2017-05-12T08:17:43-05:00 2016-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2015-07-01 390807236 AGNESIAN HEALTHCARE INC AGNE 9209265519 430 EAST DIVISION ST FOND DU LAC WI 53935 BONNIE SCHMITZ VP AND CFO 9209265519 2017-05-11 1 TERRI REXRODE CPA MST P00096513 9206620016 2017-05-11 2015 2021-01-29 14:40:06Z STEVEN LITTLE CEO 430 EAST DIVISION ST FOND DU LAC WI 53935 445050424 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. 14 10 4120 532 4212865 -964765 620042 848003 332741447 345488864 11492881 8886890 16790832 16174531 361645202 371398288 0 0 0 0 146098380 156598769 0 0 0 192654040 198902309 338752420 355501078 22892782 15897210 534790023 533058855 211346231 216873372 323443792 316185483 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 241025778 337389521 AGNESIAN HEALTHCARE OPERATES ST. AGNES HOSPITAL, A 168-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 2016, ST. AGNES HOSPITAL HAD 6,882 INPATIENT ADMISSIONS, WITH TOTAL PATIENT DAYS OF 27,405. THERE WAS A TOTAL OF 30,314 EMERGENCY ROOM VISITS AND 14,065 SURGERIES PERFORMED IN FY16. IN ADDITION, ST. AGNES HOSPITAL PROVIDED 433,423 PHYSICIAN CLINIC VISITS, 80,210 MEDICAL IMAGING PROCEDURES, AND 1,587,135 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY UNITS. THERE WERE 1,797 CARDIAC CATH LAB VISITS AND 45,390 HOSPICE DAYS. THE HOSPITAL ALSO OPERATES SAMARITAN CLINIC, A FREE CLINIC OFFERING MEDICAL SERVICES TO QUALIFIED INDIVIDUALS. SAMARITAN CLINIC PROVIDED 738 VISITS TO PATIENTS, AT A COST OF $70,570 FOR FY16. 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 $697,912. 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 $3,531,599. 8275395 4363434 AGNESIAN HEALTHCARE OPERATES AGNESIAN ENTERPRISES, WHICH IS COMPRISED OF EIGHT 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 470,149 PRESCRIPTIONS DURING FY16. 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 $3,862. AGNESIAN HEALTHCARE ENTERPRISES CONTRIBUTES TO COMMUNITY BENEFIT WITH SEVERAL SUPPORT GROUPS. THE COST OF THE COMMUNITY BENEFIT WAS $5,958. 1097673 14346584 AGNESIAN HEALTHCARE OPERATES CONSULTANTS LABORATORY OF WISCONSIN, AN INDEPENDENT REFERENCE LAB SERVING FOND DU LAC, DODGE, OUTAGAMIE, WINNEBAGO AND COLUMBIA COUNTIES. CLW PROVIDED 1,083,639 TESTS DURING FISCAL YEAR 2016. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $74,169. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY WAS $24,694. 250398846 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 1 362 0 1 4120 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 14 10 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 821140 0 40806 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 DR STEPHEN MASSICK DIRECTOR 1.00 X 0 0 0 ROBERT MIKKELSEN DIRECTOR 1.00 X 0 0 0 JAMES B SIMON SECRETARY 1.00 X X 5055 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 RICHARD SCHAEFER MD DIRECTOR 1.00 X 0 0 0 THOMAS SCHUESSLER DIRECTOR 1.00 X 0 0 0 JAMES P MUGAN SR VP CLINICAL SERVICES 50.00 X 321789 0 40587 BONNIE R SCHMITZ CHIEF FINANCIAL OFFICER 50.00 X 473353 0 27234 MARY J MOLLISON VP SPIRITUALITY AND CARE 50.00 X 202885 0 8662 SUSAN L EDMINSTER VP - HUMAN RESOURCES 50.00 X 301940 0 38551 NANCY A BIRSCHBACH VP - CIO 50.00 X 312575 0 42871 JILL A STENSON VP NURSING 50.00 X 233256 0 22167 BARBARA L KNUTZEN PRES AND CEO-AHE AND