2025-11-17T14:22:51-06:00 2024-12-31 990 2024-01-01 390807236 AGNESIAN HEALTHCARE INC AGNE 9209265519 430 E DIVISION ST FOND DU LAC WI 54935 STEPHANIE KING VP FINANCE 9209265519 2025-11-17 0 2024 2025-03-06 01:10:19Z FOND DU LAC REGIONAL CLINIC KATHERINE VERGOS 430 E DIVISION ST FOND DU LAC WI 54935 584671655 0 0928 X WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/ST-AGNES-HO 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 ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. 12 8 3465 142 13896430 805234 2755200 959929 500366408 553753598 15045228 27146564 3305704 2553698 521472540 584413789 693525 622655 0 0 205645124 204105126 0 0 527547 325738591 341117232 532077240 545845013 -10604700 38568776 689139561 743414239 176384478 306875329 512755083 436538910 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 ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. 0 0 429369526 622655 539857168 AGNESIAN HEALTHCARE INC. INCLUDES ST. AGNES HOSPITAL, HAS BEEN PROVIDING HEALING CARE FOR OVER 125 YEARS. THE HOSPITAL HAS GROWN INTO BOTH AN INPATIENT AND OUTPATIENT FACILITY PROVIDING INNOVATIVE COMMUNITY AND REGIONAL HEALTHCARE SERVICES TO THE GREATER FOND DU LAC AREA. AS A NONPROFIT CATHOLIC INSTITUTION, ST. AGNES HOSPITAL SERVES PEOPLE OF ALL FAITHS AND BELIEFS. IT IS A LEADER IN PROVIDING QUALITY STATE-OF-THE-ART HEALTHCARE SERVICES. THE 146-BED HOSPITAL HAS GROWN INTO A STATE-OF-THE-ART FACILITY PROVIDING HEALTH CARE SERVICES TO THE GREATER FOND DU LAC AREA, INCLUDING:* COMPREHENSIVE HEART AND VASCULAR CARE AT SSM HEALTH DALE MICHELS HEART & VASCULAR CARE.* IMMEDIATE CARE FOR STROKE PATIENTS AT OUR JOINT COMMISSION CERTIFIED PRIMARY STROKE CENTER.* INPATIENT PHYSICAL REHABILITATION FOR PATIENTS WITH SERIOUS CONDITIONS.* PRIVATE, SPA-LIKE BIRTHING SUITES TO WELCOME YOUR BABY INTO THE WORLD.* 24/7 EMERGENCY CARE AT OUR DESIGNATED LEVEL III TRAUMA CENTER.MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS 429369526 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 X 0 0 3465 1 1 1 0 0 0 0 0 0 0 0 0 X 12 8 1 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 1 X BRADLEY REACH 6082416949 1808 W BELTLINE HWY MADISON WI 53713 SUE ANDERSON DIRECTOR, REGIONAL PRESIDENT 1.00 54.00 X X 0 1377728 548240 WESLEY SPARKMAN DIRECTOR, CHAIR 1.00 5.00 X X 0 0 0 WAYNE MATZKE DIRECTOR, VICE CHAIR 1.00 5.00 X X 0 0 0 SR RHEA EMMER DIRECTOR 1.00 5.00 X 0 0 0 PENG HER DIRECTOR 1.00 5.00 X 0 0 0 MARK HOLZMAN DIRECTOR 1.00 5.00 X 0 0 0 JOAN KARSTEN DIRECTOR 1.00 5.00 X 0 0 0 PATTI LEITZEN FYE DIRECTOR 1.00 5.00 X 0 0 0 JENNIFER MASKEL MD DIRECTOR, PHYSICIAN AT SSM HEALTH 1.00 54.00 X 0 145868 14398 THEODORE TED MILLER MD DIRECTOR 1.00 5.00 X 0 0 0 OLIVIA OTTE DIRECTOR 1.00 5.00 X 0 0 0 MATTHEW POGODZINSKI MD DIRECTOR, PHYSICIAN AT SSM HEALTH 1.00 54.00 X 0 813233 65767 STEVE SMOOT VICE PRESIDENT, COO AT SSM HEALTH 1.00 54.00 X 0 2364935 1119698 KEVIN SMITH TREASURER, CFO AT SSM HEALTH 1.00 54.00 X 0 1050477 627081 DOUGLAS LONG SECRETARY, CLO AT SSM HEALTH 1.00 54.00 X 0 1587150 700771 THOMAS KIRSCHBAUM ASST SEC, REG GENERAL COUNSEL 1.00 54.00 X 0 561495 175772 MATT KINSELLA REGIONAL VP FINANCE-WISCONSIN 1.00 54.00 X 0 561331 175077 KATHERINE VERGOS PRESIDENT - ST. AGNES HOSPITAL 50.00 0.00 X 328025 0 26123 TARA RHODES VP OPS ST. AGNES HOSPITAL 50.00 0.00 X 267002 0 84276 TAMARA SCHATTSCHNEIDER VP PATIENT CARE SVCS, CNO 50.00 0.00 X 310340 0 94222 MICHAEL VANDER KOOY RADIATION ONCOLOGIST 40.00 0.00 X 660801 0 72138 NOMAN MAHMOOD PHYSICIAN 40.00 0.00 X 612630 0 63337 SYED MOHIUDDIN PHYSICIAN 40.00 0.00 X 630253 0 73265 KRISTOF GEHRKE PHYSICIAN 40.00 0.00 X 629071 0 64422 JACOB WAIDELICH PHYSICIAN 40.00 0.00 X 611433 0 74686 RANDY COMBS FORMER OFFICER 0.00 0.00 X 0 1454021 29506 NANCY BIRSCHBACH FORMER KEY EMPLOYEE 0.00 50.00 X 0 481357 148052 4049555 10397595 4156831 364 1 1 0 OWENS & MINOR DISTRIBUTION INC 9120 LOCKWOOD BOULEVARD MECHANICSVILLE VA 23116 HEALTHCARE LOGISTIC SERVICES 2086205 BOSTON SCIENTIFIC CORPORATION 300 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 017521234 BIOMEDICAL ENGINEERING SERVICES 1918342 CD SMITH CONSTRUCTION INC 125 CAMELOT DRIVE FOND DU LAC WI 54935 CONSTRUCTION SERVICES 1707698 TRIMEDX HOLDINGS LLC 5451 LAKEVIEW PARKWAY S DR INDIANAPOLIS IN 46268 ENGINEERING SERVICES 1527071 CARDIAC SURGERY ASSOCIATES SC 2650 WARRENVILLE RD STE 280 DOWNERS GROVE IL 60515 CARDIAC CARE SERVICES 821847 47 956229 3700 27600 959929 NET PATIENT SVC REV 623000 489888061 489888061 PHARMACY REVENUE 456110 31732602 19676468 12056134 CORPORATE FEES 623000 25632992 25632992 OTHER PROGRAM REVENUE 623000 4015022 2174726 1840296 340B PHARMACY REVENUE 456110 1793855 1793855 691066 691066 553753598 9968281 9968281 377684 0 377684 377684 377684 17185044 0 6761 17185044 -6761 17178283 17178283 1153349 251105 902244 902244 CAFETERIA REVENUE 722514 1271598 1271598 OTHER REVENUE 900099 2172 2172 1273770 584413789 539857168 13896430 29700262 X 579305 579305 43350 43350 1109987 1085316 22202 2469 158261981 154744293 3165600 352088 8089559 7909752 161810 17997 25640449 25070539 512867 57043 11003150 10758583 220088 24479 7848797 