AGNESIAN HEALTHCARE INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization: AGNESIAN HEALTHCARE INC (EIN 39-0807236)
Tax period: 2017-07-01 to 2018-06-30
Filed: 2019-05-14
IRS object ID: 201941349349307664
Schema version: 2017v2.3
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 J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2019-05-14T14:48:40-05:00	ReturnTs
Tax Period End	2018-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390758449	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 12237	AddressLine1Txt
City	GREEN BAY	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	543072237	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2017-07-01	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 EAST DIVISION ST	AddressLine1Txt
City	FOND DU LAC	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53935	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	AUDRA HOFFMANN	PersonNm
Person Title	DIRECTOR OF FINANCE	PersonTitleTxt
Phone	9209265519	PhoneNum
Signature	2019-05-14	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	TERRI REXRODE CPA MST	PreparerPersonNm
PTIN	P00096513	PTIN
Phone	9206620016	PhoneNum
Preparation	2019-05-14	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	74.87.127.216	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2019-05-14	IPDt
IP Tm	07:56:57	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	DA39A3EE5E6B4B0D3255BFEF95601890AFD80709	AtSubmissionCreationDeviceId
At Submission Filing Device Id	A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2017	TaxYr
Build TS	2019-02-21 02:37:17Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	KATHERINE VERGOS	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	430 EAST DIVISION ST	AddressLine1Txt
City	FOND DU LAC	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53935	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$442,172,832	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	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	14	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	4494	TotalEmployeeCnt
Total Volunteers	575	TotalVolunteersCnt
Total Gross UBI	$4,449,246	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$450,708	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$985,901	PYContributionsGrantsAmt
CY Contributions Grants	$1,861,609	CYContributionsGrantsAmt
PY Program Service Revenue	$353,753,153	PYProgramServiceRevenueAmt
CY Program Service Revenue	$367,524,738	CYProgramServiceRevenueAmt
PY Investment Income	$9,341,789	PYInvestmentIncomeAmt
CY Investment Income	$8,486,861	CYInvestmentIncomeAmt
PY Other Revenue	$16,571,485	PYOtherRevenueAmt
CY Other Revenue	$15,567,330	CYOtherRevenueAmt
PY Total Revenue	$380,652,328	PYTotalRevenueAmt
CY Total Revenue	$393,440,538	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$165,819,796	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$165,388,485	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$208,046,706	PYOtherExpensesAmt
CY Other Expenses	$212,622,208	CYOtherExpensesAmt
PY Total Expenses	$373,866,502	PYTotalExpensesAmt
CY Total Expenses	$378,010,693	CYTotalExpensesAmt
PY Revenues Less Expenses	$6,785,826	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$15,429,845	CYRevenuesLessExpensesAmt
Total Assets BOY	$587,595,135	TotalAssetsBOYAmt
Total Assets EOY	$611,748,301	TotalAssetsEOYAmt
Total Liabilities BOY	$253,246,914	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$227,032,946	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$334,348,221	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$384,715,355	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
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	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$260,327,040	ExpenseAmt
Revenue	$358,222,720	RevenueAmt
Desc	AGNESIAN HEALTHCARE OPERATES ST. AGNES HOSPITAL, A 146-LICENSED BED GENERAL/SURGICAL ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO RESIDENTS OF FOND DU LAC AND THE SURROUNDING COUNTIES. DURING FISCAL YEAR 2018, ST. AGNES HOSPITAL HAD 6,574 INPATIENT ADMISSIONS, WITH TOTAL PATIENT DAYS OF 26,469. THERE WAS A TOTAL OF 31,169 EMERGENCY ROOM VISITS AND 13,874 SURGERIES PERFORMED IN FY18. IN ADDITION, ST. AGNES HOSPITAL PROVIDED 424,881 PHYSICIAN CLINIC VISITS, 81,181 MEDICAL IMAGING PROCEDURES, AND 36,553 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY UNITS. THERE WERE 2,135 CARDIAC CATH LAB VISITS AND 52,805 HOSPICE DAYS. THE HOSPITAL ALSO OPERATES SAMARITAN CLINIC, A FREE CLINIC OFFERING MEDICAL SERVICES TO QUALIFIED INDIVIDUALS. SAMARITAN CLINIC PROVIDED 649 VISITS TO PATIENTS, AT A COST OF $307,822 FOR FY18. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY IT PROVIDES TO ITS PATIENTS. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS $1,101,543. IN ADDITION TO QUALITY HEALTH CARE SERVICES, ST. AGNES HOSPITAL PROVIDES ITS COMMUNITIES WITH EDUCATION, SUPPORT GROUPS AND OTHER COMMUNITY BENEFITS. THE NET COST OF THESE COMMUNITY BENEFITS WAS $3,101,976.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$7,697,171	ExpenseAmt
Revenue	$4,521,247	RevenueAmt
Desc	AGNESIAN HEALTHCARE OPERATES AGNESIAN ENTERPRISES, WHICH IS COMPRISED OF PHARMACIES SERVING FOND DU LAC AND SURROUNDING TOWNS, AS WELL AS AGNESIAN HEALTH SHOPPE, WHICH SERVES THE POPULATION WITH HOSPITAL (INPATIENT AND OUTPATIENT), CLINIC AND HOME HEALTH EQUIPMENT. AGNESIAN ENTERPRISES FILLED 460,526 PRESCRIPTIONS DURING FY18. AGNESIAN HEALTH SHOPEE PROVIDES RETAIL SALES OF DURABLE MEDICAL EQUIPMENT, AS WELL AS TELECARE AND HOME OXYGEN SERVICES. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER AHE'S CHARITY CARE POLICY WAS $1,699. AGNESIAN HEALTHCARE ENTERPRISES CONTRIBUTES TO COMMUNITY BENEFIT WITH SEVERAL SUPPORT GROUPS. THE COST OF THE COMMUNITY BENEFIT WAS $1,743.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$527,088	ExpenseAmt
Revenue	$14,505,306	RevenueAmt
Desc	AGNESIAN HEALTHCARE OPERATES CONSULTANTS LABORATORY OF WISCONSIN, AN INDEPENDENT REFERENCE LAB SERVING FOND DU LAC, DODGE, OUTAGAMIE, WINNEBAGO AND COLUMBIA COUNTIES. CLW PROVIDED 1,096,843 TESTS DURING FISCAL YEAR 2018. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $25,102. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY WAS $23,702.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$268,551,299	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (1)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	340	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	4494	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	Yes (1)	ForeignFinancialAccountInd
Foreign Country	CJ	ForeignCountryCd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	14	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (1)	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

