AGNESIAN HEALTHCARE INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: AGNESIAN HEALTHCARE INC (EIN 39-0807236)
Tax period: 2014-07-01 to 2015-06-30
Filed: 2016-05-12
IRS object ID: 201631339349304508
Schema version: 2014v6.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-05-12T15:02:52-05:00	ReturnTs
Tax Period End	2015-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

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

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

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

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2014-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390807236	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	AGNESIAN HEALTHCARE INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AGNE	BusinessNameControlTxt
Phone	9209264512	PhoneNum

US Address USAddress

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

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	BONNIE SCHMITZ	PersonNm
Person Title	VP AND CFO	PersonTitleTxt
Phone	9209264512	PhoneNum
Signature	2016-05-12	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	TERRI REXRODE CPA MST	PreparerPersonNm
PTIN	P00096513	PTIN
Phone	9206620016	PhoneNum
Preparation	2016-05-12	PreparationDt

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-08-17 19:52:53Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	STEVEN LITTLE CEO	PrincipalOfficerNm

US Address USAddress

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

Field	Value	IRS element (for citing)
Gross Receipts	$428,222,698	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
All Affiliates Included	Yes (1)	AllAffiliatesIncludedInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.AGNESIAN.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1892	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	AGNESIAN HEALTHCARE IS A LOCALLY-BASED, INTEGRATED HEALTHCARE SYSTEM WHICH BEGAN ITS MISSION IN 1892. THE SYSTEM IS COMPRISED OF SEVEN MINISTRIES - ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, RIPON MEDICAL CENTER, ST. FRANCIS HOME, FOND DU LAC REGIONAL CLINIC, CONSULTANTS LABORATORY OF WISCONSIN, AND AGNESIAN HEALTHCARE ENTERPRISES. AGNESIAN PROVIDES A CONTINUUM OF HEALTHCARE SERVICES FROM BIRTH TO END OF LIFE, PREVENTIVE HEALTHCARE DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT SKILL CARE SERVICES.	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	3823	TotalEmployeeCnt
Total Volunteers	580	TotalVolunteersCnt
Total Gross UBI	$4,921,511	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$203,752	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$0	PYContributionsGrantsAmt
CY Contributions Grants	$620,042	CYContributionsGrantsAmt
PY Program Service Revenue	$313,130,739	PYProgramServiceRevenueAmt
CY Program Service Revenue	$332,741,447	CYProgramServiceRevenueAmt
PY Investment Income	$7,711,309	PYInvestmentIncomeAmt
CY Investment Income	$11,492,881	CYInvestmentIncomeAmt
PY Other Revenue	$18,516,764	PYOtherRevenueAmt
CY Other Revenue	$16,790,832	CYOtherRevenueAmt
PY Total Revenue	$339,358,812	PYTotalRevenueAmt
CY Total Revenue	$361,645,202	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$141,083,903	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$146,098,380	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$182,688,316	PYOtherExpensesAmt
CY Other Expenses	$192,654,040	CYOtherExpensesAmt
PY Total Expenses	$323,772,219	PYTotalExpensesAmt
CY Total Expenses	$338,752,420	CYTotalExpensesAmt
PY Revenues Less Expenses	$15,586,593	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$22,892,782	CYRevenuesLessExpensesAmt
Total Assets BOY	$513,745,283	TotalAssetsBOYAmt
Total Assets EOY	$534,790,023	TotalAssetsEOYAmt
Total Liabilities BOY	$212,513,802	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$211,346,231	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$301,231,481	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$323,443,792	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH AS WE CONTINUE THE MISSION OF OUR SPONSOR, THE CONGREGATION OF SISTERS OF ST. AGNES.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$222,006,512	ExpenseAmt
Revenue	$323,745,476	RevenueAmt
Desc	AGNESIAN HEALTHCARE OPERATES ST. AGNES HOSPITAL, A 160-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 2015, ST. AGNES HOSPITAL HAD 6,866 INPATIENT ADMISSIONS, WITH TOTAL PATIENT DAYS OF 27,354. THERE WAS A TOTAL OF 29,278 EMERGENCY ROOM VISITS AND 13,033 SURGERIES PERFORMED IN FY15. IN ADDITION, ST. AGNES HOSPITAL PROVIDED 419,382 PHYSICIAN CLINIC VISITS, 78,539 MEDICAL IMAGING PROCEDURES, AND 1,460,370 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY UNITS. THERE WERE 1,731 CARDIAC CATH LAB VISITS AND 47,643 HOSPICE DAYS. THE HOSPITAL ALSO OPERATES SAMARITAN CLINIC, A FREE CLINIC OFFERING MEDICAL SERVICES TO QUALIFIED INDIVIDUALS. SAMARITAN CLINIC PROVIDED 870 VISITS TO PATIENTS, AT A COST OF $302,204 FOR FY15. 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 $1,144,601. 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 $3,753,216.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$2,111,753	ExpenseAmt