7436264 412533 195266 25679 169587 96637808 23089401 73548407 66738 21051 2891 42796 5853279 5136913 713394 2972 15455750 15455750 10761027 9422487 1338540 869324 800253 67829 1242 145254 98750 46369 135 57284754 29835856 27448898 13626156 13343075 282579 502 2197534 1408001 789533 MEDICAL SUPPLIES AND EQ 122263590 122263585 0 5 TAXES 4726180 235 4725945 OTHER EXPENSES 2028001 163739 1851947 12315 LICENSES, DUES & SUBSRI 1137994 663041 461449 13504 19780 14308 5472 545845013 429369526 115947940 527547 757223 9115 35084645 64706482 5692450 7387846 679607 1451521 331359279 114805787 217836228 216553492 340468887 372982804 22864017 0 1191876 796991 64564628 79525988 689139561 743414239 33265095 25807962 411163 2401297 142708220 278666070 176384478 306875329 X 502372074 436306050 10383009 232860 512755083 436538910 689139561 743414239 X 38568776 5360629 89908 -120235488 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25480 25480 0 PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL, STATE AND LOCAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WERE ALLOCATED TO LOBBYING ACTIVITIES. 2562797 -824 2266182 1858 4826297 2562797 2562797 1488000 1075000 203 2562797 1487797 1487797 1487797 1487797 0.00000 1.00000 0.00000 1 0 15028937 15028937 222747447 56900013 165847433 7220779 4545477 2675303 84078871 53360297 30718574 2283245 2283245 216553492 SSM COMPREHENSIVE INVESTMENT PROGRAM 372982804 F 372982804 ESTIMATED THIRD PARTY SETTLEMENT 973652 PENSION RESTORATION & DEFERRED COMPENSATION 75173614 COLLATERAL HELD UNDER AGREEMENT 3378722 79525988 THIRD PARTY PAYABLES 4452558 INTERCOMPANY PAYABLES 184491313 OPERATING RIGHT-OF-USE LIABILITIES 3372207 DEFERRED COMPENSATION PLAN LIABILITIES 86349992 278666070 X PART V, LINE 4: ENDOWMENTS ARE DESIGNATED FOR MEDICAL CARE FOR THOSE IN FINANCIAL NEED, HEART AND CANCER CARE, AND OTHER HEALTH-RELATED NEEDS. PART X, LINE 2: AGNESIAN HEALTHCARE INC'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2024 OR 2023. 1 1 X 1 X 1 X 1 1 1 0 1 1 3567628 3567628 0.00650 45616765 21689189 23927576 0.04380 7874830 6140514 1734316 0.00320 57059223 27829703 29229520 0.05350 470367 470367 0.00090 736388 736388 0.00130 1085905 1085905 0.00200 541557 541557 0.00100 2834217 2834217 0.00520 59893440 27829703 32063737 0.05870 5979 5979 0.00000 1012 1012 0.00000 6991 6991 0.00000 1 2453054 0 54582321 16668910 37913411 X 1 1 1 1 ST AGNES HOSPITAL 430 E DIVISION STREET FOND DU LAC WI 54935 HTTPS://WWW.SSMHEALTH.COM/LOCATIONS/ST 120 X X X ST AGNES HOSPITAL 1 0 0 1 X X X X X X X X X X 24 1 0 1 1 X HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH X 1 22 1 HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA X WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA X WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA 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 3J: THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA. ST. AGNES HOSPITAL PART V, SECTION B, LINE 5: SSM HEALTH ST. AGNES HOSPITAL FOND DU LAC WORKED CLOSELY WITH THE FOND DU LAC COUNTY HEALTH DEPARTMENT TO DEVELOP THE 2024-2027 FOND DU LAC COUNTY COMMUNITY HEALTH ASSESSMENT (CHA). THE HOSPITAL WAS AN ACTIVE MEMBER OF THE HEALTHY FOND DU LAC COUNTY STEERING COMMITTEE AND HAS A REPRESENTATIVE SERVING AS AN ADVISOR TO AND ASSISTED IN INVITING COMMUNITY MEMBERS TO CONVERSATIONS TO GATHER AND COLLECT COMMUNITY PERSPECTIVES. SSM HEALTH ST. AGNES HOSPITAL FOND DU LAC SOUGHT AND RECEIVED INPUT FROM THE FOND DU LAC COUNTY PUBLIC HEALTH DEPARTMENT. THE HOSPITAL ALSO WORKED CLOSELY WITH HEALTHY FOND DU LAC COUNTY STEERING COMMITTEE TO DEVELOP THE 2024-2027 FOND DU LAC COUNTY COMMUNITY HEALTH ASSESSMENT (CHA). COMMUNITY PERSPECTIVES AND DATA GATHERED DURING THIS ENDEAVOR WERE INCORPORATED INTO THE SSM HEALTH ST. AGNES HOSPITAL FOND DU LAC'S COMMUNITY HEALTH NEEDS ASSESSMENT. COMMUNITY PERSPECTIVES WERE GATHERED FROM MULTIPLE ACTIVITIES, INCLUDING A COMMUNITY SURVEY, PUBLIC INPUT SURVEY, KEY INFORMANT INTERVIEWS, AND FOCUS GROUPS (COMMUNITY CONVERSATIONS). IN ADDITION TO A REVIEW OF DEMOGRAPHICS, DATA FROM BROAD SOURCES WAS GATHERED AND REVIEWED TO SET THE INITIAL DIRECTION AND PRIORITIES OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE SECONDARY DATA WAS DERIVED FROM A VARIETY OF UNBIASED SOURCES INCLUDING THE COUNTY HEALTH RANKINGS, AND THE WISCONSIN DEPARTMENT OF HEALTH SERVICES. ST. AGNES HOSPITAL PART V, SECTION B, LINE 6B: THE 2024 CHNA WAS COMPLETED COLLABORATIVELY COMPLETED WITH THE FOLLOWING OTHER COMMUNITY PARTNERS:* FOND DU LAC COUNTY HEALTH DEPARTMENT * HEALTHY FOND DU LAC COUNTY STEERING COMMITTEE* DRUG FREE COMMUNITIES OF FOND DU LAC* FOND DU LAC COUNTY MENTAL HEALTH ACTION TEAM* LIVING WELL COALITION OF FOND DU LAC COUNTY ST. AGNES HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED VARIOUS HEALTH NEEDS IN THE 2024 CHNA. IN ORDER TO MAKE A MEANINGFUL IMPACT, AND TO USE ITS FINANCES MOST EFFECTIVELY AND EFFICIENCY, THE HOSPITAL WILL PLACE PRIMARY FOCUS ON THE FOLLOWING KEY PRIORITIES:* MENTAL HEALTH* SUBSTANCE ABUSE* HEALTH CARE ACCESSMENTAL HEALTHMENTAL HEALTH WAS IDENTIFIED AS THE NUMBER ONE PRIORITY TO