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

Field	Value	IRS element (for citing)
Phone	9209265519	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	430 EAST DIVISION STREET	AddressLine1Txt
City	FOND DU LAC	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54935	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd
STEVEN N LITTLE
REGIONAL CEO SSM HEALTH- WI	50.00	Yes (X)	Yes (X)	$1,661,617	$0	$41,563
JOAN KARSTEN
DIRECTOR	1.00	Yes (X)		$0	$0	$0
SR HERTHA LONGO
TREASURER	1.00	Yes (X)	Yes (X)	$0	$0	$0
THOR H GILBERTSON
VICE CHAIRPERSON	1.00	Yes (X)	Yes (X)	$0	$0	$0
WAYNE E MATZKE
CHAIRPERSON	1.00	Yes (X)	Yes (X)	$0	$0	$0
DR JEFFERY STRONG
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR JUDITH WESTPHAL
DIRECTOR	1.00	Yes (X)		$0	$0	$0
MARYSUE MICHELS
DIRECTOR	1.00	Yes (X)		$0	$0	$0
THOMAS SCHUESSLER
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR TONI STANLEY
SECRETARY	1.00	Yes (X)		$0	$0	$0
SR MARIE SCOTT
DIRECTOR	1.00	Yes (X)		$0	$0	$0
SR SUSAN M STUCKI
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR MARK THOMPSON MD
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR TED MILLER MD
DIRECTOR	1.00	Yes (X)		$0	$0	$0
PAULA FRIEDMAN
SSM VP, CHEIF STRATEGY	1.00	Yes (X)	Yes (X)	$0	$856,416	$891,366	54.00
JUNE PICKETT
SSM SECRETARY, ASST VP GOVERNANCE	1.00		Yes (X)	$0	$262,856	$51,074	65.10
KRIS ZIMMER
SSM TREASURER, SENIOR VP FINANCE	1.00		Yes (X)	$0	$973,103	$961,176	57.00
JAMES P MUGAN
SR VP CLINICAL SERVICES	50.00			$333,960	$0	$43,609		Yes (X)
BONNIE R SCHMITZ
CHIEF FINANCIAL OFFICER	50.00			$523,125	$0	$49,394		Yes (X)
SUSAN L EDMINSTER
VP - HUMAN RESOURCES	50.00			$360,903	$0	$38,974		Yes (X)
NANCY A BIRSCHBACH
VP - CIO	50.00			$381,785	$0	$47,261		Yes (X)
BARBARA L KNUTZEN
PRES AND CEO-AHE AND PERFO	50.00			$295,016	$0	$36,583		Yes (X)
HOLLY BRENNER
VP STRATEGIC DEVELOPMENT/M	50.00			$362,506	$0	$17,273		Yes (X)
MICHAEL DEGERE
VP POPULATION HEALTH MANAG	50.00			$389,910	$0	$43,415		Yes (X)
MICHAEL DREES
CHIEF OPERATING OFFICER FD	50.00			$296,651	$0	$49,143		Yes (X)
KATHERINE VERGOS
CHIEF NURSING OFFICER	50.00			$291,616	$0	$17,832		Yes (X)
JOHN CHOI MD
ANESTHESIOLOGIST - PAIN RE	50.00			$751,708	$0	$41,698			Yes (X)
YASIR HATAHET MD
INTENSIVIST/PULMONOLOGIST	50.00			$887,671	$0	$49,447			Yes (X)
MICHAEL VANDER KOOY MD
RADIATION ONCOLOGIST	50.00			$690,665	$0	$50,327			Yes (X)
STEVEN FLURRY MD
ANESTHESIOLOGIST	50.00			$642,056	$0	$35,882			Yes (X)
PONTUS OSTMAN MD
PHYSICIAN-PAIN MEDICINE	50.00			$676,214	$0	$17,219			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$8,545,403	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,092,375	TotReportableCompRltdOrgAmt
Total Other Compensation	$2,483,236	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	206	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
FOND DU LAC REGIONAL CLINIC
420 E DIVISION ST	FOND DU LAC	WI	54935	PHYSICIAN SERVICES	$52,736,790
CERNER CORP
2800 ROCKCREEK PKWY	KANSAS CITY	MO	64141	COMPUTER SERVICES	$11,855,139
CD SMITH CONSTRUCTION
PO BOX 1066	FOND DU LAC	WI	54935	CONSTRUCTION	$8,597,250
MEDICAL COLLEGE OF WI
8701 WATERTOWN PLANK RD PO BOX 26	WAUWATOSA	WI	53226	PHYSICIAN SERVICES	$2,568,455
MI-HEALTH HOLDINGS
PO BOX 128	BROWNSVILLE	WI	530060128	COMPUTER SERVICES	$1,169,282

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	81	CntrctRcvdGreaterThan100KCnt
Related Organizations	$1,861,609	RelatedOrganizationsAmt
Total Contributions	$1,861,609	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE	621400	$223,635,455	$222,525,083	$1,110,372
MEDICARE/MEDICAID REVENUE	621400	$143,889,283	$143,889,283

Field	Value	IRS element (for citing)
Total Program Service Revenue	$367,524,738	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$7,137,691	TotalRevenueColumnAmt
Exclusion	$7,137,691	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$35,161	TotalRevenueColumnAmt
Exclusion	$35,161	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$22,204,305	SecuritiesAmt
Other	$369,106	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$20,714,020	SecuritiesAmt
Other	$545,382	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$1,490,285	SecuritiesAmt
Other	-$176,276	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,314,009	TotalRevenueColumnAmt
Exclusion	$1,314,009	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$38,544,445	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$27,472,892	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$11,071,553	TotalRevenueColumnAmt
Related Or Exempt Func Income	$7,835,450	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$3,236,103	UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
WORK INJURY/OCC HEALTH	621990	$1,887,457	$1,887,457
CAFETERIA SALES	900099	$1,496,320		$102,771	$1,393,549
MEDICARE EHR	900099	$52,947	$52,947

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,059,053	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,059,053	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$4,495,777	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$393,440,538	TotalRevenueColumnAmt
Related Or Exempt Func Income	$377,249,273	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$4,449,246	UnrelatedBusinessRevenueAmt
Exclusion	$9,880,410	ExclusionAmt

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

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$4,340,242	TotalAmt
Management And General	$4,340,242	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$140,313,402	TotalAmt
Program Services	$109,213,478	ProgramServicesAmt
Management And General	$31,099,924	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$8,560,435	TotalAmt
Program Services	$6,345,175	ProgramServicesAmt
Management And General	$2,215,260	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,232,333	TotalAmt
Program Services	$1,561,024	ProgramServicesAmt
Management And General	$671,309	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$9,942,073	TotalAmt
Program Services	$7,330,049	ProgramServicesAmt
Management And General	$2,612,024	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$1,935,470	TotalAmt
Program Services	$730,133	ProgramServicesAmt
Management And General	$1,205,337	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$131,124	TotalAmt
Management And General	$131,124	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$75,088,689	TotalAmt
Program Services	$70,768,125	ProgramServicesAmt
Management And General	$4,320,564	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$877,242	TotalAmt
Program Services	$46,488	ProgramServicesAmt
Management And General	$830,754	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$58,569,901	TotalAmt
Program Services	$56,716,245	ProgramServicesAmt
Management And General	$1,853,656	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$28,599,036	TotalAmt
Program Services	$2,076,010	ProgramServicesAmt
Management And General	$26,523,026	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$13,804,295	TotalAmt
Program Services	$5,215,690	ProgramServicesAmt
Management And General	$8,588,605	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$676,429	TotalAmt
Program Services	$535,106	ProgramServicesAmt
Management And General	$141,323	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$714,921	TotalAmt
Program Services	$397,926	ProgramServicesAmt
Management And General	$316,995	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$4,436,510	TotalAmt
Management And General	$4,436,510	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$17,454,783	TotalAmt
Program Services	$798,487	ProgramServicesAmt
Management And General	$16,656,296	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$1,706,349	TotalAmt
Program Services	$1,018,025	ProgramServicesAmt
Management And General	$688,324	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
HOSPITAL ASSESSMENT	$5,116,412	$5,116,412
MISCELLANEOUS	$2,110,806	$420,281	$1,690,525
INVESTMENT FEES	$656,893		$656,893
DUES, SUBSCRIPTIONS, LI	$631,571	$262,645	$368,926

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$111,777	TotalAmt
Management And General	$111,777	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$378,010,693	TotalAmt
Program Services	$268,551,299	ProgramServicesAmt
Management And General	$109,459,394	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$4,371,979	BOYAmt
EOY	$23,450,028	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$6,584,344	BOYAmt
EOY	$10,982,903	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$57,466,984	BOYAmt
EOY	$66,464,368	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$5,347,100	BOYAmt
EOY	$4,771,573	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$3,765,809	BOYAmt
EOY	$3,731,614	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$406,036,852	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$239,870,679	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$172,400,872	BOYAmt
EOY	$166,166,173	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$227,296,330	BOYAmt
EOY	$238,747,076	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$110,361,717	BOYAmt
EOY	$97,434,566	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$587,595,135	BOYAmt
EOY	$611,748,301	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$43,689,173	BOYAmt
EOY	$49,564,586	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$165,518,041	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$44,039,700	BOYAmt
EOY	$177,468,360	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$253,246,914	BOYAmt
EOY	$227,032,946	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$320,651,021	BOYAmt
EOY	$379,352,597	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$12,530,403	BOYAmt
EOY	$4,195,961	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,166,797	BOYAmt
EOY	$1,166,797	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$334,348,221	BOYAmt
EOY	$384,715,355	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$587,595,135	BOYAmt
EOY	$611,748,301	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$15,429,845	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$10,988,411	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$23,948,878	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$20,420	OtherActivitiesAmt
Total Lobbying Expenditures	$20,420	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	LOBBYING PORTION OF WISCONSIN HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,716,640	OtherCostOrOtherBasisAmt
Book Value	$6,716,640	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$208,630,852	OtherCostOrOtherBasisAmt
Depreciation	$99,116,202	DepreciationAmt
Book Value	$109,514,650	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,006,335	OtherCostOrOtherBasisAmt
Depreciation	$2,244,961	DepreciationAmt
Book Value	$1,761,374	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$182,261,137	OtherCostOrOtherBasisAmt
Depreciation	$138,509,516	DepreciationAmt
Book Value	$43,751,621	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,421,888	OtherCostOrOtherBasisAmt
Book Value	$4,421,888	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$166,166,173	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDesc	Book ValueBookValueAmt
DUE FROM AFFILIATED ENTITIES	$9,931,801
INVESTMENT - MERCURY CLINIC	$3,005,130
INVESTMENT - SAH FOUNDATION	$13,257,747
LIMITED USE ASSETS - BOND FUNDS	$18,237,877
LIMITED USE ASSETS - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN	$46,207,334
OTHER RECEIVABLES	$5,055,446
MISCELLANEOUS	$1,739,231

