2018-05-10T10:32:26-05:00 2017-06-30 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-07-01 390807236 Agnesian Healthcare Inc AGNE 9209265519 430 East Division St Fond du Lac WI 53935 BONNIE SCHMITZ VP and CFO 9209265519 2018-05-09 1 Terri Rexrode CPA MST P00096513 9206620016 2018-05-09 2016 2022-09-23 18:48:47Z STEVEN LITTLE CEO 430 East Division St Fond du Lac WI 53935 488786133 0 0928 X WWW.AGNESIAN.COM X 1892 WI 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 CONTINUE THE MISSION OF THE CATHOLIC CONGREGATION OF SISTERS OF ST. AGNES. 15 12 4313 567 4658207 -548634 848003 985901 345488864 353753153 8886890 9341789 16174531 16571485 371398288 380652328 0 0 0 0 156598769 165819796 0 0 0 198902309 208046706 355501078 373866502 15897210 6785826 533058855 587595135 216873372 253246914 316185483 334348221 X 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 CONTINUE THE MISSION OF THE CATHOLIC CONGREGATION OF SISTERS OF ST. AGNES. 0 0 256201247 346253487 Agnesian healthcare operates St. Agnes hospital, a 163-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 2017, St. Agnes hospital had 6,806 inpatient admissions, with total patient days of 26,997. There was a total of 30,480 emergency room visits and 14,276 surgeries performed in FY17. In addition, St. Agnes Hospital provided 436,023 physician clinic visits, 80,904 medical imaging procedures, and 35,154 physical, occupational and speech therapy units. There were 1,881 cardiac cath lab visits and 47,496 hospice days. The hospital also operates Samaritan clinic, a free clinic offering medical services to qualified individuals. Samaritan clinic provided 740 visits to patients, at a cost of $173,999 for FY17. 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 $1,105,071. 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 $4,238,674. 8485795 3405987 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 503,182 PRESCRIPTIONS DURING FY17. 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 $4,534. AGNESIAN HEALTHCARE ENTERPRISES CONTRIBUTES TO COMMUNITY BENEFIT WITH SEVERAL SUPPORT GROUPS. THE COST OF THE COMMUNITY BENEFIT WAS $6,143. 949845 14596104 AGNESIAN HEALTHCARE OPERATES CONSULTANTS LABORATORY OF WISCONSIN, AN INDEPENDENT REFERENCE LAB SERVING FOND DU LAC, DODGE, OUTAGAMIE, WINNEBAGO AND COLUMBIA COUNTIES. CLW PROVIDED 1,100,128 TESTS DURING FISCAL YEAR 2017. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $43,476. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY WAS $29,858. 265636887 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 0 1 340 0 1 4313 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Audra Hoffmann 9209265519 430 EAST DIVISION STREET FOND DU LAC WI 54935 STEVEN N LITTLE PRESIDENT AND CEO 50.00 X X 908932 0 39382 SR MARY NOEL BROWN EX-OFFICIO 1.00 X 0 0 0 JAMES R CHATTERTON Chairperson 1.00 X X 0 0 0 JOAN KARSTEN DIRECTOR 1.00 X 0 0 0 SR RHEA EMMER EX-OFFICIO 1.00 X 0 0 0 SR HERTHA LONGO TreasuRER 1.00 X X 0 0 0 thor h