ADDRESS AS A RESULT OF THE 2024 CHNA. MENTAL HEALTH NEEDS IN THE GREATER FOND DU LAC AREA, WHICH MAY INCLUDE BUT IS NOT LIMITED TO CHALLENGES, BARRIERS OR NEEDS RELATED TO PROVIDER AVAILABILITY, AFFORDABILITY, TRANSPORTATION, INSURANCE, STIGMA, SUBSTANCE USE, CULTURAL SENSITIVITY AND DIVERSE PROVIDERS AND SERVICES, STRESS, AND SUICIDE. * 15 DEATHS BY SUICIDE REPORTED IN 2024. * 20% OF ADULTS REPORTED TO HAVE A MENTAL HEALTH CONDITION IN THE PAST THREE YEARS. * 49% OF YOUTH REPORTED SIGNIFICANT PROBLEMS WITH FEELINGS (ANXIOUS, NERVOUS, TENSE, ETC.). * 14% OF HOUSEHOLDS REPORTED NOT RECEIVING MENTAL HEALTH CARE AS NEEDED. * 67% OF ADULTS STRONGLY AGREED THAT MENTAL HEALTH CONCERN CAN BE AS SERIOUS AS A PHYSICAL CONCERN.PROGRESS MADE SINCE 2021* ART THERAPY WAS OFFERED BY SSM HEALTH ART THERAPISTS AT THE BERRY DROP-IN CENTER, LOCATED IN DOWNTOWN FOND DU LAC, WHICH OPENED ITS DOORS TO THOSE STRUGGLING WITH MENTAL ILLNESS AND/OR SUBSTANCE USE.GOALS & OBJECTIVES INCREASE ACCESS TO BEHAVIORAL/MENTAL HEALTH SERVICES.* PROMOTE VIRTUAL BEHAVIORAL HEALTH INTEGRATION (VBHI) IN PRIMARY CARE AND TELEHEALTH OPTIONS.* SUPPORT, BUILD AND MAINTAIN COMMUNITY SUPPORT GROUPS AND TOOLS (PATHWAYS TO CARE DOCUMENT, NAMI PEER TO PEER GROUPS, LOCAL SUPPORT GROUPS).* PROVIDE SCHWARTZ ROUNDS QUARTERLY IN ALL HOSPITAL SETTINGS. PROVIDE PEER GRIEF SUPPORT GROUPS (I.E. CARE FOR THE CAREGIVERS) AND ZERO SUICIDE.* ENCOURAGE LOCAL EMPLOYERS TO ADOPT A SICK LEAVE POLICY TO INCLUDE MENTAL HEALTH (WORKPLACE MENTAL HEALTH TOOLKIT).DECREASE NUMBER OF DEATHS BY SUICIDE.* HAVE SSM STAFF ATTEND SODRT (SUICIDE OVERDOSE DEATH REVIEW TEAM) AT EVERY MEETING.* HOST AT LEAST FOUR QPR TRAININGS PER YEAR.* PROMOTE ZERO SUICIDE WORK AND EXPAND HEARTMATH EDUCATION AND TRAINING.* ENCOURAGE LOCAL EMPLOYERS TO ADOPT A SICK LEAVE POLICY TO INCLUDE MENTAL HEALTH (WORKPLACE MENTAL HEALTH TOOLKIT).SUBSTANCE ABUSESUBSTANCE USE WAS IDENTIFIED AS THE NUMBER TWO PRIORITY TO ADDRESS IN THE 2025-2027 CHIP. SUBSTANCE USE NEEDS IN THE GREATER FOND DU LAC AREA, WHICH MAY INCLUDE BUT ARE NOT LIMITED TO BARRIERS, CHALLENGES AND NEEDS RELATED TO TOBACCO, VAPING, DRUGS (NARCOTICS, MARIJUANA, ETC.) PRESCRIPTION MEDICATIONS, AND ALCOHOL USE, MENTAL HEALTH AND ACCESS TO CARE. THROUGHOUT THE CHNA, SUBSTANCE USE WAS CONSISTENTLY A TOP-RANKING PRIORITY.* 18 OPIOID RELATED DEATHS IN 2022, COMPARED TO 24 IN 2020. * 16% OF YOUTH REPORTED DRINKING ALCOHOL IN THE PAST MONTH. * 7% OF YOUTH REPORTED BINGE DRINKING IN THE PAST MONTH. * 6% OF YOUTH WHO BOUGHT OR DRANK ALCOHOL AT A COMMUNITY EVENT. * 44% OF YOUTH WHO THIS THE COMMUNITY IS "ACTIVELY DISCOURAGING OR "THINK IT ISN'T OK" UNDERAGE DRINKING. * 33% OF YOUTH WHO REPORT THEY TALKED WITH THEIR PARENTS ABOUT ALCOHOL IN THE PAST MONTH. * 27% OF ADULTS REPORTED *BINGE DRINKING ALCOHOL IN THE PAST MONTH. * 71% OF ADULTS REPORTED DRINKING ALCOHOL IN THE PAST MONTH. * 4% OF YOUTH WHO REPORT USING PRESCRIPTION MEDICATION FOR NON-MEDICAL USE. * 23% OF YOUTH WHO REPORT RELATIVE EASE IN OBTAINING PRESCRIPTION MEDICATION FOR NON-MEDICAL USE. PROGRESS MADE SINCE 2021* ON AVERAGE SSM HEALTH ST. AGNES HOSPITAL COLLECTS 90 POUNDS OF PRESCRIPTION MEDICATIONS EACH MONTH IN THE DRUG DROP BOX LOCATED IN THE LOBBY.GOALS & OBJECTIVES DECREASE UNDERAGE DRINKING AND BINGE DRINKING.* PROMOTE ALCOHOL YOUTH PREVENTION PROGRAMS (I.E. FACT AND STAAND).* HOST A SMALL TALKS CAMPAIGN, ANNUALLY. * BUILD A COMMUNITY EVENTS BEST PRACTICE TOOLKIT.* FUND AND PROMOTE ALCOHOL YOUTH PREVENTION WORK.* REQUEST SPONSORSHIP EVENTS TO ADHERE TO COMMUNITY EVENTS BEST PRACTICE TOOLKIT.DECREASE MISUSE OF OPIOIDS AND PRESCRIPTION MEDICATIONS.* PROMOTE DRUG TAKE BACK CAMPAIGNS, ANNUALLY AND REPORT POUNDAGE DISPOSED. * PROMOTE FDL FOR RECOVERY'S MESSAGE.* MONITOR QUARTERLY PDMP AND FOLLOW UP WITH PROVIDERS TO ENSURE BEST PRACTICES ARE BEING FOLLOWED. * REPORT QUARTERLY ON POUNDAGE DISPOSED FROM INTERNAL DRUG DISPOSAL BINS.HEALTH CARE ACCESS FINANCIAL BARRIERS AND LACK OF INSURANCE AND TRANSPORTATION WERE THE MOST SIGNIFICANT BARRIERS TO ACCESSING CARE IDENTIFIED DURING THE CHNA. HEALTH CARE ACCESS IS NOT LIMITED TO THE ABOVE-MENTIONED BARRIERS TO CARE. HOWEVER, DURING THE GOAL SETTING SESSION HEALTH NAVIGATION AND TRANSPORTATION WERE THE MOST MENTIONED THEMES FROM THE GROUP. SINCE HEALTH CARE ACCESS IS A NEW PRIORITY AREA MAJORITY OF THE WORK WILL BE INITIAL AND DATA COLLECTION TO BETTER UNDERSTAND THE NEED. ALSO, A NEW GREATER FOND DU LAC AREA WORKGROUP WILL BE FORMED AND START THE WORK OUTLINED IN THIS CHIP.* 23% OF ADULTS REPORTED DELAYING OR NOT SEEKING MEDICAL CARE BECAUSE OF COST. * 32% OF ADULTS REPORTED SOMEONE IN THEIR HOUSEHOLD DID NOT RECEIVE THE HEALTH CARE NEEDED IN 2023. * 62% (ABOUT 4,200) OF ACUTE CARE PATIENTS AT ST. AGNES HOSPITAL SCREENED POSITIVE FOR TRANSPORTATION ACCESS IN 2024. * 5.6% OR 106 CALLS TO 2-1-1 FOR TRANSPORTATION ASSISTANCE (LOW-COST PUBLIC OR LONG-DISTANCE TRAVEL) WERE PLACED IN 2023.PROGRESS MADE SINCE 2021* HEALTHY LIVING WITH DIABETES WAS OFFERED SUMMER OF 2024 AT ST. AGNES HOSPITAL, THROUGH A COLLABORATIVE EFFORT WITH SSM HEALTH, FOND DU LAC COUNTY HEALTH DEPARTMENT AND YMCA. CLASSES WERE OFFERED TO THOSE WITH A RECENT DIABETES DIAGNOSIS.GOALS & OBJECTIVES INCREASE UTILIZATION OF HEALTH NAVIGATORS IN THE COMMUNITY.