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$97,434,566	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
CAPITAL LEASE PAYABLE	$3,106,030
PHYSICIANS SUPPLEMENTAL BENEFIT PLAN	$45,209,058
DUE TO MEDICARE/MEDICAID	$2,172,496
EXECUTIVE DEFERRED COMP PLAN	$998,276
2018 SSM CORP DEBT	$125,982,500

Field	Value	IRS element (for citing)
Total Liability	$177,468,360	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$393,440,538	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$393,440,538	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$393,440,538	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$378,010,693	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$378,010,693	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$378,010,693	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART XI, LINE 2D - OTHER ADJUSTMENTS:	FormAndLineReferenceDesc
Explanation	NONOPERATING INCOME	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	165.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,126,944	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,126,944	NetCommunityBenefitExpnsAmt
Total Expense	0.00300	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$22,920,434	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$22,920,434	NetCommunityBenefitExpnsAmt
Total Expense	0.06060	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$24,047,378	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$24,047,378	NetCommunityBenefitExpnsAmt
Total Expense	0.06360	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,613,592	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$238,615	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,374,977	NetCommunityBenefitExpnsAmt
Total Expense	0.00360	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$732,968	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$732,968	NetCommunityBenefitExpnsAmt
Total Expense	0.00190	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$845,520	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$23,650	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$821,870	NetCommunityBenefitExpnsAmt
Total Expense	0.00220	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,387	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,387	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$193,620	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$193,620	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,391,087	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$262,265	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,128,822	NetCommunityBenefitExpnsAmt
Total Expense	0.00820	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$27,438,465	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$262,265	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$27,176,200	NetCommunityBenefitExpnsAmt
Total Expense	0.07180	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$15,570	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$15,570	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,249	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$4,249	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$115,239	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$115,239	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$135,058	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$135,058	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$13,504,473	BadDebtExpenseAmt
Reimbursed By Medicare	$123,744,927	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$186,521,599	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$62,776,672	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	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)
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ST AGNES HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	17	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.AGNESIAN.COM, SEE PART V, PAGE 8	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	WWW.FDLCO.WI.GOV/HOME/SHOWDOCUMENT?ID=15481	OtherWebsiteURLTxt
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	17	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.FDLCO.WI.GOV/HOME/SHOWDOCUMENT?ID=20012	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	165.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	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 (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	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 (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr Prvt	Yes (X)	LookBackMedicaidMedcrPrvtInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 5: THE CHNA WAS COMMISSIONED BY AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), AURORA HEALTHCARE, FOND DU LAC AREA UNITED WAY, FOND DU LAC COUNTY HEALTH DEPARTMENT, FOND DU LAC FAMILY YMCA, AND FOND DU LAC SCHOOL DISTRICT. THE TASK FORCE REVIEWED COUNTY AND STATE DISEASE INCIDENCE AND DEATH DATA, AS WELL AS ECONOMIC, DEMOGRAPHIC, AND HEALTH STATUS DATA. TO SUPPLEMENT THIS DATA, COMMUNITY AND STAKEHOLDER OPINION SURVEYS WERE CONDUCTED TO DETERMINE WHAT PEOPLE IN FDL COUNTY PERCEIVED AS THE MAJOR HEALTH PROBLEMS IN THE COUNTY. COMMUNITY MEMBERS WERE SCIENTIFICALLY SELECTED SO THAT THE SURVEY WOULD BE REPRESENTATIVE OF ALL ADULTS 18 YEARS OLD AND OLDER. A TOTAL OF 400 TELEPHONE INTERVIEWS WERE COMPLETED WITH COMMUNITY MEMBERS. THE FOND DU LAC HEALTH 2020 COALITION, WHICH WAS FORMED AFTER THE 2014 SURVEY, RESPONDED TO THE NEEDS IDENTIFIED IN THE CHNA. THE HEALTHY 2020 STEERING COMMITTEE INCLUDES THE FOLLOWING MEMBERS: MICHAEL DEGERE, DPM, AGNESIAN HEALTHCARE/SSM HEALTH; ERIN GERRED, FOND DU LAC COUNTY, GREG GILES, FOND DU LAC YMCA, SARA HATHAWAY, RIPON COLLEGE, AMBER KILAWEE, FOND DU LAC AREA UNITED WAY; BILL LAMB, FOND DU LAC CITY POLICE DEPARTMENT; KIM MUELLER, FOND DU LAC COUNTY HEALTH DEPARTMENT, KELLY NORTON, ST. MARY'S SPRINGS ACADEMY; LALITHA RAMAMOORTHY, PH. D, MARION UNIVERSITY; LARRY RICHARDSON, FABOH; JACKIE RUNGE, FOND DU LAC AREA FOUNDATION; MARTY RYAN, ROTARY; JIM SALASEK, PH.D., COMMUNITY MEMBER; HEATHER SCHMIDT, DO, AGNESIAN HEALTHCARE/SSM HEALTH; LORI SCHRAGE, MORAINE PARK TECHNICAL COLLEGE; MARIAN SHERIDAN, FOND DU LAC SCHOOL DISTRICT; MICHELLE TIDEMANN, UW- EXTENSION FOND DU LAC; ERIC TONEY, FOND DU LAC COUNTY; JENNIFER WALTERS, AURORA HEALTH CARE; MELISSA WORTHINGTON, ENVISION GREATER FOND DU LAC. THE HEALTHY 2020 COALITION HAS TAKEN THE LEAD ON DISTRIBUTION OF INFORMATION TO THE PUBLIC, AS WELL AS CONTINUING COMMUNITY UPDATES AND ASSESSMENT OF PROGRESS.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 6A: HOSPITALS INCLUDED IN THE CHNA WERE AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL), WAUPUN MEMORIAL HOSPITAL AND RIPON MEDICAL CENTER.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED BY AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPON MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), AURORA HEALTHCARE, FOND DU LAC AREA UNITED WAY, FOND DU LAC COUNTY HEALTH DEPARTMENT, FOND DU LAC FAMILY YMCA, AND FOND DU LAC SCHOOL DISTRICT.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 7D: IN ADDITION TO THE HOSPITAL'S WEBSITE, THE HEALTHY 2020 COALITION MADE THE RESULTS OF THE CHNA WIDELY AVAILABLE THROUGH A SERIES OF COMMUNITY MEETINGS, DISTRIBUTION OF COMMUNITY HEALTH IMPROVEMENT PLAN FLYERS, NEWSPAPER ARTICLES, AND THE HEALTHY 2020 WEBSITE, WWW.LIVINGWELLFDL.ORG. THE FULL REPORT IS AVAILABLE ON THE FOND DU LAC COUNTY WEBSITE.PART V, LINE 7A HOSPITAL FACILITY'S WEBSITE: WWW.AGNESIAN.COM - AT BOTTOM OF HOME PAGE LABELED: "COMMUNITY HEALTH NEEDS ASSESSMENT."