Revenue	$13,994,419	RevenueAmt
Desc	AGNESIAN HEALTHCARE OPERATES CONSULTANTS LABORATORY OF WISCONSIN, AN INDEPENDENT REFERENCE LAB SERVING FOND DU LAC, DODGE, OUTAGAMIE, WINNEBAGO AND COLUMBIA COUNTIES. CLW PROVIDED 1,125,498 TESTS DURING FISCAL YEAR 2015. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $145,478. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY WAS $25,852.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$7,634,439	ExpenseAmt
Revenue	$5,589,426	RevenueAmt
Desc	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 442,510 PRESCRIPTIONS DURING FY15. AGNESIAN HEALTH SHOPPE 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 $9,658. AGNESIAN HEALTHCARE ENTERPRISES CONTRIBUTES TO COMMUNITY BENEFIT WITH SEVERAL SUPPORT GROUPS. THE COST OF COMMUNITY BENEFIT WAS $34,560.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$231,752,704	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	Yes (1)	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	341	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	3823	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	Yes (1)	ForeignFinancialAccountInd
Foreign Country	CJ	ForeignCountryCd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (1)	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LESLIE STEPHANY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	9209264512	PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
STEVEN N LITTLE
PRESIDENT AND CEO	50.00	Yes (X)	Yes (X)	$756,889	$0	$40,511
SR MARY NOEL BROWN
EX-OFFICIO	1.00	Yes (X)		$0	$0	$0
JAMES R CHATTERTON
CHAIRPERSON	1.00	Yes (X)	Yes (X)	$0	$0	$0
DENISE DEVERAUX
VICE CHAIRPERSON	1.00	Yes (X)		$0	$0	$0
JOAN KARSTEN
DIRECTOR	1.00	Yes (X)		$0	$0	$0
SR RHEA EMMER
EX-OFFICIO	1.00	Yes (X)		$0	$0	$0
SR HERTHA LONGO
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR STEPHEN MASSICK
DIRECTOR	1.00	Yes (X)		$0	$0	$0
WAYNE E MATZKE
TREASURER	1.00	Yes (X)	Yes (X)	$0	$0	$0
DR ROBERT MIKKELSON
DIRECTOR	1.00	Yes (X)		$0	$0	$0
JOSEPH REITEMEIER
DIRECTOR	1.00	Yes (X)		$0	$0	$0
JAMES B SIMON
SECRETARY	1.00	Yes (X)	Yes (X)	$5,055	$0	$0
DR MICHAEL STRINGENZ
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR JEFFERY STRONG
DIRECTOR	1.00	Yes (X)		$0	$0	$0
DR JUDITH WESTPHAL
DIRECTOR	1.00	Yes (X)		$0	$0	$0
H JACK POLLEI
DIRECTOR	1.00	Yes (X)		$11,316	$0	$0
JAMES P MUGAN
SR VP CLINICAL SERVICES &	50.00			$312,418	$0	$40,191	Yes (X)
BONNIE R SCHMITZ
CHIEF FINANCIAL OFFICER	50.00			$447,714	$0	$25,735	Yes (X)
DENNIS C YUNK
SR VP CLINIC ADMINISTRATOR	50.00			$180,800	$0	$21,539	Yes (X)
CAROL B HYLAND
PRESIDENT AND CEO - CLW	50.00			$294,826	$0	$38,394	Yes (X)
DOUGLAS D TROST
CEO - ST FRANCIS HOME	50.00			$232,178	$0	$40,570	Yes (X)
MARY J MOLLISON
VP SPIRITUALITY AND CARE T	50.00			$196,784	$0	$9,571	Yes (X)
SUSAN L EDMINSTER
VP - HUMAN RESOURCES	50.00			$271,985	$0	$41,799	Yes (X)
NANCY A BIRSCHBACH
VP - CIO	50.00			$283,413	$0	$42,109	Yes (X)
JILL A STENSON
VP NURSING	50.00			$216,224	$0	$21,248	Yes (X)
BARBARA L KNUTZEN
PRES AND CEO-AHE AND PERFORMANCE	50.00			$245,378	$0	$31,551	Yes (X)
HOLLY BRENNER
VP STRATEGIC DEVELOPMENT/MARKETING	50.00			$215,970	$0	$11,026	Yes (X)
JOHN CHOI MD
ANESTHESIOLOGIST - PAIN RE	50.00			$761,197	$0	$37,310		Yes (X)
YASIR HATAHET MD
INTENSIVIST/PULMONOLOGIST	50.00			$854,469	$0	$52,355		Yes (X)
PONTUS OSTMAN MD
MEDICAL DIRECTOR - PAIN MGMT	50.00			$629,640	$0	$16,585		Yes (X)
MICHAEL VANDERKOOY MD
RADIATION ONCOLOGIST	50.00			$612,179	$0	$46,201		Yes (X)
STEVEN FLURRY MD
ANESTHESIOLOGIST	50.00			$599,067	$0	$43,046		Yes (X)
SCOTT L GRIFFIN
CHIEF OPERATING OFFICER FDL REGIONAL CLINIC	50.00			$198,508	$0	$5,854			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$7,326,010	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$565,595	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	179	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
FOND DU LAC REGIONAL CLINIC
420 E DIVISION ST	FOND DU LAC	WI	54935	PHYSICIAN SERVICES	$50,103,171
CD SMITH CONSTRUCTION
PO BOX 1066	FOND DU LAC	WI	54935	CONSTRUCTION	$12,294,880
CERNER CORP
2800 ROCKCREEK PKWY	KANSAS CITY	MO	64141	COMPUTER SERVICES	$10,153,587
IBM CORPORATION
1 NEW ORCHARD RD	ARMONK	NY	105041722	COMPUTER SERVICES	$6,995,192
VARIAN MEDICAL SYSTEMS INC
70140 NETWORK PLACE	CHICAGO	IL	60673	XRAY REPAIR	$2,854,768