* PARTICIPATE IN A NEW ACCESS TO HEALTH CARE WORKGROUP, AT LEAST SIX TIMES ANNUALLY.* CONDUCT AN ENVIRONMENTAL SCAN OF TRANSPORTATION RESOURCES.* BUILD PATHWAYS DOCUMENT FOR PATIENTS TO ACCESS TRANSPORTATION SERVICES.* REEVALUATE CURRENT PATIENT TRANSPORTATION POLICY TO BE USEFUL AND CONCISE.THE CHNA ALSO IDENTIFIED THE FOLLOWING AS TOP HEALTH AREAS THAT WERE NOT SELECTED BY THE COMMUNITY PARTICIPANTS TO BE IN THE TOP THREE PRIORITIES TO ADDRESS:* VIOLENCE AND CRIME* HOUSING * CHILDCARE ST. AGNES HOSPITAL PART V, SECTION B, LINE 13H: SSM HEALTH MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS, INCLUDING BUT NOT LIMITED TO THE HOMELESS POPULATION, WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. IRREGULARLY, IN THE ABSENCE OF USING THE PREDICTIVE ANALYTICAL SOFTWARE, PRESUMPTIVE CHARITY MAY BE AUTHENTICATED BY THE PATIENT CARE TEAM AS REPRESENTED AS CHARITY OR UNINSURED DISCOUNTS TO THE PATIENTS' FINANCIAL OBLIGATION.ADDITIONALLY, PATIENTS MAY BE ELIGIBLE TO RECEIVE A DISCOUNT ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS. 4 1 - FOND DU LAC REGIONAL CLINIC 420 E DIVISION STREET FOND DU LAC WI 54935 OUTPATIENT CLINIC 2 - CONSULTANTS LAB OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC WI 54935 LABORATORY AND TESTING 3 - AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC WI 54935 PHARMACEUTICALS, HOME HEALTH, AND MEDICAL SUPPLIES 4 - SSM HEALTH EYE CARE 421 CAMELOT DRIVE FOND DU LAC WI 54935 OUTPATIENT CLINIC PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE WILL BE CONSIDERED FOR THOSE INDIVIDUALS WHO:* HAVE LIMITED OR NO HEALTH INSURANCE;* COOPERATE WITH SSM HEALTH'S POLICIES AND PROCEDURES;* DEMONSTRATE FINANCIAL NEED;* SUPPLY ALL REQUIRED INFORMATION TO PROCESS THE APPLICATION; AND * REIMBURSES THE HOSPITAL FOR ANY MONIES PAID DIRECTLY TO PATIENT BY INSURANCE. PATIENTS WHOSE FAMILY INCOME EXCEED 400% OF THE FEDERAL POVERTY GUIDELINES (FPL) MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF THE HOSPITAL. IN SUCH CASES, OTHER FACTORS MAY BE CONSIDERED IN DETERMINING THEIR ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES, INCLUDING:*BANK ACCOUNTS, INVESTMENTS AND OTHER ASSETS*EMPLOYMENT STATUS AND EARNING CAPACITY*AMOUNT AND FREQUENCY OF BILLS FOR HEALTH CARE SERVICES*OTHER FINANCIAL OBLIGATIONS AND EXPENSES*GENERALLY, FINANCIAL RESPONSIBILITY WILL BE NO MORE THAN 25% OF GROSS FAMILY INCOME.SSM HEALTH MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS, INCLUDING BUT NOT LIMITED TO THE HOMELESS POPULATION, WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. IRREGULARLY, IN THE ABSENCE OF USING THE PREDICTIVE ANALYTICAL SOFTWARE, PRESUMPTIVE CHARITY MAY BE AUTHENTICATED BY THE PATIENT CARE TEAM AS REPRESENTED AS CHARITY OR UNINSURED DISCOUNTS TO THE PATIENTS' FINANCIAL OBLIGATION. PART I, LINE 6A: SSM HEALTH CARE CORPORATION FILES A COMBINED COMMUNITY BENEFIT REPORT FOR ALL ITS AFFILIATES. THE COMMUNITY BENEFIT REPORT CAN BE FOUND ON SSM'S WEBSITE AT: HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH. PART I, LINE 7: THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A, 7B, AND 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E, 7F, 7G, 7H, AND 7I ARE REPORTED AT COST AS REPORTED. THE CALCULATION OF FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F UTILIZES FORM 990, PART IX, LINE 25, COLUMN A, WHICH DOES NOT INCLUDE BAD DEBT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: SSM HEALTH ST. AGNES HOSPITAL PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN SCHEDULE H, PART II ST. AGNES HOSPITAL INCLUDE THE FOLLOWING:* JOB SHADOWS & MENTORSHIP PROGRAMS * ENVIRONMENTAL IMPROVEMENTS SHARPS HOME COLLECTION DISPOSAL PART III, LINE 2: AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. PART III, LINE 3: FOR FINANCIAL STATEMENT PURPOSES, SSM HEALTH HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDE BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THEREFORE, THERE IS NO AMOUNT REPORTED ON PART III, LINE 3 FOR THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER SSM HEALTH'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: AGNESIAN HEALTHCARE, INC. IS PART OF THE SSM HEALTH CONSOLIDATED AUDIT. THE FOOTNOTE THAT REFERENCES THE TREATMENT OF UNCOLLECTIBLE ACCOUNTS AND IMPLICIT PRICE CONCESSIONS IN THE DECEMBER 31, 2024 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COSTS REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST. PART III, LINE 9B: THE HOSPITALS HAVE ESTABLISHED A WRITTEN CREDIT AND COLLECTION POLICY AND PROCEDURES. THE BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES OF SSM HEALTH, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE, THE HOSPITAL EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH IT PARTICIPATES BY ESTABLISHING SOUND BUSINESS PRACTICES. THE HOSPITALS' BILLING AND COLLECTION PRACTICES WILL BE FAIRLY AND CONSISTENTLY APPLIED.ALL STAFF AND VENDORS ARE EXPECTED TO TREAT ALL PATIENTS CONSISTENTLY AND FAIRLY, REGARDLESS OF THEIR