PERFO 50.00 X 253396 0 32369 HOLLY BRENNER VP STRATEGIC DEVELOPMENT/M 50.00 X 237923 0 12381 MICHAEL DEGERE VP POPULATION HEALTH MANAGEMENT 50.00 X 276231 0 39245 MICHAEL DREES CHIEF OPERATING OFFICER FDL REG 50.00 X 269692 0 28501 JOHN CHOI MD ANESTHESIOLOGIST - PAIN RE 50.00 X 815101 0 38795 YASIR HATAHET MD INTENSIVIST/PULMONOLOGIST 50.00 X 931158 0 45476 PONTUS OSTMAN MD MEDICAL DIRECTOR - PAIN MG 50.00 X 657761 0 16760 MICHAEL VANDER KOOY MD RADIATION ONCOLOGIST 50.00 X 629155 0 46426 STEVEN FLURRY MD ANESTHESIOLOGIST 50.00 X 613984 0 43291 H JACK POLLEI FORMER DIRECTOR 1.00 X 11316 0 0 DENNIS C YUNK FORMER SR VP CLINIC ADMINISTRATOR 50.00 X 20501 0 8143 CAROL B HYLAND PRESIDENT AND CEO - CLW 50.00 X 200901 0 28496 7589112 0 560761 178 1 1 0 FOND DU LAC REGIONAL CLINIC 420 E DIVISION ST FOND DU LAC WI 54935 PHYSICIAN SERVICES 51065497 CERNER CORP 2800 ROCKCREEK PKWY KANSAS CITY MO 64141 COMPUTER SERVICES 13517815 CD SMITH CONSTRUCTION PO BOX 1066 FOND DU LAC WI 54935 CONSTRUCTION 6461205 MEDICAL COLLEGE OF WI 8701 WATERTOWN PLANK RD PO BOX 26 WAUWATOSA WI 53226 PHYSICIAN SERVICES 2143140 LOGICALIS INC DEPT # 172301 PO BOX 67000 DETROIT MI 48267 COMPUTER SERVICES 1588311 69 848003 848003 NET PATIENT SERVICE REVENUE 621400 218167086 217358456 808630 MEDICARE/MEDICAID REVENUE 621400 127321778 127321778 345488864 5728903 5728903 86466 86466 49767036 132706 46589107 239114 3177929 -106408 3071521 3071521 36657950 26823915 9834035 6465713 3368322 WORK INJURY/OCC HEALTH 621990 1695000 1695000 MEDICARE EHR 900099 1664294 1664294 CAFETERIA SALES 900099 1386904 35913 1350991 1594298 1594298 6340496 371398288 356099539 4212865 10237881 X 4071386 4071386 131722683 101948990 29773693 6780595 4983397 1797198 5087951 2596709 2491242 8936154 6506793 2429361 504799 504799 126896 126896 72209521 67918404 4291117 1133013 87073 1045940 53350769 51039495 2311274 26316242 279421 26036821 13593270 5244262 8349008 705875 570726 135149 734412 437885 296527 4868009 4868009 15367387 1857939 13509448 1878741 1217974 660767 HOSPITAL ASSESSMENT 5031792 5031792 MISCELLANEOUS 2154369 431398 1722971 INVESTMENT FEES 643963 643963 DUES, SUBSCRIPTIONS, LI 566209 246588 319621 -282958 -282958 355501078 250398846 105102232 0 8449951 4976303 14209288 19075426 51807749 57815091 5783059 5584360 4232055 3746011 376586256 206203978 170956029 170382278 216431616 206669832 62920276 64809554 534790023 533058855 35647967 43689233 136105860 134013484 39592404 39170655 211346231 216873372 X 310945702 302538252 10333000 11481683 2165090 2165548 323443792 316185483 534790023 533058855 X 15897210 -17801786 -5353733 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 17193 17193 0 PART II-B, LINE 1: OTHER LOBBYING ACTIVITIES: LOBBYING PORTION OF WISCONSIN HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND AMERICAN COLLEGE OF RADIOLOGY ASSOCIATION DUES. 1049591 36713 50000 3447 1032857 1039915 13223 3547 1049591 1019387 73707 50000 3179 1039915 1004976 57144 40000 2733 1019387 992140 15366 2530 1004976 1.00000 0 1 1 6681757 6681757 188566502 81614584 106951918 3560267 1798566 1761701 161196888 122790828 38406060 16580842 16580842 170382278 DUE FROM AFFILIATED ENTITIES 433478 LONG TERM DEBT FROM AFFILIATED ENTITY 5000000 INVESTMENT - MERCURY CLINIC 3005130 INVESTMENT - SAH FOUNDATION 11816618 