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 11: AS A RESULT OF THE CHNA CONDUCTED IN 2012, 2014 AND 2017, THREE MAJOR AREAS OF FOCUS WERE DETERMINED, AND TWO OVERARCHING PRIORITIES SPANNING THE THREE AREAS OF FOCUS WERE AGREED UPON. A STRATEGIC ACTION PLAN HAS BEEN DEVELOPED FOR EACH FOCUS AREA.1) PRIORITY: NUTRITION AND PHYSICAL ACTIVITY - INCREASE THE NUMBER OF FOND DU LAC COUNTY RESIDENTS LIVING AT HEALTHY WEIGHT FOR THEIR HEIGHT THROUGH EATING HEALTHIER AND BEING MORE ACTIVE. HEALTHYOUTH IS A 4TH GRADE PROGRAM DONE AT 3 DIFFERENT ELEMENTARY SCHOOLS WITH THE HIGHEST PERCENTAGE OF FREE/REDUCED LUNCH RECIPIENTS. THE PROGRAM FOCUSES ON NUTRITION, SAFETY, PHYSICAL ACTIVITY AND EMOTIONAL WELL-BEING. EACH SESSION RUNS 5 WEEKS AND IS STAFFED BY MULTIPLE VOLUNTEERS FROM AGNESIAN HEALTHCARE MINISTRIES. THIS PARTNERSHIP WAS RECENTLY EXPANDED TO INCLUDE THE UNIVERSITY OF WISCONSIN EXTENSION. AGNESIAN HEALTHCARE PARTICIPATES IN LOCAL MIDDLE SCHOOL WELLNESS INSTRUCTION AND PROGRAMMING (PRIORITY-SPECIFIC: "FUEL FOR PERFORMANCE," TWICE WEEKLY) COMMUNITY PARTNERSHIPS TO PROVIDE ELDER COMMUNITY PROGRAMMING (PRIORITY-SPECIFIC: "SENIOR CENTER AGING MASTERY PROGRAM,") FOOD FOREST- AGNESIAN HEALTHCARE AND COMMUNITY PARTNERS FOCUSING ON ACCESS TO FRESH FRUITS AND VEGETABLES AND COLLABORATION WITH MULTIPLE STAKEHOLDERS TO PLANT AND MAINTAIN FREE COMMUNITY FRUIT GROVES AND VEGETABLE GARDENS. WALK WITH A DOC PROGRAM: AGNESIAN HEALTHCARE CLINICIANS MEET WITH COMMUNITY MEMBERS TO PROVIDE A BRIEF MEDICAL TOPIC REVIEW BEFORE AND DURING A WALK TOGETHER IN A MALL SETTING. 2) PRIORITY; MENTAL HEALTH - DECREASE THE NUMBER OF DEATHS BY SUICIDE IN FOND DU LAC COUNTY AND REDUCE STIGMA SURROUNDING MENTAL HEALTH. AGNESIAN HEALTHCARE: PARTICIPATES IN LOCAL MIDDLE SCHOOL WELLNESS INSTRUCTION AND PROGRAMMING (PRIORITY SPECIFIC: "BRAIN HEALTH," TWICE WEEKLY), HAS PARTNERED WITH COMMUNITY STAKEHOLDERS TO FORM TRAUMA-INFORMED CARE COMMITTEE AND PROMOTING A STIGMA-FREE APPROACH TO MENTAL/BEHAVIORAL WELLNESS, IS AN ACTIVE PARTICIPANT IN THE SUICIDE PREVENTION INITIATIVE: DESTINATION ZERO SUICIDE. 3) PRIORITY: ALCOHOL AND OTHER DRUG USE - DECREASE UNDERAGE DRINKING, ADULT BINGE DRINKING, AND THE MISUSE AND ABUSE OF DRUGS, PARTICULARLY OPIODS. AGNESIAN HEALTHCARE HAS REPRESENTATION ON DRUG-FREE COMMUNITIES, WITH FULL INTEGRATION OF A FOUR-PILLAR APPROACH TO FORM THE OPIOD INITATIVE. ACTION PLAN, GOALS AND INITIATIVES, BUILDING CAPACITY, AND DATA COLLECTION REFINEMENT HAVE ALL BEEN COMPLETED. AGNESIAN HEALTHCARE IS ACTIVELY INVOLVED IN PROVIDING DRUG DROP BOXES IN ALL FACILITIES, PARTICIPATING IN COMMUNITY NARCAN TRAINING, COMMUNITY AWARENESS, EDUCATION AND ENGAGEMENT CAMPAIGNS. ITS STRATEGIES INCLUDE IMPLEMENTING AN APPROACH TO ADDRESS HERION/OPIOD ABUSE AND IS ALSO UTILIZING A MEDIA/MARKETING CAMPAIGN TO RAISE AWARENESS AND ACTIVELY DISCOURAGE BINGE DRINKING AND OVER-CONSUMPTION. TWO OVERARCHING PRIORITIES:1) SOCIAL DETERMINANTS OF HEALTH - THE SOCIAL DETERMINANTS OF HEALTH ARE THE CONDITIONS IN WHICH PEOPLE ARE BORN, WORK AND AGE. WE RECOGNIZE THAT HEALTH BEGINS IN THESE ENVIRONMENTS WHERE WE SPEND THE MAJORITY OF OUR TIME. RESEARCH SHOWS THAT INDIVIDUAL HEALTH BEHAVIORS AND ACCESS TO CLINICAL CARE ONLY MAKE UP ABOUT HALF OF WHAT PREDICTS HEALTH. SOCIAL, ECONOMIC, AND PHYSICAL ENVIRONMENTS (OFTEN REFERRED TO AS THE SOCIAL DETERMINANTS OF HEALTH) MAKE UP THE OTHER 50% OF WHAT PREDICTS HEALTH OUTCOMES. EXAMPLES OF SOCIAL DETERMINANTS INCLUDE: AVAILABILITY OF COMMUNITY-BASED RESOURCES TO MEET DAILY NEEDS (E.G. ACCESS TO HEALTHY FOODS, SAFE HOUSING), TRANSPORTATION OPTIONS, EDUCATION, LANGUAGE, AND LITERACY, ACCESS TO HEALTH CARE, SOCIAL COHESION AND SOCIAL SUPPORT, SOCIOECONOMIC CONDITIONS, AND NEIGHBORHOOD AND BUILT ENVIRONMENT OUR GOALS: 1) INCREASE AWARENESS OF THE INFLUENCE SOCIAL DETERMINANTS HAVE IN SHAPING HEALTHY OUTCOMES. 2) IMPROVE HEALTH CONSIDERATIONS IN DECISION-MAKING.2) TRAUMA- INFORMED CARE - TRAUMAIES ON TRAUMA-INFORMED CARE IN FOND DU LAC COUNTY. 3). IMPLEMENT A TRAMA-INFORMED CARE ASSESSMENT AMONG A VARIETY OF COMMUNITY ORGANIZATIONS.THE HOSPITAL IS PARTICIPATING IN THE INITIATIVES NOTED ABOVE TO ADDRESS THE NEEDS IDENTIFIED IN CHNA. OUR INITIATIVES ARE ALREADY SHOWING POSITIVE RESULTS. THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE PRODUCES A WELL-KNOWN DOCUMENT TITLED "COUNTY HEALTH RANDINGS AND ROADMAPS". THE MOST CURRENT REPORT SHOWS THAT FOND DU LAC COUNTY HAS IMPROVED FROM THE HEALTH FACTORS RANK OF 20 RANK OF 16 IN THE STATE. IN ORDER TO FURTHER HELP COMMUNITY MEMBERS TAKE POSITIVE STEPS IN IMPROVING THEIR HEALTH, AGNESIAN HEALTHCARE DISTRIBUTED 2018 WELLNESS CALENDARS TO 75,000 RESIDENTS.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 13B: PATIENTS AND THEIR GUARANTOR'S INCOME IS USED IN DETERMINING INCOME LEVEL FOR FREE OR DISCOUNTED CARE.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 18E: COLLECTION AGENCIES ARE ENGAGED TO COLLECT UNPAID BALANCES. THESE AGENCIES ARE AUTHORIZED TO REPORT TO CREDIT AGENCIES. COLLECTION AGENCIES ARE AUTHORIZED BY THE HOSPITAL TO ESTABLISH GARNISHMENT AGAINST WAGES ON UNPAID BALANCES THEY ARE ATTEMPTING TO COLLECT. THESE ACTIONS ARE NOT UNDERTAKEN UNTIL REASONABLE EFFORTS TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE FAP HAVE BEEN MADE.AGNESIAN HEALTHCARE DOES NOT TAKE ANY OF THE ACTIONS AGAINST AN INDIVIDUAL THAT ARE LISTED IN 18A - 18D.
PART V, LINE 22	UNINSURED PATIENTS RECEIVE A DISCOUNT AT THE TIME THE UNDISCOUNTED CHARGES ARE RENDERED. THIS APPLIES TO PATIENTS WITH NO COVERAGE FOR PAYMENT FROM HEALTH CARE INSURANCE AND/OR OTHER THIRD PARTY PAYORS.