gilbertson DIRECTOR 1.00 X 0 0 0 wayne e matzke VICE CHAIRPERSON 1.00 X X 0 0 0 JAMES B SIMON SECRETARY 1.00 X X 0 0 0 dr JEFFERY STRONG DIRECTOR 1.00 X 0 0 0 DR JUDITH WESTPHAL DIRECTOR 1.00 X 0 0 0 MarySue Michels direCTOR 1.00 X 0 0 0 DR richard schaefer direCTOR 1.00 X 0 0 0 thomas schuessler direCTOR 1.00 X 0 0 0 Dr Toni Stanley direcTOR 1.00 X 0 0 0 JAMES P MUGAN SR VP CLINICAL SERVICES 50.00 X 332020 0 41281 BONNIE R SCHMITZ CHIEF FINANCIAL OFFICER 50.00 X 488547 0 27858 SUSAN L EDMINSTER VP - HUMAN RESOURCES 50.00 X 315385 0 43710 NANCY A BIRSCHBACH VP - CIO 50.00 X 338309 0 43166 Barbara L Knutzen Pres and ceo-ahe and perfo 50.00 X 268433 0 33479 Holly brenner vp strategic development/m 50.00 X 293402 0 14489 Michael Degere VP population health manag 50.00 X 387276 0 40306 Michael Drees chief operating officer fd 50.00 X 281672 0 44753 Katherine Vergos Chief Nursing Officer 50.00 X 258959 0 16134 JOHN CHOI MD ANESTHESIOLOGIST - PAIN RE 50.00 X 755269 0 38079 YASIR HATAHET MD INTENSIVIST/pulmonologist 50.00 X 955386 0 45978 MICHAEL VANDER KOOY MD RADIATION ONCOLOGIST 50.00 X 672183 0 46760 michael freeland MD intensivist 50.00 X 628719 0 37567 allen foster md physician - sleep medicine 50.00 X 653489 0 43118 MARY j MOLLISON FORMER VP SPIRITUALITY AND CARE 50.00 X 227999 0 8714 JILL A STENSON FORMER vp NURSING 50.00 X 259096 0 24107 8025076 0 588881 193 1 1 0 FOND DU LAC REGIONAL CLINIC 420 E DIVISION ST FOND DU LAC WI 54935 PHYSICIAN SERVICES 54043230 CERNER CORP 2800 ROCKCREEK PKWY KANSAS CITY MO 64141 COMPUTER SERVICES 11070817 CD SMITH CONSTRUCTION PO BOX 1066 FOND DU LAC WI 54935 CONSTRUCTION 4553034 Medical College of WI 8701 watertown Plank Rd po box 26 Wauwatosa WI 53226 physician serVICES 1720436 MI-HEALTH HOLDINGS PO BOX 128 BROWNSVILLE WI 530060128 ComPUTER SERVICES 1169282 65 985901 985901 NET PATIENT SERVICE REVENUE 621400 220542583 219547226 995357 MEDICARE/MEDICAID REVENUE 621400 133210570 133210570 353753153 5844596 5844596 78177 78177 82500699 4403 79038025 48061 3462674 -43658 3419016 3419016 39497882 29047719 10450163 6833608 3616555 WORK INJURY/OCC HEALTH 621990 1922057 1922057 CAFETERIA SALES 900099 1457148 46295 1410853 MEDICARE EHR 900099 940203 940203 1801914 1801914 6121322 380652328 364255578 4658207 10752642 X 4970088 4970088 139682374 109462202 30220172 6140589 4616131 1524458 5474142 3503878 1970264 9552603 6978273 2574330 692830 59039 633791 128365 128365 74744877 69946832 4798045 998705 85404 913301 57624471 55253406 2371065 28307469 1848560 26458909 13685578 5094451 8591127 729474 606330 123144 799001 469398 329603 4877594 4877594 15298212 887134 14411078 1819348 1083004 736344 HOSPITAL ASSESSMENT 5044397 5044397 Miscellaneous 2007883 433012 1574871 DUES, SUBSCRIPTIONS, LI 661565 265436 396129 INVESTMENT FEES 656464 656464 -29527 -29527 373866502 265636887 108229615 0 4976303 4371979 19075426 6584344 57815091 57466984 5584360 5347100 3746011 3765809 395976101 223575229 170382278 