | $0 | $0 | 0 | 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 | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Agnesian Healthcare Foundation Inc | ||
| C | $568,781 | Book |
| The Christian Home and Rehabilitation Center Incorporated | ||
| M | $27,736 | Cash payments |
| St Francis Home of Fond du Lac Wisconsin | ||
| M | $201,678 | Cash payments |
| Sister Servants of Christ the King Villa Loretto | ||
| M | $58,058 | Cash payments |
| Ripon Medical Center | ||
| M | $36,757 | Cash payments |