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	80	CntrctRcvdGreaterThan100KCnt
Related Organizations	$620,042	RelatedOrganizationsAmt
Total Contributions	$620,042	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE	621400	$196,434,217	$194,845,889	$1,588,328
MEDICARE/MEDICAID REVENUE	621400	$136,307,230	$136,307,230

Field	Value	IRS element (for citing)
Total Program Service Revenue	$332,741,447	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$5,828,561	TotalRevenueColumnAmt
Exclusion	$5,828,561	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$85,432	TotalRevenueColumnAmt
Exclusion	$85,432	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$47,334,371	SecuritiesAmt
Other	$40,005	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$41,783,526	SecuritiesAmt
Other	$11,962	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$5,550,845	SecuritiesAmt
Other	$28,043	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$5,578,888	TotalRevenueColumnAmt
Exclusion	$5,578,888	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$34,787,440	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$24,782,008	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$10,005,432	TotalRevenueColumnAmt
Related Or Exempt Func Income	$6,707,442	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$3,297,990	UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
MEDICARE EHR	900099	$2,397,464	$2,397,464
WORK INJURY/OCC HEALTH	592512	$1,451,538	$1,451,538
CAFETERIA SALES	900099	$1,316,640		$35,193	$1,281,447

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,619,758	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,619,758	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$6,785,400	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$361,645,202	TotalRevenueColumnAmt
Related Or Exempt Func Income	$343,329,321	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$4,921,511	UnrelatedBusinessRevenueAmt
Exclusion	$12,774,328	ExclusionAmt