172400872 206669832 227296330 64809554 110361717 533058855 587595135 43689233 43689173 134013484 165518041 39170655 44039700 216873372 253246914 X 302538252 320651021 11481683 12530403 2165548 1166797 316185483 334348221 533058855 587595135 X 6785826 12897926 -1521014 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19407 19407 0 Part II-B, Line 1: LOBBYING PORTION OF WISCONSIN HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION and AMERICAN COLLEGE OF RADIOLOGY ASSOCIATION DUES. 1032857 -1000000 -29891 2785 181 1049591 36713 50000 3447 1032857 1039915 13223 3547 1049591 1019387 73707 50000 3179 1039915 1004976 57144 40000 2733 1019387 0 1 1 6716640 6716640 194692541 90237251 104455290 4002469 1989992 2012477 174989058 131347986 43641072 15575393 15575393 172400872 DUE FROM AFFILIATED ENTITIES 4574435 LONG TERM DEBT FROM AFFILIATED ENTITY 5000000 INVESTMENT - MERCURY CLINIC 3005130 INVESTMENT - SAH FOUNDATION 12952060 Limited Use Assets - BOND FUNDS 4720746 Limited Use Assets - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN 40437228 OTHER RECEIVABLES 2718212 MISCELLANEOUS 1321628 RECEIVABLE FROM RIPON MEDICAL CENTER 35632278 110361717 CAPITAL LEASE PAYABLE 1315046 PHYSICIANS SUPPLEMENTAL BENEFIT PLAN 39561061 FUND BALance SWAP MarKeT ADJUSTMENT 1977264 DUE TO MEDICARE/MEDICAID 183196 Executive Deferred Comp PLAN 876168 Land Contract - Family Foot Clinic 126965 44039700 Part V, Line 4: AGNESIAN HEALTHCARE, INC. NO LONGER HOLDS AN ENDOWMENT FROM THE CONGREGATION OF THE SISTERS OF ST. AGNES. THE ORIGINAL ENDOWMENT OF $1,000,000 WAS PERMANENTLY RESTRICTED. INCOME GENERATED FROM THE ENDOWMENT WAS UNRESRICTED AND TO BE USED AT THE DISCRETION OF THE CHIEF EXECUTIVE OFFICER TO FUND PROGRAMS SUCH AS DOMESTIC VIOLENCE, CHARITY CARE, ETC. 1 1 X 1 X 165.000000000000 1 X 1 1 1 0 1 1 1139463 1139463 0.00300 25551208 25551208 0.06830 26690671 26690671 0.07130 1749662 227747 1521915 0.00410 661540 661540 0.00180 693387 22126 671261 0.00180 7030 7030 0.00000 1426545 1426545 0.00380 4538164 249873 4288291 0.01150 31228835 249873 30978962 0.08280 16685 16685 0.00000 17128 17128 0.00000 101971 101971 0.00300 135784 135784 0.00300 1 12242102 113412898 180568798 -67155900 X 1 1 1 1 ST AGNES HOSPITAL 430 E DIVISION STREET FOND DU LAC WI 54935 X X X ST AGNES HOSPITAL 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X www.agnesian.com X www.fdlco.wi.gov/home/showdocument?id=7260 X X 1 14 1 www.fdlco.wi.gov/home/showdocument?id=7260 0 1 X 165.000000000000 300.000000000000 X X X X X X X 1 1 X X X X 1 X WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE X WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 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), 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 SPECIFIC 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. IN ADDITION, ALL STUDENTS IN 8TH, 10TH, AND 11TH GRADES WERE ASKED TO PARTICIPATE IN AN ANONYMOUS AND CONFIDENTIAL SURVEY. THE 124-QUESTION SURVEY WAS