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
1 - AGNESIAN HEALTHCARE ENTERPRISES LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	PHARMACEUTICALS, HOME HEALTH, MEDICAL SUPPLIES
2 - CONSULTANTS LAB OF WISCONSIN LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	LABORATORY AND TESTING
3 - FOND DU LAC REGIONAL CLINIC
420 E DIVISION STREET	FOND DU LAC	WI	54935	OUTPATIENT PHYSICIAN CLINIC

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 3C:	AGNESIAN HEALTHCARE DOES NOT USE ANY OTHER FACTORS THAN FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY.
PART I, LINE 6A:	THE CHNA WAS COMMISSIONED BY AGNESIAN HEALTHCARE, COUNTY HEALTH DEPARTMENT, FOND DU LAC COUNTY YMCA, AND FOND DU LAC SCHOOL DISTRICT. AN ANNUAL COMMUNITY BENEFIT REPORT IS COMPLETED BY THE FINANCE DEPARTMENT AND DISTRIBUTED TO THE PUBLIC THROUGH THE PUBLIC RELATIONS OFFICE OF AGNESIAN HEALTHCARE, INC.
PART I, LINE 7:	A COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST OF COMMUNITY BENEFIT SERVICES. OVERALL COSTS LESS TAXES WERE DIVISIBLE BY TOTAL CHARGES.
PART I, LINE 7G:	AGNESIAN HEALTHCARE SUBSIDIZES A SAMARITAN CLINC AND PALLIATIVE CARE FOR THOSE THAT QUALIFY.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE THAT WAS INCLUDED ON FORM 990, PART VIII AND THEREFORE NOT CONSIDERED IN THE PERCENTAGE CALCULATION FOR PURPOSES OF PART I, LINE 7, COL(F) IS 13,504,473.
PART II, COMMUNITY BUILDING ACTIVITIES:	AGNESIAN HEALTHCARE PROVIDES COMMUNITY SUPPORT, LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, COALITION BUILDING AND WORKFORCE DEVELOPMENT THROUGH THEIR COMMUNITY BENEFIT ACTIVITIES.
PART III, LINE 4:	THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO CONTRACTUAL ADJUSTMENTS AND A CREDIT TO THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY FOR DETERMINING BAD DEBTS IS A COST TO CHARGE RATIO.
PART III, LINE 8:	MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES, THE TOTAL EXPENSE LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE.ALTHOUGH MEDICARE SHORTFALL HAS NOT BEEN REPORTED AS A COMMUNITY BENEFIT, IT SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE IT PROMOTES ACCESS TO HEALTHCARE TO THE UNDERSERVED ELDERLY POPULATION, WHO WOULD NOT HAVE ACCESS TO LOCAL CARE IF WE WERE NOT ABLE TO SERVE THEM. ALTHOUGH OUR HOSPITAL IS EFFICIENTLY OPERATED, THE CALCULATIONS USED FOR MEDICARE REIMBURSEMENT DO NOT ALLOW FOR PAYMENTS THAT COVER COSTS OF NECESSARY SERVICES.
PART III, LINE 9B	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.A ZERO DOLLAR AMOUNT WAS ESTIMATED FOR THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. IF PATIENTS QUALIFY, THEIR EXPENSES ARE RECLASSIFIED AS CHARITY CARE. PATIENTS WHO RECEIVED A COLLECTION NOTICE COULD APPLY FOR CHARITY CARE. IF THEIR APPLICATION IS APPROVED, THIS WOULD TRIGGER A TRANSFER OF EXPENSES FROM BAD DEBT TO CHARITY CARE.
PART VI, LINE 2:	IN ADDITION TO THE CHNA NOTED ABOVE, THE HOSPITAL'S SENIOR LEADERS MEET REGULARLY WITH COMMUNITY LEADERS TO GATHER INPUT FROM AND RESPOND TO PATIENT AND CUSTOMER NEEDS. SENIOR LEADERS AND MEMBERS OF THE WORKFORCE PARTICIPATE IN A VARIETY OF ORGANIZATIONS IN SUPPORT OF ST. AGNES HOSPITAL'S KEY COMMUNITIES. THROUGH THE HOSPITAL'S PARTICIPATION IN THESE ACTIVITIES, COMMUNITY MEMBERS LEARN OF THE HOSPITAL'S COMMITTMENT TO COMMUNITY-WIDE HEALTHCARE AND PROVIDE AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), WITH INSIGHTS INTO COMMMUNITY HEALTH NEEDS AND DESIRES.
PART VI, LINE 3:	FINANCIAL COUNSELORS AT ST. AGNES HOSPITAL ASSIST PATIENTS WITH APPLICATION FOR COMMUNITY CARE. PATIENTS CAN BE REFERRED TO COMMUNITY CARE BY CLERGY, DEPARTMENTS OF ST. AGNES HOSPITAL, SISTERS OF ST. AGNES, PHYSICIANS, AREA SOCIAL AND HEALTH AGENCIES, FAMILY OR SELF. THE APPLICATION IS COMPLETED BY THE PATIENT WITH ASSISTANCE FROM THE FINANCIAL COUNSELOR IF NEEDED. THE FINANCIAL COUNSELOR WILL COMMUNICATE TO THE PATIENT WHAT PROGRAMS THEY WILL BE ELIGIBLE FOR, AS WELL AS PROVIDE NOTIFICATION OF APPROVAL OR DENIAL OF THEIR APPLICATION IN A TIMELY MANNER.
PART VI, LINE 4:	COMMUNITY CARE APPLICATIONS ARE ACCEPTED ONLY FROM PATIENTS OF ST. AGNES HOSPITAL WHO RESIDE IN THE COUNTIES OF DODGE, FOND DU LAC OR GREEN LAKE IN THE STATE OF WISCONSIN. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THESE AREAS FOR A MINIMUM OF THREE MONTHS AND PROVIDE SUPPORTING DOCUMENTATION. ON OCCASION, INDIVIDUALS WHO ARE NOT COMMUNITY MEMBERS BUT MAY NEED ASSISTANCE; THOSE APPLICATIONS ARE CONSIDERED ON A CASE-BY-CASE BASIS.
PART VI, LINE 5:	WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THIS IS A WORK IN PROGRESS. OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFIT AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT, WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY, BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: DIALYSIS CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH AND AUDIOLOGY, SURGICAL SERVICES, AND WOMEN'S SERVICES.
PART VI, LINE 6:	ST. AGNES HOSPITAL IS PART OF SSM HEALTH, AN INTEGRATED, COMPREHENSIVE NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM COMPRISED OF NUMEROUS MINISTRIES LISTED ON SCHEDULE R. SSM HEALTH PROVIDES A CONTINUUM OF HEALTHCARE FROM BIRTH TO END OF LIFE, PREVENTATIVE CARE, DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT AND SKILLED CARE SERVICES. AGNESIAN HEALTHCARE IS COMMITTED TO ENSURING THAT INDIVIDUALS NEEDING VITAL HEALTHCARE SERVICES GET THE HELP THEY NEED AND DESERVE.
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