ABILITY TO PAY. THEY RESPOND TO PATIENTS IN A PROMPT AND COURTEOUS MANNER REGARDING ANY QUESTIONS ABOUT THEIR BILLS AND PROVIDE NOTIFICATION OF THE AVAILABILITY OF FINANCIAL ASSISTANCE.ALL UNINSURED PATIENTS WILL BE PROVIDED A STANDARD DISCOUNT FOR MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES, INCLUDING SERVICES PROVIDED AT OFF-CAMPUS OUTPATIENT SITES. THE HOSPITAL DETERMINED THE AMOUNT OF THE DISCOUNT BASED ON THE LOCAL MANAGED CARE MARKET, APPLICABLE STATUTORY REQUIREMENTS AND OTHER RELEVANT LOCAL CIRCUMSTANCES. THE RATE MUST BE NO LESS THAN THE LOWEST EFFECTIVE DISCOUNT RATE AND NO GREATER THAN THE HIGHEST EFFECTIVE DISCOUNT RATE FOR THE CURRENT MANAGED CARE CONTRACTS OF THE HOSPITAL. UNINSURED PATIENTS MAY ALSO QUALIFY FOR AN ADDITIONAL DISCOUNT BASED UPON FINANCIAL NEED UNDER THE SYSTEM FINANCIAL ASSISTANCE POLICY.ALL ACCOUNTS DUE FROM THE PATIENT WILL RECEIVE A STATEMENT AFTER DISCHARGE OR AFTER FINAL ADJUDICATION FROM PATIENT'S INSURANCE. GENERALLY, THE PATIENT WILL RECEIVE 4 MONTHS (120 DAYS) OF IN-HOUSE COLLECTION EFFORTS (INCLUDING EARLY OUT VENDORS) AND 12 MONTHS OF BAD DEBT COLLECTION EFFORTS. THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO DETERMINE FAP ELIGIBILITY INCLUDING:1. THE FINANCIAL ASSISTANCE SUMMARY WILL BE INCLUDED WITH EACH BILLING STATEMENT2. EXTRAORDINARY COLLECTION ACTIVITY (ECAS) MAY NOT OCCUR UNTIL BAD DEBT PLACEMENT AND ONLY AFTER 120 DAYS.3. ECAS MUST BE SUSPENDED IF A GUARANTOR SUBMITS A FAP APPLICATION DURING THE APPLICATION PERIOD.4. REASONABLE MEASURES MUST BE TAKEN TO REVERSE ECAS IF THE APPLICATION IS APPROVED WHICH MAY INCLUDE REFUNDING ANY PAYMENTS MADE IN EXCESS OF AMOUNTS OWED AS AN FAP-ELIGIBLE INDIVIDUAL.5. BAD DEBT VENDORS WILL GAIN WRITTEN APPROVAL FROM SSM PRIOR TO ENGAGING IN ECAS. SSM WILL REVIEW THE ACCOUNTS AND VERIFY SATISFACTORY COMPLETION OF REASONABLE EFFORTS DURING THE NOTIFICATION AND APPLICATION PERIOD.A WAIVER IS NOT CONSIDERED REASONABLE EFFORTS. OBTAINING A SIGNED WAIVER THAT AN INDIVIDUAL DOES NOT WISH TO APPLY FOR FAP ASSISTANCE OR RECEIVE FAP APPLICATION INFORMATION WILL NOT MEET THE REQUIREMENT TO MAKE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE BEFORE ENGAGING IN ECAS.ALL OUTSIDE COLLECTION AGENCIES MUST COMPLY WITH STATE AND FEDERAL LAWS, COMPLY WITH THE ASSOCIATION OF CREDIT AND COLLECTION PROFESSIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY AND COMPLY WITH THE HOSPITAL'S COLLECTION AND FINANCIAL ASSISTANCE POLICIES. PART VI, LINE 2: SSM HEALTH (SSMH) PARTICIPATES IN COMMUNITY BENEFIT ACCORDING TO OUR VISION, THROUGH OUR PARTICIPATION IN THE HEALING MINISTRY OF JESUS CHRIST, COMMUNITIES, ESPECIALLY THOSE THAT ARE ECONOMICALLY, PHYSICALLY, AND SOCIALLY MARGINALIZED, WILL EXPERIENCE IMPROVED HEALTH IN MIND, BODY, SPIRIT AND ENVIRONMENT. IN THE TRADITION OF OUR FOUNDERS, THE FRANCISCAN SISTERS OF MARY, CARING FOR THOSE IN GREATEST NEED REMAINS OUR ORGANIZATIONAL PRIORITY. TODAY OUR SYSTEM BOARD MONITORS COMMUNITY BENEFIT EFFORTS, AND VIEWS ACHIEVEMENT OF OUR VISION AS A PRIMARY RESPONSIBILITY.THE PURPOSE OF SSMH'S COMMUNITY BENEFIT PROGRAM IS TO ASSESS AND ADDRESS COMMUNITY HEALTH NEEDS. MAKING OUR COMMUNITIES HEALTHIER IN MEASURABLE WAYS IS ALWAYS OUR GOAL. TO FULFILL THIS COMMITMENT, SSMH'S COMMUNITY BENEFIT IS DIVIDED INTO TWO PARTS: 1) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND 2) COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA).THE CHNA IS AN ASSESSMENT AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS AND THE ADOPTION AND IMPLEMENTATION OF STRATEGIES TO ADDRESS THOSE NEEDS. A CHNA IS CONDUCTED EVERY THREE YEARS BY EACH HOSPITAL ACCORDING TO THEFOLLOWING STEPS:*ASSESS AND PRIORITIZE COMMUNITY HEALTH NEEDS: GATHER CHNA DATA FROM SECONDARY SOURCES; OBTAIN INPUT FROM STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY THROUGH INTERVIEWS AND FOCUS GROUPS; USE DATATO SELECT TOP HEALTH PRIORITIES; AND COMPLETE WRITTEN CHNA.*DEVELOP, ADOPT, AND IMPLEMENT STRATEGIES TO ADDRESS TOP-HEALTH PRIORITIES: ESTABLISH STRATEGIES TO ADDRESS PRIORITIES; COMPLETE STRATEGIC IMPLEMENTATION PLAN; OBTAIN REGIONAL/DIVISIONAL BOARD APPROVAL; AND INTEGRATE STRATEGIES INTO OPERATIONAL PLAN.*MAKE CHNA WIDELY AVAILABLE TO THE PUBLIC: PUBLISH CHNA AND SUMMARY DOCUMENT ON HOSPITAL'S WEBSITE.*MONITOR, TRACK, AND REPORT PROGRESS ON TOP HEALTH PRIORITIES: COLLECT DATA AND EVALUATE PROGRESS; REPORT TO REGIONAL/DIVISIONAL BOARD EVERY SIX MONTHS AND SYSTEM BOARD EVERY YEAR; SHARE FINDINGS WITH COMMUNITYSTAKEHOLDERS; AND SEND RESULTS TO FINANCE FOR SUBMISSION TO THE INTERNAL REVENUE SERVICE (IRS).SYSTEM OFFICE STAFF AND LEADERS OVERSEE AND MONITOR SSMH'S COMMUNITY BENEFIT PROGRAM, AND ENSURE REPORTING IS IN COMPLIANCE WITH IRS REGULATIONS. IN COLLABORATION WITH COMMUNITY STAKEHOLDERS AND PARTNER ORGANIZATIONS, SSM HEALTH CARE CORPORATION ALSO IDENTIFIES NEEDS BASED ON ASSESSMENTS AND RESEARCH, AND SSMH FACILITIES ALSO INVOLVE CASE MANAGERS AND CARE TEAM STAFF TO PINPOINT CRITICAL HEALTH ISSUES IN THE COMMUNITY. ALL HOSPITAL CHNAS ARE COMPLETED, APPROVED, AND INTEGRATED INTO THE ORGANIZATION'S STRATEGIC PLAN. WE CONTINUE TO