ADMINSTERED BY TRAINED VOLUNTEERS AND STAFF. THE SCHOOL DISTRICTS OF CAMPBELLSPORT, FOND DU LAC, NORTH FOND DU LAC, ST. MARY'S SPRINGS ACADEMY, AND WINNEBAGO LUTHERAN ACADEMY PARTNERED TOGETHER TO CONDUCT THE IDENTICAL STUDENT HEALTH SURVEY. THE FOND DU LAC HEALTH 2020 COALITION, WHICH WAS FORMED AFTER THE PREVIOUS SURVEY, RESPONDED TO THE NEEDS IDENTIFIED IN THE CHNA. THE HEALTHY 2020 STEERING COMMITTEE INCLUDES THE FOLLOWING MEMBERS: DR. MATT DOLL, AGNESIAN HEALTHCARE PSYCHOLOGIST; ERIN GERRED, FOND DU LAC COUNTY; GREG GILES, YMCA; BILL LAMB, FOND DU LAC COUNTY POLICE DEPARTMENT; SR. MARY MOLLISON, AGNESIAN HEALTHCARE; LALITHA RAMAMOORTHY, MARIAN UNIVERSITY; LARRY RICHARDSON, FABOH; SANDI ROEHRIG, FOND DU LAC AREA FOUNDATION; MARTY RYAN, ROTARY; HEATHER SCHMIDT, DO, AGNESIAN HEALTHCARE; MARIAN SHERIDAN, FOND DU LAC SCHOOL DISTRICT; MICHELLE TIDEMANN, UW EXTENSION; DEANN THURMER, AGNESIAN HEALTHCARE; KATHERINE VERGOS, AGNESIAN HEALTHCARE; JENNIFER WALTERS, AURORA HEALTHCARE; GREG BREWER, AURORA HEALTHCARE; ALAN HATHAWAY, BROWN BOOTS INTERACTIVE; AMBER KILAWEE, FOND DU LAC AREA UNITED WAY; ERIC TONEY, FOND DU LAC COUNTY, KIM MUELLER, FOND DU LAC COUNTY HEALTH DEPARTMENT; KELLY NORTON, ST. MARY'S SPRINGS ACADEMY; TERI MATTEK, UW 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 COMMISSIONED BY AGNESIAN HEALTHCARE, FOND DU LAC AREA UNITED WAY, FOND DU LAC COUNTY HEALTH DEPARTMENT, FOND DU LAC COUNTY YMCA, AND FOND DU LAC SCHOOL DISTRICT. ST. AGNES HOSPITAL Part V, Section B, Line 7d: 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. IN ADDITION, THE FULL REPORT IS AVAILABLE ON THE FOND DU LAC COUNTY WEBSITE. ST. AGNES HOSPITAL Part V, Section B, Line 11: AS A RESULT OF THE CHNA CONDUCTED IN 2012 AND 2014, FOUR MAJOR AREAS OF CONCERN WERE DETERMINED, AND A STRATEGIC ACTION PLAN HAS BEEN DEVELOPED FOR EACH AREA.1) INCREASE THE NUMBER OF FDL COUNTY RESIDENTS WHO ARE AT A HEALTHY WEIGHT - AGNESIAN HEALTHCARE HAS COLLABORATED WITH THE YMCA BY HIRING AND PROVIDING FUNDING FOR A WELLNESS COORDINATOR FOR OUTREACH INTO THE COMMUNITY. THE WELLNESS COORDINATOR IS DEVELOPING AND IMPLEMENTING A COMMUNITY EDUCATION CAMPAIGN ON HEALTHY EATING AND ACTIVE LIVING, INCLUDING THE 5,2,1,0 CAMPAIGN IN THE SCHOOL DISTRICT.2) INCREASE DENTAL CARE ACCESS FOR CHILDREN AND ADULTS WITH MEDICAID - AGNESIAN HEALTHCARE HAS PROVIDED FUNDING TO FOND DU LAC COUNTY TO EXTEND THEIR PROGRAM TO PROVIDE DENTAL CARE TO ADuLTS WHO DO NOT CURRENTLY HAVE ACCESS TO DENTAL CARE. IN ADDITION, AGNESIAN HEALTHCARE HAS PROVIDED FUNDING TO THE SAVE A SMILE INITIATIVE, WHICH PROVIDES ACCESS TO DENTAL CARE FOR CHILDREN UTILIZING THE MEDICAID PROGRAM.3) IMPROVE MENTAL HEALTH ACCESS - AGNESIAN HEALTHCARE ASSOCIATES ARE PARTICIPATING ON A COMMUNITY-WIDE TASK FORCE TO PROVIDE EDUCATIONAL PROGRAMS TO DECREASE THE STIGMA SURROUNDING MENTAL HEALTH ISSUES. AGNESIAN HEALTHCARE IS PARTNERING WITH THE YMCA TO PROVIDE CITY AND COUNTY EVENTS AND EDUCATION. FUNDING HAS ALSO BEEN