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	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	Yes (1)	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 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
STEVEN N LITTLE
REGIONAL CEO SSM HEALTH- WI	$721,252	$0	$926,023	$0	$14,342	$0	$16,025	$0	$25,538	$0	$1,703,180	$0	$0	$0
PAULA FRIEDMAN
SSM VP, CHEIF STRATEGY	$0	$706,550	$0	$0	$0	$149,866	$0	$871,392	$0	$19,974	$0	$1,747,782	$0	$0
JUNE PICKETT
SSM SECRETARY, ASST VP GOVERNANCE	$0	$229,924	$0	$0	$0	$32,932	$0	$34,295	$0	$16,779	$0	$313,930	$0	$0
KRIS ZIMMER
SSM TREASURER, SENIOR VP FINANCE	$0	$870,069	$0	$0	$0	$103,034	$0	$930,581	$0	$30,595	$0	$1,934,279	$0	$0
JAMES P MUGAN
SR VP CLINICAL SERVICES	$286,665	$0	$32,521	$0	$14,774	$0	$16,002	$0	$27,607	$0	$377,569	$0	$0	$0
BONNIE R SCHMITZ
CHIEF FINANCIAL OFFICER	$415,077	$0	$92,022	$0	$16,026	$0	$18,675	$0	$30,719	$0	$572,519	$0	$0	$0
SUSAN L EDMINSTER
VP - HUMAN RESOURCES	$286,593	$0	$71,988	$0	$2,322	$0	$15,901	$0	$23,073	$0	$399,877	$0	$0	$0
NANCY A BIRSCHBACH
VP - CIO	$305,911	$0	$74,884	$0	$990	$0	$14,925	$0	$32,336	$0	$429,046	$0	$0	$0
BARBARA L KNUTZEN
PRES AND CEO-AHE AND PERFO	$244,530	$0	$47,281	$0	$3,205	$0	$13,222	$0	$23,361	$0	$331,599	$0	$0	$0
HOLLY BRENNER
VP STRATEGIC DEVELOPMENT/M	$275,246	$0	$71,791	$0	$15,469	$0	$15,709	$0	$1,564	$0	$379,779	$0	$0	$0
MICHAEL DEGERE
VP POPULATION HEALTH MANAG	$319,218	$0	$37,753	$0	$32,939	$0	$16,025	$0	$27,390	$0	$433,325	$0	$0	$0
MICHAEL DREES
CHIEF OPERATING OFFICER FD	$249,207	$0	$29,663	$0	$17,781	$0	$15,416	$0	$33,727	$0	$345,794	$0	$0	$0
KATHERINE VERGOS
CHIEF NURSING OFFICER	$255,783	$0	$29,325	$0	$6,508	$0	$13,655	$0	$4,177	$0	$309,448	$0	$0	$0
JOHN CHOI MD
ANESTHESIOLOGIST - PAIN RE	$624,553	$0	$124,833	$0	$2,322	$0	$16,025	$0	$25,673	$0	$793,406	$0	$0	$0
YASIR HATAHET MD
INTENSIVIST/PULMONOLOGIST	$489,346	$0	$313,296	$0	$85,029	$0	$14,599	$0	$34,848	$0	$937,118	$0	$0	$0
MICHAEL VANDER KOOY MD
RADIATION ONCOLOGIST	$638,020	$0	$0	$0	$52,645	$0	$16,025	$0	$34,302	$0	$740,992	$0	$0	$0
STEVEN FLURRY MD
ANESTHESIOLOGIST	$641,246	$0	$0	$0	$810	$0	$16,025	$0	$19,857	$0	$677,938	$0	$0	$0
PONTUS OSTMAN MD
PHYSICIAN-PAIN MEDICINE	$400,000	$0	$272,650	$0	$3,564	$0	$16,025	$0	$1,194	$0	$693,433	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 1A	THERE WERE NOT ANY GROSSUP PAYMENTS OR SOCIAL CLUB DUES FOR THIS TAX YEAR. THERE IS A WRITTEN POLICY IF ANY PAYMENTS OCCUR. THESE PAYMENTS WOULD POTENTIALLY BE MADE TO SURRENT AND FORMER MEMBERS OF THE BOARD OF DIRECTORS IF APPLICABLE AND WOULD REQUIRE SUBSTANTIATION FOR THE EXPENSE(S).
PART I, LINE 4B	ALL EXECUTIVES PARTICIPATE IN A 457(B) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN.
PART I, LINE 5	COMPENSATION FOR SOME EMPLOYED PHYSICIANS IS BASED ON A PERCENTAGE OF GROSS BILLINGS.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
THOR GILBERTSON
DIRECTOR	$121,817	THOR GILBERTSON IS THE PRESIDENT OF HOLIDAY AUTOMOTIVE, A DEALERSHIP IN FOND DU LAC. HOLIDAY HAS SOLD AND SERVICED VEHICLES OWNED BY AGNESIAN HEALTHCARE IN THE AMOUNT OF $121,817	0
WAYNE MATZKE
CHAIRPERSON	$2,655,206	WAYNE MATZKE FORMER PRESIDENT OF GRANDE CHEESE AND RETIRED IN FEBRUARY 2017. AGNESIAN HEALTHCARE, INC PROVIDES A HEALTH CARE CLINIC TO GRANDE CHEESE, BILLING $2,655,206 OF THESE SERVICES IN FISCAL YEAR 2018.	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990 ATTACHEMENT	ATTACHED IS A 409A RELIEF UNDER VI.C. OF NOTICE 2008-113 AGNESIAN HEALTHCARE, INC. 409A RELIEF UNDER VI.C. OF NOTICE 2008-113 NAME OF AFFECTED EMPLOYEE: AVAILABLE UPON REQUEST (THE "AFFECTED EMPLOYEE") EMPLOYEE'S TAXPAYER IDENTIFICATION NUMBER: AVAILABLE UPON REQUEST NAME OF NQDC PLAN: AGNESIAN HEALTHCARE, INC. EMPLOYER DEFERRAL ACCOUNT PLAN (457(F)) (THE "PLAN") DESCRIPTION OF 409A COMPLIANCE FAILURE: THE PLAN IS AN INELIGIBLE DEFERRED COMPENSATION PLAN SUBJECT TO INTERNAL REVENUE CODE ("CODE") SECTIONS 457(F) AND 409A. THE PLAN DOCUMENT, AS WRITTEN, COMPLIES WITH THE REQUIREMENTS OF CODE SECTION 409A. THE PLAN IS ADMINISTERED BY A THIRD-PARTY ADMINISTRATOR (THE "TPA"). PURSUANT TO THE PLAN'S TERMS, THE AFFECTED EMPLOYEE HAD AN ACCOUNT BALANCE UNDER THE PLAN THAT VESTED ON JANUARY 1, 2016. THE PLAN DOCUMENT PROVIDED THAT THE VESTED ACCOUNT WAS TO BE PAID WITHIN 15 BUSINESS DAYS OF THE DATE ON WHICH THE ACCOUNT VESTED. AS A RESULT, THE TPA SHOULD HAVE DISTRIBUTED THE AFFECTED EMPLOYEE'S ACCOUNT BALANCE NO LATER THAN JANUARY 18, 2016. UNFORTUNATELY, THE TPA DID NOT DISTRIBUTE THE AFFECTED EMPLOYEE'S VESTED ACCOUNT UNTIL AUGUST, 2017. UNDER CODE SECTION 457(F), THE BALANCE OF THE AFFECTED EMPLOYEE'S ACCOUNT AS OF JANUARY 1, 2016 WAS PROPERLY TAXED IN 2016 AND WAS DEEMED PAID. (SEE CODE SECTION 457(F)(1)(A) AND PROPOSED TREASURY REGULATION SECTION 1.409A-1(Q).) THE FAILURE TO DISTRIBUTE THE ACCOUNT TIMELY, HOWEVER, RESULTED IN ADDITIONAL EARNINGS ACCRUING ON THE ACCOUNT AND THESE EARNINGS WERE NOT DISTRIBUTED OR TAXED UNTIL AUGUST 9, 2017. (SEE TREASURY REGULATION SECTION 1.457-11(A)(3) AND PROPOSED TREASURY REGULATION SECTION 1.457-12(A)(3).) THERE WAS NO PROVISION IN THE PLAN THAT PROVIDED FOR THE DEFERRAL OF THE PAYMENT OF THE ADDITIONAL EARNINGS ON THE AFFECTED EMPLOYEE'S ACCOUNT UNTIL 2017. THEREFORE, WHEN PAYMENT OF THE EARNINGS DID NOT OCCUR IN 2016, THE PLAN VIOLATED CODE SECTION 409A DURING THE 2016 TAX YEAR. THE AMOUNT INVOLVED IN THE OPERATIONAL FAILURE WAS THE ADDITIONAL EARNINGS THAT ACCRUED ON THE VESTED ACCOUNT FROM THE DATE THE ACCOUNT SHOULD HAVE BEEN DISTRIBUTED IN 2016 UNTIL THE DATE THE ACCOUNT WAS DISTRIBUTED IN 2017. THIS AMOUNT TOTALED $4,819.45 AND, PURSUANT TO SECTION VI.C. OF NOTICE 2008-113 IS THE AMOUNT SUBJECT TO THE 20% CODE SECTION 409A TAX. STEPS TAKEN TO AVOID RECURRENCE: SINCE DISCOVERING THE ERROR IN MAY OF 2017, AGNESIAN HEALTHCARE, INC. HAS WORKED WITH THE TPA TO IMPROVE PROCEDURES FOR MONITORING VESTING DATES UNDER THE PLAN. THE TPA HAS IDENTIFIED THE CAUSE OF THE ERROR AND ASSURED AGNESIAN HEALTHCARE, INC. THAT THE TPA WILL MONITOR PLAN PARTICIPANT VESTING DATES MORE CLOSELY TO PREVENT FUTURE ERRORS. ELIGIBILITY FOR CORRECTION: THE OPERATIONAL FAILURE REFERENCED ABOVE IS ELIGIBLE FOR THE CORRECTION UNDER SECTION VI.C. OF NOTICE 2008-113. AGNESIAN HEALTHCARE, INC., THE SERVICE RECIPIENT, HAS TAKEN ALL ACTIONS REQUIRED, AND OTHERWISE MET ALL REQUIREMENTS, FOR CORRECTION.