MONITOR AND ASSESS THE PROGRESS OF OUR LOCAL EFFORTS IN THE SPIRIT OF CARING FOR OTHERS AND IMPROVING COMMUNITY HEALTH. PART VI, LINE 3: EACH ENTITY PROVIDING MEDICAL SERVICE SHALL PROVIDE INFORMATION TO THE PUBLIC REGARDING ITS CHARITY CARE POLICIES AND THE QUALIFICATION REQUIREMENTS FOR EACH OF ITS FACILITIES. WHEN STANDARD SYSTEM NOTICES AND COMMUNICATION REGARDING CHARITY CARE ARE AVAILABLE, THESE MUST BE USED. MODIFICATIONS TO THE STANDARD MAY BE MADE TO COMPLY WITH STATE AND LOCAL LAWS, AS WELL AS REFLECT CULTURALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES ARE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY PROVIDE INFORMATION ABOUT:* THE PATIENT'S RESPONSIBILITY FOR PAYMENT,* THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND ENTITY CHARITY CARE AND PAYMENT ARRANGEMENTS* THE ENTITY'S CHARITY POLICY AND APPLICATION PROCESS, AND* WHO TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELING THE FOLLOWING TYPES OF NOTICES TO THE PUBLIC ARE PROVIDED:*SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS.*BROCHURES OR FLIERS PROVIDED AT TIME OF REGISTRATION AND AVAILABLE IN THE FINANCIAL COUNSELING AREAS.*NOTICES SENT WITH OR ON PATIENT BILLS OR COMMUNICATIONS SENT TO PATIENTS AND GUARANTORS RELATED TO MEDICAL SERVICES.*APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION.THE APPLICATION FOR CHARITY CARE, TOGETHER WITH ANY INSTRUCTIONS, MUST CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES IS ALSO PROVIDED TO PUBLIC AGENCIES. PART VI, LINE 4: COUNTY INCLUDE, 6.4% HISPANIC/LATINX, 2.3% BLACK/AFRICAN AMERICAN AND 1.2% ASIAN. FOND DU LAC COUNTY'S POPULATION IS 50.4% FEMALE AND 49.6% MALE.THE PERCENTAGE OF FOND DU LAC COUNTY ADULTS WITH A HIGH SCHOOL EDUCATION IS 51% COMPARED TO THE STATE PERCENTAGE OF 42%. FOND DU LAC COUNTY HAS A SIGNIFICANTLY LOWER POPULATION WITH A COLLEGE EDUCATION AT 15% COMPARED TO THE STATE AT 23%. THE PERCENTAGE OF PERSONS LIVING IN POVERTY IS COMPARABLE IN FOND DU LAC COUNTY AT 9.6% AND THE STATE AT 10.7%. FOND DU LAC COUNTY AND THE SSM HEALTH ST. AGNES HOSPITAL SERVICE AREA INCLUDE PEOPLE WHO ARE HIGH RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE DUE TO BEING UNINSURED/UNDERINSURED, ARE EXPERIENCING HEALTH DISPARITIES, OR FACING BARRIERS RELATED TO GEOGRAPHY, LANGUAGE, FINANCIAL CIRCUMSTANCES, TRANSPORTATION, STIGMA, ACCESSIBILITY TO TECHNOLOGY OR KNOWLEDGE OF TECHNOLOGY, MEDICATION COMPLIANCE DUE TO COST OR COVERAGE, ACCESS TO HEALTHY FOODS, AND LOW-INCOME HOUSING. POTENTIALLY MEDICALLY UNDERSERVED POPULATIONS INCLUDE THE RURAL, POOR, AND OLDER ADULTS WHO MAY BE WITHOUT ADEQUATE TRANSPORTATION; BLACK, INDIGENOUS AND OTHER PERSONS OF COLOR (BIPOC) INDIVIDUALS WHO MAY BE EXPERIENCING DISCRIMINATION AND RACIAL OR ETHNIC HEALTH DISPARITIES; NON-ENGLISH (PRIMARILY SPANISH) SPEAKING INDIVIDUALS WHO MAY ALSO BE UNDOCUMENTED; LOW SOCIO-ECONOMIC STATUS (SES) AND HOMELESS INDIVIDUALS; LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER (LGBTQ+) RESIDENTS; AND INCARCERATED INDIVIDUALS OR PEOPLE IN THE CRIMINAL JUSTICE SYSTEM. PART VI, LINE 5: COUNTY INCLUDE, 6.4% HISPANIC/LATINX, 2.3% BLACK/AFRICAN AMERICAN AND 1.2% ASIAN. FOND DU LAC COUNTY'S POPULATION IS 50.4% FEMALE AND 49.6% MALE.THE PERCENTAGE OF FOND DU LAC COUNTY ADULTS WITH A HIGH SCHOOL EDUCATION IS 51% COMPARED TO THE STATE PERCENTAGE OF 42%. FOND DU LAC COUNTY HAS A SIGNIFICANTLY LOWER POPULATION WITH A COLLEGE EDUCATION AT 15% COMPARED TO THE STATE AT 23%. THE PERCENTAGE OF PERSONS LIVING IN POVERTY IS COMPARABLE IN FOND DU LAC COUNTY AT 9.6% AND THE STATE AT 10.7%. FOND DU LAC COUNTY AND THE SSM HEALTH ST. AGNES HOSPITAL SERVICE AREA INCLUDE PEOPLE WHO ARE HIGH RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE DUE TO BEING UNINSURED/UNDERINSURED, ARE EXPERIENCING HEALTH DISPARITIES, OR FACING BARRIERS RELATED TO GEOGRAPHY, LANGUAGE, FINANCIAL CIRCUMSTANCES, TRANSPORTATION, STIGMA, ACCESSIBILITY TO TECHNOLOGY OR KNOWLEDGE OF TECHNOLOGY, MEDICATION COMPLIANCE DUE TO COST OR COVERAGE, ACCESS TO HEALTHY FOODS, AND LOW-INCOME HOUSING. POTENTIALLY MEDICALLY UNDERSERVED POPULATIONS INCLUDE THE RURAL, POOR, AND OLDER ADULTS WHO MAY BE WITHOUT ADEQUATE TRANSPORTATION; BLACK, INDIGENOUS AND OTHER PERSONS OF COLOR (BIPOC) INDIVIDUALS WHO MAY BE EXPERIENCING DISCRIMINATION AND RACIAL OR ETHNIC HEALTH DISPARITIES; NON-ENGLISH (PRIMARILY SPANISH) SPEAKING INDIVIDUALS WHO MAY ALSO BE UNDOCUMENTED; LOW SOCIO-ECONOMIC STATUS (SES) AND HOMELESS INDIVIDUALS; LESBIAN, GAY, BISEXUAL, TRANSGENDER AND QUEER (LGBTQ+) RESIDENTS; AND INCARCERATED INDIVIDUALS OR PEOPLE IN THE CRIMINAL JUSTICE SYSTEM. PART VI, LINE 6: AGNESIAN HEALTHCARE, INC. IS A 501(C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. SSM HEALTH CARE CORPORATION (SSMHCC), A MISSOURI NONPROFIT CORPORATION, IS THE ULTIMATE PARENT ENTITY OF A FULLY INTEGRATED HEALTH SYSTEM WITH ITS HEADQUARTERS BASED IN ST. LOUIS, MISSOURI. SSMHCC AND ITS CONSOLIDATED SUBSIDIARIES (DOING BUSINESS AS SSM HEALTH (SSMH) OWNS AND OPERATES 23 ACUTE CARE HOSPITALS, ONE OF WHICH SPECIALIZES IN PEDIATRICS, TWELVE POST-ACUTE CARE FACILITIES, A NATIONAL PHARMACY BENEFIT