PROVIDED TO SHARDS, A MENTAL HEALTH PROVIDER WHICH PROVIDES MENTAL HEALTH COUNSELING TO THOSE WITHOUT INSURANCE.4) DECREASE BINGE DRINKING AND DRUG AbUSE/MISUSE AMOUNG YOUNG AND ADULTS - THE TASK FORCE IS WORKING WITH COMMUNITIES TO IMPLEMENT BEST PRACTICES AS DESCRIBED IN THE COMMUNITY EVENTS TOOLKIT. ITS STRATEGIES INCLUDE IMPLEMENTING AN APPROACH TO ADDRESS HEROIN/OPIOD ABUSE AND IS also UTILIZING A MEDIA/MARKETING CAMPAIGN TO RAISE AWARENESS, AND ACTIVELY DISCOURAGE BINGE DRINKING AND OVER-CONSUMPTION.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 RANKINGS AND ROADMAPS". THE MOST CURRENT REPORT SHOWS THAT FOND DU LAC COUNTY HAS IMPROVED FROM THE HEALTH FACTORS RANK OF 20 TO RANK OF 16 IN THE STATE. IN ORDER TO FURTHER HELP COMMUNITY MEMBERS TAKE POSITIVE STEPS IN IMPROVING THEIR HEALTH, AGNESIAN HEALThCARE DISTRIBUTED 2017 WELLNESS CALENDARS TO 75,000 RESIDENTS. ST. AGNES HOSPITAL Part V, Section B, Line 13b: PATIENTS AND THEIR GURANTOR'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 GAP 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. 3 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 Part I, Line 3c: Agnesian healthcare does not use any other factors than federal poverty guidelines to determine eligibility. Part I, Line 6a: An annual community benefit report is completed by the finance department and distributed to the public through the public relations office of agnesian healthcare, inc. Part I, Line 7: A COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST OF COMMUNITY BENEFIT SERVICES. OVERALL COSTS LESS TAXES WERE DIVISIBLE BY TOTAL CHARGES. Part I, Line 7g: 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 12,242,102. 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 EMERGANCY 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 ST. AGNES HOSPITAL 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 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 AGNESIAN HEALTHCARE, AN INTEGRATED, COMPREHENSIVE NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM COMPRISED OF TEN MINISTRIES: AGNESIAN HEALTHCARE ENTERPRISES, LLC, CONSULTANTS LAB OF WI, LLC, FOND DU LAC REGIONAL CLINIC, ST. AGNES HOSPITAL, ST. FRANCIS HOME, SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO NURSING HOME, VILLA ROSA, INC, CHRISTIAN HOME, WAUPUN MEMORIAL HOSPITAL AND RIPON MEDICAL CENTER. AGNESIAN PROVIDES A CONTINUUM OF HEALTHCARE FROM BIRTH TO END OF LIFE, PREVENTIVE 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 X X 1 1 X X X X 1 1 0 1 0 0 0 0 0 STEVEN N LITTLE PRESIDENT AND CEO 681981 0 168050 0 58901 0 13861 0 25521 0 948314 0 0 0 JAMES P MUGAN SR VP CLINICAL SERVICES 280554 0 36934 0 14532 0 15847 0 25434 0 373301 0 0 0 BONNIE R SCHMITZ CHIEF FINANCIAL OFFICER 409577 0 55849 0 23121 0 18040 0 9818 0 516405 0 0 0 SUSAN L EDMINSTER VP - HUMAN RESOURCES 277979 0 36164 0 1242 0 15467 0 28243 0 359095 0 0 0 NANCY A BIRSCHBACH VP - CIO 298544 0 38775 0 990 0 13861 0 29305 0 381475 0 0 0 