FORM 990, PART VI, SECTION A, LINE 4	AS OF JANUARY 1, 2018, AGNESIAN HEALTHCARE INC. IS PART OF SSM HEALTH CARE CORPORATION, A MISSOURI NONPROFIT CORPORATION, WHICH IS THE SOLE MEMBER OF THE CORPORATION. THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE CORPORATION SHALL BE SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH CARE CORPORATION IS THE SOLE MEMBER OF THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	SSM HEALTH CARE CORPORATION, HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS, TO APPOINT AND REMOVE THE DIRECTORS, AND TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF AN OPERATING DIVISION OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B	CERTAIN POWERS WITH RESPECT TO THE CORPORATION ARE RESERVED TO SSM HEALTH CARE CORPORATION (SSMHCC) AS THE SOLE MEMBER OF THE MEMBER. SSMHCC MAY EXERCISE ANY OF ITS RESERVED POWERS THROUGH AUTHORITY DELEGATED TO THE OFFICERS OR MANAGEMENT OF SSMHCC OR THE BOARD OR OFFICERS OF THE CORPORATION PURSUANT TO CORPORATE RESOLUTIONS AND POLICIES WHICH MAY BE ADOPTED BY SSMHCC, PROVIDED THAT THE EXERCISE OF THE RESERVED POWERS REMAINS THE ULTIMATE RESPONSIBILITY OF SSMHCC.
FORM 990, PART VI, SECTION B, LINE 11B	THE FINANCE DEPARTMENT PREPARES THE FORM 990 AND THE RETURN IS REVIEWED BY THE DIRECTOR OF FINANCE. A FINAL COPY OF THE 2017 FORM 990 IS PROVIDED TO THE BOARD EXECUTIVE COMMITTEE FOR REVIEW AND APPROVAL TO THE AGNESIAN HEALTHCARE BOARD BEFORE THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON AN ANNUAL BASIS TO THE DESIGNATED AUTHORITY A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DESIGNATED AUTHORITY ENSURES THAT ALL STATEMENTS ARE COMPLETED, REVIEWS THEM FOR CONFLICTS, AND SUBMITS TO THE BOARD FOR REVIEW ANY CONFLICT OF INTEREST DISCLOSURE STATEMENTS THAT DISCLOSE ACTUAL OR POTENTIAL CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15	FORM 990, PART VI, SECTION B, LINE 15(A): DETERMINATION OF COMPENSATION OF THE CEO AND OFFICERS INCLUDES ANALYSIS OF COMPARABLE COMPENSATION SURVEYS BY AN INDEPENDENT COMPENSATION CONSULTANT, WHO RECOMMENDS RANGES OF APPROPRIATE COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVES THE COMPENSATION PACKAGE FOR OFFICERS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATIONS AND DECISION IS INCLUDED IN THE BOARD MINUTES. THE FINAL AGREEMENT IS DOCUMENTED WITH A WRITTEN CONTRACT, WHICH IS SIGNED BY BOTH PARTIES. FORM 990, PART VI, SECTION B, LINE 15(B): AN ANNUAL SURVEY IS PERFORMED BY AN OUTSIDE COMPANY
FORM 990, PART VI, SECTION C, LINE 19	AGNESIAN HEALTHCARE'S POLICY AND PROCEDURE FIN1069 DEFINES THE PROCEDURE FOR MAKING ANNUAL INFORMATION RETURNS AVAILABLE FOR PUBLIC INSPECTION. INDIVIDUALS REQUESTING INSPECTION ARE REFERRED TO THE ADMINISTRATION OFFICE, WHERE THEY ARE PROVIDED WITH THE DOCUMENTS AND A CONFERENCE ROOM FOR INSPECTING DOCUMENTS. PHOTOCOPIES WILL BE PROVIDED TO THE REQUESTOR. ANYONE MAY INSPECT THE RETURNS UPON DEMAND, WITHOUT AN APPOINTMENT OR ANY FOREWARNING, DURING AGNESIAN HEALTHCARE INC'S NORMAL BUSINESS HOURS. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION, BUT CAN BE MADE AVAILABLE IF THE REQUESTING PARTY HAS A BONAFIDE REASON.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES - PHYSICIANS: PROGRAM SERVICE EXPENSES 8,329,670. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,329,670. PURCHASED SERVICES - LABORATORY: PROGRAM SERVICE EXPENSES 205,764. MANAGEMENT AND GENERAL EXPENSES 402. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206,166. PURCHASED SERVICES - ELEVATOR: PROGRAM SERVICE EXPENSES 1,599. MANAGEMENT AND GENERAL EXPENSES 137,107. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,706. PURCHASED SERVICES - MISCELLANEOUS: PROGRAM SERVICE EXPENSES 59,510,643. MANAGEMENT AND GENERAL EXPENSES 2,258,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,769,035. PURCHASED SERVICES - TEMPORARY STAFF: PROGRAM SERVICE EXPENSES 822,655. MANAGEMENT AND GENERAL EXPENSES 84,825. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 907,480. PURCHASED SERVICES - REFERENCE TESTS: PROGRAM SERVICE EXPENSES 1,052,817. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,052,817. PURCHASED SERVICES - HOUSEKEEPING: PROGRAM SERVICE EXPENSES 58,870. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,870. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 512,363. MANAGEMENT AND GENERAL EXPENSES 238,550. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 750,913. PROFESSIONAL FEES - MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 267,538. MANAGEMENT AND GENERAL EXPENSES 6,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 273,538. PROFESSIONAL FEES - COLLECTION: PROGRAM SERVICE EXPENSES 6,206. MANAGEMENT AND GENERAL EXPENSES 856,879. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 863,085. PURCHASED SERVICES - LAUNDRY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 709,587. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 709,587. PURCHASED SERVICES - TRANSCRIPTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 28,822. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,822.
FORM 990, PART XI, LINE 9:	CHANGE IN SWAP FUND BALANCE 1,032,207. CHANGE IN FUND BALANCE - SAH FOUNDATION -147,052. CAPITAL CONTRIBUTIONS - FOUNDATION 302,370. CSA LEGACY CONTRIBUTIONS -840,000. FUND BALANCE TRANSFER SSM HEALTH 23,601,353.