MANAGEMENT COMPANY (PBM), AN EXTENSIVE NETWORK OF PHYSICIAN PRACTICE OPERATIONS, OTHER HEALTH CARE BUSINESSES AND SEVERAL FOUNDATIONS. SSMH'S HOSPITAL OPERATIONS ARE LOCATED PRIMARILY IN MISSOURI, WISCONSIN, OKLAHOMA AND ILLINOIS, AND ITS RELATED BUSINESSES PROVIDE HEALTH RELATED SERVICES IN 50 STATES. SSMH'S MISSION STATEMENT IS AS FOLLOWS:THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.SSMHCC AND MOST OF ITS AFFILIATED SUBSIDIARY CORPORATIONS HAVE BEEN GRANTED EXEMPTION FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). CERTAIN SUBSIDIARIES OF SSMH ARE FOR-PROFIT ENTITIES THAT ARE TAXABLE UNDER THE IRC.SSMH IS SPONSORED BY SSM HEALTH MINISTRIES, A MINISTERIAL JURIDIC PERSON, WHICH IS CURRENTLY COMPOSED OF ONE FRANCISCAN SISTER OF MARY (FSM), ONE SISTER OF ST. AGNES, ONE JESUIT PRIEST, ONE FRANCISCAN PRIEST, AND FOUR LAY PERSONS WHO COLLECTIVELY HOLD CERTAIN RESERVED POWERS OVER SSMH. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 SOCIETY OF ST VINCENT DE PAUL FOND DU LAC COUNTY 330 N PETERS AVENUE FOND DU LAC WI 54935 390824875 501(C)(3) 10000 0 GENERAL SUPPORT BOYS & GIRLS CLUB OF FOND DU LAC INC 6 WEST 2ND STREET FOND DU LAC WI 54936 391896496 501(C)(3) 110000 0 GENERAL SUPPORT FOND DU LAC COUNTY 160 S MACY ST FOND DU LAC WI 54935 396005696 GOVERNMENT 20120 0 GENERAL SUPPORT FOND DU LAC FAMILY YMCA 90 W SECOND ST FOND DU LAC WI 54935 390806436 501(C)(3) 75000 0 GENERAL SUPPORT MARIAN UNIVERSITY 3200 COLD SPRING ROAD INDIANAPOLIS IN 46222 350868175 501(C)(3) 30000 0 GENERAL SUPPORT HOLY FAMILY CONGREGATION 271 FOURTH STREET WAY FOND DU LAC WI 54937 391998002 501(C)(3) 27000 0 GENERAL SUPPORT FONDY FOOD PANTRY INC PO BOX 492 FOND DU LAC WI 54936 510156435 501(C)(3) 20000 0 GENERAL SUPPORT SOLUTIONS CENTER SHELTER & SUPPORT SERVICES INC 358 N PETERS AVENUE FOND DU LAC WI 54935 391452956 501(C)(3) 10000 0 GENERAL SUPPORT THE ARC FOND DU LAC INC 500 N PARK AVE FOND DU LAC WI 54935 391034161 501(C)(3) 10000 0 GENERAL SUPPORT FRIENDS OF WOMEN IN RECOVERY INC DBA BEACON HOUSE PO BOX 1524 FOND DU LAC WI 549361524 391678741 501(C)(3) 10000 0 GENERAL SUPPORT FDL SCHOOL DISTRICT ADMINISTRATIVE OFFICES 72 W NINTH STREET FOND DU LAC WI 54935 391411371 GOVERNMENT 20000 0 GENERAL SUPPORT FOND DU LAC LITERACY SVCS INC 32 SHEBOYGAN ST FOND DU LAC WI 54935 391901303 501(C)(3) 10000 0 GENERAL SUPPORT CHILDRENS MUSEUM OF FOND DU LAC INC 75 W SCOTT ST FOND DU LAC WI 54935 562471187 501(C)(3) 10000 0 GENERAL SUPPORT BLANDINE HOUSE INC 25 N PARK AVE FOND DU LAC WI 54935 237025601 501(C)(3) 10000 0 GENERAL SUPPORT FOND DU LAC AREA ASSOCIATION OF COMMERCE FOUNDATION 1020 S MAIN ST SUITE E FOND DU LAC WI 54935 510181570 501(C)(3) 12000 0 GENERAL SUPPORT BIG BROTHERS BIG SISTERS OF FOND DU LAC CO 448 S MILITARY RD FOND DU LAC WI 54935 391330971 501(C)(3) 7500 0 GENERAL SUPPORT MAHALA'S HOPE INC N4590 HWY 45 EDEN WI 53019 841680693 501(C)(3) 6500 0 GENERAL SUPPORT FOND DU LAC COUNTY UNITED WAY 74 S MAIN ST FOND DU LAC WI 54935 390806194 501(C)(3) 20000 0 GENERAL SUPPORT ENVISION GREATER FOND DU LAC 23 SOUTH MAIN ST SUITE 101 FOND DU LAC WI 54935 390284470 501(C)(3) 82000 0 GENERAL SUPPORT DOWNTOWN FOND DU LAC PARTNERSHIP INC 131 S MAIN ST FOND DU LAC WI 54935 461169019 501(C)(3) 10000 0 GENERAL SUPPORT ROBERT E BERRY HALFWAY HOUSE INC ROBERT BERRY HOUSE INC 178 6TH ST FOND DU LAC WI 54935 391085048 501(C)(3) 10000 0 GENERAL SUPPORT SIGMA OF FOND DU LAC PO BOX 733 FOND DU LAC WI 54935 900656442 501(C)(3) 7500 0 GENERAL SUPPORT 21 0 CARING FOR YOU - FOOD ASSISTANCE 24 43350 FMV GROCERY CARDS - FOOD ASSISTANCE PART I, LINE 2: GRANTS ARE MADE TO ORGANIZATIONS AND OFTEN MADE TO RELATED ORGANIZATIONS THAT ARE TAX EXEMPT UNDER SECTION 501(C)(3). THE ORGANIZATIONS HAVE DEVELOPED INTERNAL CONTROL PROCEDURES FOR THE USE OF GRANT FUNDS. ALL GRANTS TO INDIVIDUALS, WHEN APPLICABLE, INCLUDE A GRANT APPLICATION PROCESS THROUGH A PARTNER ORGANIZATION. APPROVED GRANT APPLICATIONS ARE FORWARDED TO THE MONROE CLINIC AND THE CLINIC PAYS THE REQUESTED EXPENDITURES. X 1 1 0 1 0 0 0 0 0 0 0 STEVE SMOOT VICE PRESIDENT, COO AT SSM HEALTH 0 1305272 0 895103 0 164560 0 1075677 0 44021 0 3484633 0 1036001 DOUGLAS LONG SECRETARY, CLO AT SSM HEALTH 0 813979 0 583198 0 189973 0 676547 0 24224 0 2287921 0 583198 SUE ANDERSON DIRECTOR, REGIONAL PRESIDENT 0 787210 0 422941 0 167577 0 527309 0 20931 0 1925968 0 480783 KEVIN SMITH TREASURER, CFO AT SSM HEALTH 0 1034519 0 0 0 15958 0 586407 0 40674 0 1677558 0 0 RANDY COMBS FORMER OFFICER 0 323766 0 923306 0 206949 0 13881 0 15625 0 1483527 0 923306 MATTHEW POGODZINSKI MD DIRECTOR, PHYSICIAN AT SSM HEALTH 0 735611 0 75000 0 2622 0 19513 0 46254 0 879000 0 0 THOMAS KIRSCHBAUM ASST SEC, REG GENERAL COUNSEL 0 400165 0 115798 0 45532 0 136607 0 39165 0 737267 0 115798 MATT KINSELLA REGIONAL VP FINANCE-WISCONSIN 0 417285 0 101437 0 42609 0 132986 0 42091 0 736408 0 121251 MICHAEL VANDER KOOY RADIATION ONCOLOGIST 655899 0 0 0 4902 0 19835 0 52303 0 732939 0 0 0 SYED MOHIUDDIN PHYSICIAN 627785 0 0 0 2468 0 30978 0 42287 0 703518 0 0 0 KRISTOF GEHRKE PHYSICIAN 626587 0 0 0 2484 0 20105 0 44317 0 693493 0 0 0 JACOB WAIDELICH