Barbara L Knutzen Pres and ceo-ahe and perfo 234758 0 30607 0 3068 0 12553 0 20926 0 301912 0 0 0 Holly brenner vp strategic development/m 249156 0 30387 0 13859 0 13146 0 1343 0 307891 0 0 0 Michael Degere VP population health manag 310877 0 40732 0 35667 0 15900 0 24406 0 427582 0 0 0 Michael Drees chief operating officer fd 241062 0 32004 0 8606 0 14736 0 30017 0 326425 0 0 0 Katherine Vergos Chief Nursing Officer 222910 0 29610 0 6439 0 12072 0 4062 0 275093 0 0 0 JOHN CHOI MD ANESTHESIOLOGIST - PAIN RE 609011 0 143936 0 2322 0 15900 0 22179 0 793348 0 0 0 YASIR HATAHET MD INTENSIVIST/pulmonologist 482971 0 377801 0 94614 0 14571 0 31407 0 1001364 0 0 0 MICHAEL VANDER KOOY MD RADIATION ONCOLOGIST 620647 0 0 0 51536 0 15900 0 30860 0 718943 0 0 0 michael freeland MD intensivist 421547 0 7200 0 199972 0 15390 0 22177 0 666286 0 0 0 allen foster md physician - sleep medicine 328006 0 324241 0 1242 0 15390 0 27728 0 696607 0 0 0 MARY j MOLLISON FORMER VP SPIRITUALITY AND CARE 189984 0 32964 0 5051 0 0 0 8714 0 236713 0 0 0 JILL A STENSON FORMER vp NURSING 222383 0 29835 0 6878 0 11516 0 12591 0 283203 0 0 0 Part I, Line 1a ALL GROSSUP PAYMENTS AND SOCIAL CLUB DUES ARE INCLUDED ON FORM 1099. These payments are made for a current and former member of the board of directors. Part I, Lines 4a-b ALL EXECUTIVES PARTICIPATE IN A 457(B) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. JILL STENSON WAS PAID SEVERANCE PAY OF $71,739. THIS PAYMENT WAS COMPLETED IN THIS FISCAL YEAR; NO FURTHER RESTRICTIONS EXIST. Part I, Line 5 COMPENSATION FOR SOME EMPLOYED PHYSICIANS IS BASED ON A PERCENTAGE OF GROSS BILLINGS. A WI HEALTH AND EDUC FACILITIES AUTHORITY 391337855 97710Bgg1 2008-12-11 49330000 REFUNDING OF 2001 ISSUE, PRIVATE ROOM PROJECT 0 0 0 B WI HEALTH AND EDUC FACILITIES AUTHORITY 391337855 97710BYW6 2010-12-01 57260000 REFUNDING OF 2001 ISSUE, PRIVATE ROOM PROJECT 0 0 0 C WI HEALTH AND EDUC FACILITIES AUTHORITY 391337855 NONEAVAIL 2011-12-15 10020000 PARTIAL REFUNDING OF 1998 ISSUE 0 0 0 D WI HEALTH AND EDUC FACILITIES AUTHORITY 391337855 97710B7C0 2013-03-14 5705000 CONSTRUCTION AND EXPANSION OF FACILITIES 0 0 0 A 5625000 49330000 430000 48900000 2005 1 0 1 1 B 8015000 57260000 4518399 31465565 767686 20498350 2014 1 0 1 1 C 6186000 10020000 9930000 90000 2011 1 0 1 1 D 210000 5705000 61653 32111 5672889 2015 0 0 1 1 A 0 0 0 0 0.01470 0.01470 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 D 0 0 0 0 1 0 1 A 1 1 1 Piper jaffray 28.000000000000 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 A WI HEALTH AND EDUC FACILITIES AUTHORITY 391337855 97710B7C0 2013-03-14 53276496 conSTRUCTION AND EXPANSION OF FACILITIES 0 0 0 A 53276496 569394 296559 52979937 2015 0 0 1 1 A 0 0 0 0 1 0 1 A 1 0 0 0 0 1 A 1 Richard Schaefer md director 84928 richard schaefer's wife, evelyn schaefer, is employed as a psychologist at agnesian healthcare, earning an annual salary of $84,928. 