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	$28,968,376	$37,881,889	AGNESIAN HEALTHCARE INC
AGNESIAN HEALTHCARE ENTERPRISES LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	392038757	RETAIL PHARMACY	WI	$10,925,768	$9,250,133	AGNESIAN HEALTHCARE INC

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (48 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
ST FRANCIS HOME OF FOND DU LAC
33 EVERETT STREET	FOND DU LAC	WI	54935	391029998	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN	0
AGNESIAN HEALTHCARE FOUNDATION
430 E DIVISION STREET	FOND DU LAC	WI	54935	391684956	FOUNDATION	WI	501(C)(3)	LINE 7	SSM HEALTH OF WISCONSIN	0
WAUPUN MEMORIAL HOSPITAL
620 WEST BROWN STREET	WAUPUN	WI	53963	390806265	HOSPITAL	WI	501(C)(3)	LINE 3	SSM HEALTH OF WISCONSIN	0
RIPON MEDICAL CENTER
845 PARKSIDE STREET	RIPON	WI	54971	391101287	HOSPITAL	WI	501(C)(3)	LINE 3	SSM HEALTH OF WISCONSIN	0
VILLA ROSA INC
N8114 COUNTY WW	FOND DU LAC	WI	53057	421670962	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN	0
SISTER SERVANTS OF CHRIST THE KING
N8114 COUNTY WW	FOND DU LAC	WI	53057	391022770	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN	0
THE CHRISTIAN HOME & REHABILITATION CENTER
331 BLY STREET	WAUPUN	WI	53963	390884514	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN	0
THE MONROE CLINIC INC
515 22 ND AVENUE	MONROE	WI	53566	390808509	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH OF WISCONSIN	0
MONROE CLINIC AND HOSPITAL FOUNDATION
515 22 ND AVENUE	MONROE	WI	53566	205769038	SUPPORT THE MISSION	WI	501(C)(3)	LINE 7	SSM HEALTH OF WISCONSIN	0
GOOD SAMARITAN REGIONAL HEALTH CENTER
10101 WOODFIELD LANE	ST LOUIS	MO	63132	430653587	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES	0
ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431575307	FUNDRAISING	MO	501(C)(3)	LINE 12B, II	SSM REGIONAL HEALTH SERVICES	0
ST MARY'S FOUNDATION INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431940686	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH OF WISCONSIN	0
ST MARY'S HOSPITAL CENTRALIA ILLINIOS
10101 WOODFIELD LANE	ST LOUIS	MO	63132	370662580	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES	0
ST MARY'S - GOOD SAMARITAN INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	364170833	HEALTH CARE	IL	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES	0
GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	262884795	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S - GOOD SAMARITAN	0
ST MARY'S HOSPITAL FOUNDATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	364636691	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S - GOOD SAMARITAN	0
ST MARY'S HOSPITAL AUXILIARY
400 N PLEASANT	CENTRALIA	IL	62801	237126345	FUNDRAISING	IL	501(C)(3)	LINE 10	ST MARY'S HOSPITAL	0
SSM HEALTH BUSINESSES
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431333488	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE CORPORATION	0
SSM HEALTH CARE ST LOUIS
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431343281	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	0
CENTRALIA MEDICAL SERVICES BLDG ASSOC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	237408025	MOB	IL	501(C)(3)	LINE 12B, II	SSM REGIONAL HEALTH SERVICES	0
ST MARY'S JANESVILLE FOUNDATION INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	273439133	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	0
SSM HEALTH MINISTRIES
3221 MCKELVEY ROAD SUITE 107	ST LOUIS	MO	63044	431012492	RELIGIOUS ORGANIZATION	MO	501(C)(3)	LINE 1		0
LEE DEWEY CORPORATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	731279603	MOB	OK	501(C)(3)	LINE 12A, I	SSM HEALTH CARE OF OKLAHOMA	0
SSM HOSPICE AND HOME CARE FOUNDATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	300012246	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH BUSINESSES	0
ST MARY'S HOSPITAL AUXILIARY
100 ST MARYS MEDICAL PLAZA	JEFFERSON CITY	MO	65101	436049878	FUNDRAISING	MO	501(C)(3)	LINE 12B, II		0
GOOD SAMARITAN HOSPITAL AUXILIARY
1 GOOD SAMARITAN WAY	MT VERNON	IL	62864	237049599	FUNDRAISING	IL	501(C)(3)	LINE 12C, III-FI		0
ST ANTHONY SHAWNEE HOSPITAL INC
1000 N LEE AVE	OKLAHOMA CITY	OK	73102	455055149	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE OF OKLAHOMA	0
SSM AUDRAIN HEALTH CARE INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431550298	HEALTH CARE	MO	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES	0
AUDRAIN MEDICAL CENTER FOUNDATION INC
620 E MONROE STREET	MEXICO	MO	65265	431265060	FUNDRAISING	MO	501(C)(3)	LINE 12A, I	SSM AUDRAIN HEALTH CARE INC	0
SSM HEALTH AT HOME FOUNDATION OF WISCONSIN INC
2802 WALTON COMMONS LANE	MADISON	WI	53718	391839309	FUNDRAISING	WI	501(C)(3)	LINE 12A, I		0
SSM-SLUH INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	474196634	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS	0
SSM HEALTH CARE CORPORATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	466029223	HEALTH CARE	MO	501(C)(3)	LINE 12A, I	SSM HEALTH MINISTRIES	0
SSMHC LIABILITY TRUST I
10101 WOODFIELD LANE	ST LOUIS	MO	63132	436331003	INSURANCE	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION	0
SSM CONSOLIDATED HEALTH SERVICES
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431473657	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE CORPORATION	0
SSM POLICY INSTITUTE
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431788151	HEALTH CARE	MO	501(C)(4)		SSM HEALTH CARE CORPORATION	0
SSM HEALTH CARE PORTFOLIO MANAGEMENT CO
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431825256	MANAGEMENT	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION	0
SSM CARDINAL GLENNON CHILDREN'S HOSPITAL
10101 WOODFIELD LANE	ST LOUIS	MO	63132	430738490	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS	0
CARDINAL GLENNON CHILDREN'S FOUNDATION
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431754347	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM CARDINAL GLENNON HOSPITAL	0
SSM HEALTH FOUNDATION - ST LOUIS
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431552945	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS	0
SSM HEALTH CARE OF OKLAHOMA INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	730657693	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	0
ST ANTHONY HOSPITAL FOUNDATION INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	736104300	FUNDRAISING	OK	501(C)(3)	LINE 7	SSM HEALTH CARE OF OKLAHOMA	0
SSM HEALTH CARE OF WISCONSIN INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	430688874	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	0
DELLS MEDICAL BUILDING INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	391613292	MOB	WI	501(C)(2)		SSM HEALTH CARE OF WISCONSIN	0
ST CLARE HEALTH CARE FOUNDATION INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431940683	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	0
HOME HEALTH UNITED INC
2802 WALTON COMMONS LANE	MADISON	WI	53718	391539827	HEALTH CARE	WI	501(C)(3)	LINE 10	SSM HEALTH CARE OF WISCONSIN	0
HOME CARE UNITED INC
2802 WALTON COMMONS LANE	MADISON	WI	53718	391776340	HEALTH CARE	WI	501(C)(3)	LINE 10	SSM HEALTH CARE OF WISCONSIN	0
HHU XTRA CARE INC
2802 WALTON COMMONS LANE	MADISON	WI	53718	391705111	HEALTH CARE	WI	501(C)(3)	LINE 10	SSM HEALTH CARE OF WISCONSIN	0
SSM REGIONAL HEALTH SERVICES
10101 WOODFIELD LANE	ST LOUIS	MO	63132	440579850	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (16 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
SSM ST JOSEPH ENDOSCOPY CENTER LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	270046559	SURGERY SERVICES	MO	0	0
ST CLARE IMAGING SERVICES
707 14TH STREET SUITE A	BARABOO	WI	53913	200122365	DIAG SERVICES	WI	0	0
MT VERNON RADIATION THERAPY CENTER LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	201382620	RADIATION THERAPY	IL	0	0
SLEEP & NEUROLOGY CENTER OF S ILLINIOS LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	208468195	DIAG SERVICES	IL	0	0
CHOWSMGSI OFFICE BUILDING LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	371383861	MOB	IL	0	0
OZA CANCER CENTER LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	201382727	MOB	IL	0	0
SHAWNEE REAL ESTATE HOLDINGS LLC
1000 N LEE AVE	OKLAHOMA CITY	OK	73102	455458304	MOB	OK	0	0
DEAN CLINIC & ST MARYS HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	452995500	ACCOUNTABLE CARE ORGANIZATION	WI	0	0
WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	392016715	INFORMATION TECHNOLOGY SERVICES	WI	0	0
DEAN HEALTH HOLDINGS LLC
1277 DEMING WAY	MADISON	WI	53717	261594709	SUPPORT SERVICES	WI	0	0
WINGRA BUILDING GROUP
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	390237060	MOB	WI	0	0
JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	396220698	MOB	WI	0	0
WINDMILL LLP
50 VILLAGE VIEW LANE	CHESTERFIELD	MO	63017	431804651	INVESTMENTS	MO	0	0
B & J OFFICE BUILDING LLC
1000 N LEE AVE	OKLAHOMA CITY	OK	73102	731533449	MOB	OK	0	0
1110 N CLASSEN BOULEVARD LLC
1110 N CLASSEN BOULEVARD	OKLAHOMA CITY	OK	73106	731158158	MOB	OK	0	0
SSM ST CLARE SURGICAL CENTER LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	261439695	SURGERY SERVICES	MO	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (24 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
SSM MANAGED CARE ORGANIZATION LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431708511	HEALTH PROMOTION	MO	N/A	C	0
FPP INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431465174	HEALTH CARE	MO	N/A	C	0
DIVERSIFIED HEALTH SERVICES CORP
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431369305	MEDICAL EQUIPMENT	MO	N/A	C	0
SSM CARDIOVASCULAR AND THORACIC SERVICES INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	260286559	HEALTH CARE	MO	N/A	C	0
SSM PROPERTIES INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431462486	PROPERTY SERVICES	MO	N/A	C	0
SSM DEPAUL MEDICAL GROUP INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431715106	HEALTH CARE	MO	N/A	C	0
SSM ST CHARLES CLINIC MED GROUP INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	430626408	PHYSICIAN OFFICES	MO	N/A	C	0
HEALTH FIRST PHYSICIAN MANAGEMENT SERVICES
10101 WOODFIELD LANE	ST LOUIS	MO	63132	731534336	MEDICAL SERVICES	OK	N/A	C	0
SSMHC LIABILITY TRUST II
10101 WOODFIELD LANE	ST LOUIS	MO	63132	816128118	INSURANCE	MO	N/A	C	0
SSM NEUROSCIENCES INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	263413981	HEALTH CARE	MO	N/A	C	0
SSM MEDICAL GROUP INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	431664107	PHYSICIAN OFFICES	MO	N/A	C	0
SSMHC INSURANCE COMPANY
10101 WOODFIELD LANE	ST LOUIS	MO	63132	030310431	INSURANCE	CA	N/A	C	0
SSM ORTHOPEDIC INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	271557033	HEALTH CARE	MO	N/A	C	0
SSM CANCER CARE INC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	271557324	HEALTH CARE	MO	N/A	C	0
PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS
10101 WOODFIELD LANE	ST LOUIS	MO	63132	364161526	HEALTH CARE	IL	N/A	C	0
DEAN HEALTH SYSTEMS INC
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	391128616	PHYSICIAN OFFICES	WI	N/A	C	0
DEAN HEALTH INSURANCE INC
PO BOX 56099	MADISON	WI	53705	391830837	INSURANCE	WI	N/A	C	0
DEAN HEALTH PLAN INC
PO BOX 56099	MADISON	WI	53705	391535024	INSURANCE	WI	N/A	C	0
SMDV OFFICE BUILDING
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	391628491	PHYSICIAN OFFICES	WI	N/A	C	0
DEAN RETAIL SERVICES INC
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	391717636	PROPERTY SERVICES	WI	N/A	C	0
NAVITUS HOLDINGS LLC
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	800968174	PHARMACY BENEFITS	WI	N/A	C	0
OZA ONCOLOGY INC
4117 VETERANS MEMORIAL DRIVE	MT VERNON	IL	62804		PHYSICIAN OFFICES	IL	N/A	C	0
SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC
1808 WEST BELTLINE HIGHWAY	MADISON	WI	53713	832038674	CONDO ASSOCIATION	WI	N/A	C	0
SSM HEALTH PHARMACY LLC
10101 WOODFIELD LANE	ST LOUIS	MO	63132	264031708	PHARMACY	MO	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	Yes (1)	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (5 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
AGNESIAN HEALTHCARE FOUNDATION INC
C	$1,861,609	CASH RECEIPTS
ST FRANCIS HOME
M	$60,633	CASH PAYMENTS
WAUPUN MEMORIAL HOSPITAL
P	$419,875	CASH TRANSFER
RIPON MEDICAL CENTER
P	$84,065	CASH TRANSFER
THE CHRISTIAN HOME & REHABILITATION CENTER
M	$73,559	CASH PAYMENTS