LIMITED USE ASSETS - BOND FUNDS 4853766 LIMITED USE ASSETS - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN 33416460 OTHER RECEIVABLES 5000609 MISCELLANEOUS 1283493 64809554 CAPITAL LEASE PAYABLE 1993347 PHYSICIANS SUPPLEMENTAL BENEFIT PLAN 32671578 FUND BALANCE SWAP MARKET ADJUSTMENT 2926948 DUE TO MEDICARE/MEDICAID 461400 EXECUTIVE DEFERRED COMP PLAN 744882 LAND CONTRACT - FAMILY FOOT CLINIC 372500 39170655 PART V, LINE 4: AGNESIAN HEALTHCARE, INC. HOLDS AN ENDOWMENT FROM THE CONGREGATION OF THE SISTERS OF ST. AGNES. THE ORIGINAL ENDOWMENT OF $1,000,000 IS PERMANENTLY RESTRICTED. INCOME GENERATED FROM THE ENDOWMENT IS 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 1 X 165.000000000000 1 X 1 1 1 0 1 1 726468 726468 0.00210 24925425 24925425 0.07290 25651893 25651893 0.07500 1739850 223423 1516427 0.00440 600486 600486 0.00180 510127 6868 503259 0.00150 4033 4033 0.00000 980653 980653 0.00290 3835149 230291 3604858 0.01060 29487042 230291 29256751 0.08560 10969 10969 0.00000 842 842 0.00000 24031 24031 0.00010 23512 23512 0.00010 59354 59354 0.00020 1 14253152 109140855 169057840 -59916985 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.LIVINGWELLFDL.ORG X X 1 14 1 WWW.LIVINGWELLFDL.ORG 0 0 1 X 165.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X WWW.AGNESIAN.COM X WWW.AGNESIAN.COM 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 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; KIM MUELLER, FOND DU LAC COUNTY HEALTH DEPARTMENT; WARREN POST, MD, AGNESIAN HEALTHCARE; TINA POTTER, FOND DU LAC AREA UNITED WAY; LALITHA RAMAMOORTHY, MARIAN UNIVERSITY; LARRY RICHARDSON, FABOH; SANDI ROEHRIG, FOND DU LAC AREA FOUNDATION; MARTY RYAN, ROTARY; HEATHER SCHMIDT, DO, AGNESIAN HEALTHCARE; STEVE LITTLE, AGNESIAN HEALTHCARE; KEVIN SHAW, ST. MARY'S SPRINGS ACADEMY; MARIAN SHERIDAN, FOND DU LAC SCHOOL DISTRICT; JOHN SHORT, UW FOND DU LAC; MICHELLE TIDEMANN, UW EXTENSION; DEANN THURMER, AGNESIAN HEALTHCARE; KATHERINE VERGOS, AGNESIAN HEALTHCARE; JENNIFER WALTERS, AURORA HEALTHCARE.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. IT 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 2016 WELLNESS CALENDARS TO 75,000 RESIDENTS. ST. AGNES HOSPITAL PART V, SECTION B, LINE 13H: UNINSURED PATIENTS ARE AUTOMATICALLY GIVEN A 15% DISCOUNT. ST. AGNES HOSPITAL PART V, SECTION B, LINE 18D: 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. ST. AGNES HOSPITAL PART V, SECTION B, LINE 22D: UNINSURED PATIENTS AUTOMATICALLY RECEIVE A 15% DISCOUNT OFF GROSS CHARGES. 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, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 14,253,152. 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 ST. AGNES HOSPITAL WITH INSIGHTS INTO COMMMUNITY HEALTH NEEDS AND DESIRES. PART VI, LINE 3: FINANCIAL COUNSELORS AT ST. AGNES HOSPITAL ASSIST PATIENTS WITH THE 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 CALUMET, COLUMBIA, DODGE, FOND DU LAC, GREEN LAKE, MARQUETTE, WASHINGTON, WAUSHARA OR WINNEBAGO. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THOSE 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 WOMENS SERVICES. PART VI, LINE 6: ST. AGNES HOSPITAL IS PART OF AGNESIAN HEALTHCARE, AN INTEGRATED, COMPREHENSIVE NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM COMPRISED OF NINE 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, 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 0 1 0 1 0 0 0 0 0 STEVEN N LITTLE PRESIDENT AND CEO 642271 0 152021 0 26848 0 14600 0 26206 0 861946 0 0 0 JAMES P MUGAN SR VP CLINICAL SERVICES 272953 0 34656 0 14180 0 15287 0 25300 0 362376 0 0 0 BONNIE R SCHMITZ CHIEF FINANCIAL OFFICER 398605 0 52086 0 22662 0 17450 0 9784 0 500587 0 0 0 MARY J MOLLISON VP SPIRITUALITY AND CARE 179909 0 22976 0 0 0 0 0 8662 0 211547 0 0 0 SUSAN L EDMINSTER VP - HUMAN RESOURCES 267275 0 33443 0 1222 0 11069 0 27482 0 340491 0 0 0 NANCY A BIRSCHBACH VP - CIO 276675 0 34910 0 990 0 13840 0 29031 0 355446 0 0 0 JILL A STENSON VP NURSING 202634 0 25288 0 5334 0 10543 0 11624 0 255423 0 0 0 BARBARA L KNUTZEN PRES AND CEO-AHE AND PERFO 223203 0 27308 0 2885 0 11484 0 20885 0 285765 0 0 0 HOLLY BRENNER VP STRATEGIC DEVELOPMENT/M 200911 0 23318 0 13694 0 11096 0 1285 0 250304 0 0 0 MICHAEL DEGERE VP POPULATION HEALTH MANAGEMENT 231803 0 26163 0 18265 0 15480 0 23765 0 315476 0 0 0 MICHAEL DREES CHIEF OPERATING OFFICER FDL REG 236286 0 25025 0 8381 0 435 0 28066 0 298193 0 0 0 JOHN CHOI MD ANESTHESIOLOGIST - PAIN RE 590231 0 222548 0 2322 0 15600 0 23195 0 853896 0 0 0 YASIR HATAHET MD INTENSIVIST/PULMONOLOGIST 468789 0 370407 0 91962 0 14103 0 31373 0 976634 0 0 0 PONTUS OSTMAN MD MEDICAL DIRECTOR - PAIN MG 401962 0 252235 0 3564 0 15600 0 1160 0 674521 0 0 0 MICHAEL VANDER KOOY MD RADIATION ONCOLOGIST 602504 0 0 0 26651 0 15600 0 30826 0 675581 0 0 0 STEVEN FLURRY MD ANESTHESIOLOGIST 603613 0 0 0 10371 0 15600 0 27691 0 657275 0 0 0 H JACK POLLEI FORMER DIRECTOR 11316 0 0 0 0 0 0 0 0 0 11316 0 0 0 DENNIS C YUNK FORMER SR VP CLINIC ADMINISTRATOR 0 0 0 0 20501 0 8143 0 0 0 28644 0 0 0 CAROL B HYLAND PRESIDENT AND CEO - CLW 124744 0 28555 0 47602 0 16377 0 12119 0 229397 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, 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. 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 4875000 49330000 430000 48900000 2005 1 0 1 1 B 6260000 57260000 4518399 31465565 767686 20498350 2014 1 0 0 1 C 5025000 10020000 9930000 90000 2011 1 0 1 1 D 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 ROBERT MIKKELSEN MD DIRECTOR 44903 ROBERT MIKKELSEN'S STEP-DAUGHTER, KAYLA AVILA, IS EMPLOYED AS AN RN AT AGNESIAN HEALTHCARE, EARNING AN ANNUAL SALARY OF $44,903. 0 JAMES CHATTERTON DIRECTOR 25278 JIM CHATTERTON IS PRESIDENT OF AMERICAN BANK. AGNESIAN HEALTHCARE, INC PROVIDED OCCUPATIONAL HEALTH SERVICES TO AMERICAN BANK, BILLING $25,278 OF THESE SERVICES IN FISCAL YEAR 2016. 0 RICHARD SCHAEFER MD DIRECTOR 61384 RICHARD SCHAEFER'S WIFE, EVELYN SCHAEFER, IS EMPLOYED AS A PSYCHOLOGIST AT AGNESIAN HEALTHCARE, EARNING AN ANNUAL SALARY OF $61,384. 0 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 11 THE FINANCE DEPARTMENT PREPARES THE FORM 990 AND THE RETURN IS REVIEWED BY THE DIRECTOR OF FINANCE AND CFO. A FINAL COPY OF THE 2015 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 VI, SECTION B, LINE 15B AN ANNUAL SURVEY IS PERFORMED BY AN OUTSIDE COMPANY. FORM 990, PART IX, LINE 11G PURCHASED SERVICES - PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 7,151,956. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,151,956. PURCHASED SERVICES - LABORATORY: PROGRAM SERVICE EXPENSES 187,366. MANAGEMENT AND GENERAL EXPENSES 6,973. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 194,339. PURCHASED SERVICES - ELEVATOR: PROGRAM SERVICE EXPENSES 4,973. MANAGEMENT AND GENERAL EXPENSES 133,173. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,146. PURCHASED SERVICES - MISCELLANEOUS: PROGRAM SERVICE EXPENSES 57,727,436. MANAGEMENT AND GENERAL EXPENSES 1,749,894. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,477,330. PURCHASED SERVICES - TEMPORARY STAFF: PROGRAM SERVICE EXPENSES 768,442. MANAGEMENT AND GENERAL EXPENSES 107,362. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 875,804. PURCHASED SERVICES - REFERENCE TESTS: PROGRAM SERVICE EXPENSES 1,063,514. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,063,514. PURCHASED SERVICES - HOUSEKEEPING: PROGRAM SERVICE EXPENSES 79,883. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,883. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 661,534. MANAGEMENT AND GENERAL EXPENSES 331,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 992,534. PROFESSIONAL FEES - MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 267,180. MANAGEMENT AND GENERAL EXPENSES 13,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 280,180. PROFESSIONAL FEES - COLLECTION: PROGRAM SERVICE EXPENSES 6,120. MANAGEMENT AND GENERAL EXPENSES 904,518. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 910,638. PURCHASED SERVICES - LAUNDRY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 782,954. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 782,954. PURCHASED SERVICES - TRANSCRIPTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 262,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 262,243. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTIONS FROM AFFILIATES -1,000,000. CHANGE IN SWAP FUND BALANCE -730,140. CHANGE IN FUND BALANCE - SAH FOUNDATION 1,054,498. CAPITAL CONTRIBUTIONS - FOUNDATION 298,357. CAPITAL CONTRIBUTIONS - OTHER 23,552. CSA LEGACY CONTRIBUTIONS -5,000,000. CONSULTANTS LABORATORY OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC WI 54935 391528550 LAB SERVICES WI 28136703 23014321 N/A AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC WI 54935 392038757 RETAIL PHARMACY WI 9927784 10269336 N/A ST FRANCIS HOME OF FOND DU LAC 33 EVERETT STREET FOND DU LAC WI 54935 391029998 NURSING HOME WI 501(C)(3) 9 N/A 0 CONGREGATION OF SISTERS OF ST AGNES 320 COUNTY ROAD K FOND DU LAC WI 54935 390806217 CONVENT WI 501(C)(3) 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) 3 N/A 0 RIPON MEDICAL CENTER 845 PARKSIDE STREET RIPON WI 54971 391101287 HOSPITAL WI 501(C)(3) 3 N/A 0 VILLA ROSA INC N8120 COUNTY WW MOUNT CALVARY WI 53057 421670962 NURSING HOME WI 501(C)(3) 9 N/A 0 SISTER SERVANTS OF CHRIST THE KING N8114 COUNTY WW MOUNT CALVARY WI 53057 391022770 NURSING HOME WI 501(C)(3) 9 N/A 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 1 AGNESIAN HEALTHCARE FOUNDATION INC C 848003 CASH RECEIPTS ST FRANCIS HOME D 5000000 BOND VALUE ST FRANCIS HOME M 63202 CASH PAYMENTS CONGREGATION OF SISTERS OF ST AGNES M 5327039 CASH PAYMENTS CONGREGATION OF SISTERS OF ST AGNES O 425115 CASH PAYMENTS WAUPUN MEMORIAL HOSPITAL O 531186 CASH TRANSFER RIPON MEDICAL CENTER P 80625 CASH TRANSFER VILLA LORETTO-SISTER SERVANT OF CHRIST M 2000 CASH PAYMENTS