0 WAYNE MATZKE VICE CHAIRPERSON 2632790 WAYNE MATZKE WAS THE PRESIDENT OF GRANDE CHEESE AND RETIRED IN FEBRUARY 2017. AGNESIAN HEALTHCARE, INC PROVIDES A HEALTH CARE CLINIC TO GRANDE CHEESe, BILLING $2,632,790 OF THESE SERVICES IN FISCAL YEAR 2017. 0 Form 990, Part VI AN ANNUAL SURVEY IS PERFORMED BY AN OUTSIDE COMPANY. Form 990, Part VI, Section A, line 6 The organization has two classes of members - Class a members WHO ARE MEMBERS of the Congregation of the Sisters of St. Agnes and Class B members who constitute the Board of Directors. Form 990, Part VI, Section A, line 7a The Class A members, who are THE GENERAL COUNCIL OF THE CONGREGATION OF SISTERS OF ST. AGNES, HAVE THE POWER TO ELECT OR APPOINT THE CLASS B MEMBERS. THE CLASS B MEMBERS CONSTITUTE THE BOARD OF DIRECTORS. THE CLASS B MEMBERS HAVE THE POWER, UPON THE RECOMMENDATION OF THE BOARD OF DIRECTORS, TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION. Form 990, Part VI, Section A, line 7b THE CONGREGATION OF THE SISTERS OF ST. AGNES SPONSORSHIP MINISTRIES IS THE CLASS B MEMBER WHO IS RESPONSIBLE FOR APPROVING CERTAIN RESERVED POWERS OF THE CORPORATION DELEGATED TO THEM BY CLASS A. THE GENERAL COUNCIL OF THE CONGREGATION OF SISTERS OF ST. AGNES IS THE CLASS A MEMBER WHO IS RESPONSIBLE FOR APPROVING CERTAIN RESERVED POWERS OF THE CORPORATION. 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 AND CFO. A FINAL COPY OF THE 2016 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 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 C, line 19 AGNESIAN HEALTHCARE'S POLICY AND PROCEDURE FIN1069 DEFINES THE PROCEDURE FOR MAKING ANNUAL INFORMATION RETURNS AVAILABLE FOR PUBLIC INSPECTION. INDIVIDUALS REQUESTING INSPECTION ARE REFERRED TO THE ADMINISTRATION OFFICE, WHERE THEY ARE PROVIDED WITH THE DOCUMENTS AND A CONFERENCE ROOM FOR INSPECTING DOCUMENTS. PHOTOCOPIES WILL BE PROVIDED TO THE REQUESTOR. ANYONE MAY INSPECT THE RETURNS UPON DEMAND, WITHOUT AN APPOINTMENT OR ANY FOREWARNING, DURING AGNESIAN HEALTHCARE INC'S NORMAL BUSINESS HOURS. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION, BUT CAN BE MADE AVAILABLE IF THE REQUESTING PARTY HAS A BONAFIDE REASON. ALL FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH A POSTING ON A PUBLIC WEBSITE. Form 990, Part IX, line 11g Purchased Services - Physician services: Program service expenses 7,118,764. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,118,764. Purchased Services - Laboratory: Program service expenses 211,861. Management and general expenses 6,346. Fundraising expenses 0. Total expenses 218,207. Purchased Services - Elevator: Program service expenses 3,515. Management and general expenses 138,641. Fundraising expenses 0. Total expenses 142,156. Purchased Services - Miscellaneous: Program service expenses 59,813,109. Management and general expenses 2,505,935. Fundraising expenses 0. Total expenses 62,319,044. PURCHASED SERVICEs - TEMPORARY STAFF: Program service expenses 793,974. Management and general expenses 7,765. Fundraising expenses 0. Total expenses 801,739. Purchased Services - Reference Tests: Program service expenses 1,095,647. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,095,647. Purchased Services - Housekeeping: Program service expenses 76,960. Management and general expenses 0. Fundraising expenses 0. Total expenses 76,960. Professional Fees: Program service expenses 579,693. Management and general expenses 179,734. Fundraising expenses 0. Total expenses 759,427. Professional Fees - Medical Director: Program service expenses 248,426. Management and general expenses 14,000. Fundraising expenses 0. Total expenses 262,426. Professional Fees - Collection: Program service expenses 4,883. Management and general expenses 971,480. Fundraising expenses 0. Total expenses 976,363. Purchased Services - Laundry: Program service expenses 0. Management and general expenses 752,328. Fundraising expenses 0. Total expenses 752,328. Purchased Services - Transcription: Program service expenses 0. Management and general expenses 221,816. Fundraising expenses 0. Total expenses 221,816. Form 990, Part XI, line 9: capital contributions from affiliates change in swap fund balance 949,684. change in fund balance - sah foundation 1,081,728. capital contributions - foundation 1,447,574. CSA Legacy Contributions -5,000,000. CONSULTANTS LABORATORY OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC WI 54935 391528550 LAB SERVICES WI 28477190 30974097 agnesian healthcare INC AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC WI 54935 392038757 RETAIL PHARMACY WI 10436655 8999250 agnesian healthcare INC ST FRANCIS HOME OF FOND DU LAC 33 EVERETT STREET FOND DU LAC WI 54935 391029998 NURSING HOME WI 501(C)(3) Line 10 agnesian healthcare INC 1 CONGREGATION OF SISTERS OF ST AGNES 320 COUNTY ROAD K FOND DU LAC WI 54935 390806217 CONVENT WI 501(C)(3) Line 1 N/A 0 AGNESIAN HEALTHCARE FOUNDATION 430 E DIVISION STREET FOND DU LAC WI 54935 391684956 FOUNDATION WI 501(C)(3) PF N/A 0 WAUPUN MEMORIAL HOSPITAL 620 WEST BROWN STREET WAUPUN WI 53963 390806265 HOSPITAL WI 501(C)(3) Line 3 agnesian healthcare INC 1 RIPON MEDICAL CENTER 845 PARKSIDE STREET RIPON WI 54971 391101287 HOSPITAL WI 501(C)(3) Line 3 AGNESIAN HEALTHCARE INC 1 villa rosa inc N8120 county ww mount calvary WI 53057 421670962 nursING HOME WI 501(c)(3) Line 10 agnesian healthcare INC 1 Sister servants of christ the king n8114 county ww mount calvary WI 53057 391022770 nurSING HOME WI 501(c)(3) Line 10 AGNESIAN HEALTHCARE INC 1 THE CHRISTIAN HOME & REHABILITATION CENTER 331 BLY STREET WAUPUN WI 53963 390884514 NURSING HOME WI 501(c)(3) Line 10 AGnesian healthcare INC 1 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 1 AGNESIAN HEALTHCARE FOUNDATION INC C 985901 CASH RECEIPTS ST FRANCIS HOME D 5000000 BOND VALUE ST FRANCIS HOME M 71047 CASH PAYMENTS WAUPUN MEMORIAL HOSPITAL P 440702 CASH TRANSFER ripon medical center P 81913 cash tRANSFER THE CHRISTIAN HOME & REHABILITATION CENTER M 102167 CASH PAYMENTS