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

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$4,043,447	TotalAmt
Management And General	$4,043,447	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$123,667,473	TotalAmt
Program Services	$96,888,448	ProgramServicesAmt
Management And General	$26,779,025	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$6,882,514	TotalAmt
Program Services	$5,055,171	ProgramServicesAmt
Management And General	$1,827,343	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$3,007,378	TotalAmt
Program Services	$1,537,308	ProgramServicesAmt
Management And General	$1,470,070	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$8,497,568	TotalAmt
Program Services	$6,253,150	ProgramServicesAmt
Management And General	$2,244,418	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$570,638	TotalAmt
Management And General	$570,638	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$121,124	TotalAmt
Management And General	$121,124	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$65,363,323	TotalAmt
Program Services	$61,466,839	ProgramServicesAmt
Management And General	$3,896,484	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$1,116,308	TotalAmt
Program Services	$93,970	ProgramServicesAmt
Management And General	$1,022,338	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$51,059,273	TotalAmt
Program Services	$48,384,987	ProgramServicesAmt
Management And General	$2,674,286	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$28,350,550	TotalAmt
Program Services	$2,680,488	ProgramServicesAmt
Management And General	$25,670,062	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$12,102,166	TotalAmt
Program Services	$4,706,234	ProgramServicesAmt
Management And General	$7,395,932	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$752,887	TotalAmt
Program Services	$614,586	ProgramServicesAmt
Management And General	$138,301	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$696,185	TotalAmt
Program Services	$414,344	ProgramServicesAmt
Management And General	$281,841	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$4,324,919	TotalAmt
Management And General	$4,324,919	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$13,837,227	TotalAmt
Program Services	$1,103,821	ProgramServicesAmt
Management And General	$12,733,406	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$2,464,212	TotalAmt
Program Services	$1,552,168	ProgramServicesAmt
Management And General	$912,044	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Management And GeneralManagementAndGeneralAmt	Program ServicesProgramServicesAmt
HOSPITAL ASSESSMENT	$5,223,764	$5,223,764
MISCELLANEOUS	$4,942,310	$4,240,107	$702,203
INVESTMENT FEES	$903,299	$903,299
DUES, SUBSCRIPTIONS, LI	$639,587	$340,600	$298,987

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$186,268	TotalAmt
Management And General	$186,268	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$338,752,420	TotalAmt
Program Services	$231,752,704	ProgramServicesAmt
Management And General	$106,999,716	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$7,438,109	BOYAmt
EOY	$8,449,951	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$13,047,839	BOYAmt
EOY	$14,209,288	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$51,052,051	BOYAmt
EOY	$51,807,749	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$6,001,404	BOYAmt
EOY	$5,783,059	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$3,174,934	BOYAmt
EOY	$4,232,055	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$361,862,578	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$190,906,549	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$156,368,438	BOYAmt
EOY	$170,956,029	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$204,474,059	BOYAmt
EOY	$216,431,616	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$72,188,449	BOYAmt
EOY	$62,920,276	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$513,745,283	BOYAmt
EOY	$534,790,023	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$34,903,977	BOYAmt
EOY	$35,647,967	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$139,355,158	BOYAmt
EOY	$136,105,860	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$38,254,667	BOYAmt
EOY	$39,592,404	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$212,513,802	BOYAmt
EOY	$211,346,231	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$288,888,488	BOYAmt
EOY	$310,945,702	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$10,189,945	BOYAmt
EOY	$10,333,000	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,153,048	BOYAmt
EOY	$2,165,090	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$301,231,481	BOYAmt
EOY	$323,443,792	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$513,745,283	BOYAmt
EOY	$534,790,023	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$22,892,782	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$7,446,690	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$6,766,219	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$17,385	OtherActivitiesAmt
Total Lobbying Expenditures	$17,385	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

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

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,039,915	BeginningYearBalanceAmt
Investment Earnings Or Losses	$13,223	InvestmentEarningsOrLossesAmt
Administrative Expenses	$3,547	AdministrativeExpensesAmt
End Year Balance	$1,049,591	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,019,387	BeginningYearBalanceAmt
Investment Earnings Or Losses	$73,707	InvestmentEarningsOrLossesAmt
Other Expenditures	$50,000	OtherExpendituresAmt
Administrative Expenses	$3,179	AdministrativeExpensesAmt
End Year Balance	$1,039,915	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$1,004,976	BeginningYearBalanceAmt
Investment Earnings Or Losses	$57,144	InvestmentEarningsOrLossesAmt
Other Expenditures	$40,000	OtherExpendituresAmt
Administrative Expenses	$2,733	AdministrativeExpensesAmt
End Year Balance	$1,019,387	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$992,140	BeginningYearBalanceAmt
Investment Earnings Or Losses	$15,366	InvestmentEarningsOrLossesAmt
Administrative Expenses	$2,530	AdministrativeExpensesAmt
End Year Balance	$1,004,976	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$996,299	BeginningYearBalanceAmt
Investment Earnings Or Losses	$48,126	InvestmentEarningsOrLossesAmt
Other Expenditures	$50,000	OtherExpendituresAmt
Administrative Expenses	$2,285	AdministrativeExpensesAmt
End Year Balance	$992,140	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,486,589	OtherCostOrOtherBasisAmt
Book Value	$6,486,589	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$160,346,031	OtherCostOrOtherBasisAmt
Depreciation	$73,298,465	DepreciationAmt
Book Value	$87,047,566	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,562,265	OtherCostOrOtherBasisAmt
Depreciation	$1,582,489	DepreciationAmt
Book Value	$1,979,776	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$155,618,597	OtherCostOrOtherBasisAmt
Depreciation	$115,421,972	DepreciationAmt
Book Value	$40,196,625	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$35,849,096	OtherCostOrOtherBasisAmt
Depreciation	$603,623	DepreciationAmt
Book Value	$35,245,473	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$170,956,029	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (9 entries)