PHYSICIAN 588811 0 20000 0 2622 0 28154 0 46532 0 686119 0 0 0 NOMAN MAHMOOD PHYSICIAN 600681 0 11205 0 744 0 17963 0 45374 0 675967 0 0 0 NANCY BIRSCHBACH FORMER KEY EMPLOYEE 0 346712 0 99898 0 34747 0 120806 0 27246 0 629409 0 128697 TAMARA SCHATTSCHNEIDER VP PATIENT CARE SVCS, CNO 276237 0 32650 0 1453 0 53598 0 40624 0 404562 0 32650 0 KATHERINE VERGOS PRESIDENT - ST. AGNES HOSPITAL 191958 0 135363 0 704 0 13715 0 12408 0 354148 0 172389 0 TARA RHODES VP OPS ST. AGNES HOSPITAL 228810 0 28589 0 9603 0 43845 0 40431 0 351278 0 28589 0 JENNIFER MASKEL MD DIRECTOR, PHYSICIAN AT SSM HEALTH 0 145211 0 0 0 657 0 10712 0 3686 0 160266 0 0 PART I, LINE 1A AN INDIVIDUAL LISTED ON PART VII, SECTION A RECEIVED A TAX INDEMNIFICATION/GROSSUP PAYMENT IN 2024. THE PAYMENT WAS INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, PRESIDENT, IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B PENSION RESTORATION PLAN: SSM HEALTH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2024. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2024. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. STEVE SMOOT - $159,608 MATTHEW KINSELLA - $41,165 TARA RHODES - $8,427 NANCY BIRSCHBACH - $31,375 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DXT8 2017-08-10 62792652 (1) FINANCE CAPITAL IMPROVEMENTS AND (2) REFUND 2010 AND 2012 BONDS 0 0 0 A 11070000 63094342 656999 23301620 39135724 2020 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 A 1 CD SMITH CONSTRUCTION DIRECTOR OF AGNESIAN HEALTHCARE, INC. 1707698 WAYNE MATZKE - BOARD MEMBER OF CD SMITH CONSTRUCTION 0 X 27600 FMV 0 1 0 FORM 990, PART V, LINE 1A ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223. FORM 990, PART VI, SECTION A, LINE 2 DR JEFFREY STRONG, DR BRET PASIUK AND DR THEODORE MILLER - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 IN 2024, AGNESIAN HEALTHCARE, INC. UPATED ITS BYLAWS FOR THE FOLLOWING CHANGES: - CHANGE TO THE SIZE OF THE BOARD OF DIRECTORS AND NUMBER OF EX OFFICIO DIRECTORS - CHANGE TO TERMS AND TERM LIMITS FOR BOARD OF DIRECTORS MEMBERS - CHANGE TO OFFICER POSITIONS AND METHOD FOR APPOINTMENT - CHANGE TO THE COMMITTEES FOR THE HOSPITAL OPERATING ENTITY. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH CARE OF WISCONSIN, INC, IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH AGNESIAN HEALTHCARE INC AND SSM HEALTH CARE OF WISCONSIN, INC. ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED FOR SSM HEALTH CARE CORPORATION (SSMHCC), THE SOLE MEMBER OF SSM HEALTH CARE OF WISCONSIN, INC., THE SOLE MEMBER OF AGNESIAN HEALTHCARE, INC.: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION; B. TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS; C. TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION; D. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN; E. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; F. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; G. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; H. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; I. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; J. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY; K. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS; L. TO APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; M. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION; N. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION; O. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO SSMHCC OR TO ANY OTHER ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY SSMHCC, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF SSMHCC AS DETERMINED BY SSMHCC; P. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN SSMHCC, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE SSMHCC APPROVAL; AND Q. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO SSMHCC WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION (SSM). THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SSM PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED BOARD MEETING FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY OF THE BOARD OVERSEE COMPLIANCE WITH THIS REQUIREMENT. ALL BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAIN FROM BOARD DISCUSSIONS AND VOTES WHEN APPLICABLE. EMPLOYEES WITH PURCHASING AUTHORITY AND/OR ABILITY TO INFLUENCE PURCHASING DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUCH BE COMPLETED ON LINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR END. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THE COMMITTEE REVIEWS COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY THE POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER. ADDITIONALLY, THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 23,089,401. MANAGEMENT AND GENERAL EXPENSES 73,548,407. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,637,808. FORM 990, PART XI, LINE 9: CHANGE IN TEPORARILY RESTRICTED NET ASSETS -7,907,851. BENEFICIAL INTEREST IN FOUNDATION -14,956,165. INITIAL FIXED INCOME ACCOUNTS PAYABLE OFFSET -500. INTERCOMPANY TRANSFERS -97,370,972. 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