DescDesc	Book ValueBookValueAmt
DUE FROM AFFILIATED ENTITIES	$2,251,856
LONG TERM DEBT FROM AFFILIATED ENTITY	$5,000,000
INVESTMENT - MERCURY CLINIC	$3,005,130
INVESTMENT - SAH FOUNDATION	$11,283,280
BOND DEFERRED FINANCING COSTS	$1,046,595
ASSETS WHOSE USE IS LIMITED - BOND FUNDS	$4,555,360
ASSETS WHOSE USE IS LIMITED - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN	$32,976,527
OTHER RECEIVABLES	$2,068,746
MISCELLANEOUS	$732,782

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$62,920,276	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDesc	AmtAmt
CAPITAL LEASE PAYABLE	$3,531,710
PHYSICIANS SUPPLEMENTAL BENEFIT PLAN	$31,092,150
FUND BALANCE SWAP MARKET ADJUSTMENT	$2,196,808
DUE TO MEDICARE/MEDICAID	$280,110
EXECUTIVE DEFERRED COMPENSATION PLAN	$1,884,377
LAND CONTRACT - FAMILY FOOT CLINIC	$607,249

Field	Value	IRS element (for citing)
Total Liability	$39,592,404	TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART V, LINE 4:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule H IRS990ScheduleH

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

Free Care Oth Percentage FreeCareOthPercentageGrp

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

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

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,180,111	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,180,111	NetCommunityBenefitExpnsAmt
Total Expense	0.00350	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,055,097	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$16,055,097	NetCommunityBenefitExpnsAmt
Total Expense	0.04740	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$17,235,208	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$17,235,208	NetCommunityBenefitExpnsAmt
Total Expense	0.05090	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,671,046	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$194,060	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,476,986	NetCommunityBenefitExpnsAmt
Total Expense	0.00440	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$634,817	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$634,817	NetCommunityBenefitExpnsAmt
Total Expense	0.00190	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$750,929	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$750,929	NetCommunityBenefitExpnsAmt
Total Expense	0.00220	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,551	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,551	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,066,971	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,066,971	NetCommunityBenefitExpnsAmt
Total Expense	0.00310	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,127,314	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$194,060	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,933,254	NetCommunityBenefitExpnsAmt
Total Expense	0.01160	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$21,362,522	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$194,060	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$21,168,462	NetCommunityBenefitExpnsAmt
Total Expense	0.06250	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$9,775	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$9,775	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,440	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$5,440	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,581	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$20,581	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$116,673	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$116,673	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$152,469	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$152,469	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$11,359,356	BadDebtExpenseAmt
Reimbursed By Medicare	$117,674,862	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$157,969,312	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$40,294,450	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

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

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

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

US Address USAddress

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

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

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	14	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.AGNESIAN.COM	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	WWW.LIVINGWELLFDL.ORG	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	14	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.LIVINGWELLFDL.ORG	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	165.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.AGNESIAN.COM	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.AGNESIAN.COM	FAPAppAvailableOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 5: THE CHNA WAS COMMISSIONED BY AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), 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 PARTNEREED 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; GREGG BREWER, AURORA HEALTH CARE; 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; AMBER KILAWEE, UNITED WAY; LALITHA RAMAMOORTHY, MARIAN UNIVERSITY; LARRY RICHARDSON, FABOH; SANDI ROEHRIG, FOND DU LAC AREA FOUNDATION; MARTY RYAN, ROTARY; HEATHER SCHMIDT, DO, AGNESIAN HEALTHCARE; KELLY NORTON, ST. MARY'S SPRINGS ACADEMY; MARIAN SHERIDAN, FOND DU LAC SCHOOL DISTRICT; TERI MATTEK, UW FOND DU LAC; MICHELLE TIDEMANN, UW EXTENSION; DEANN THURMER, AGNESIAN HEALTHCARE; KATHERINE VERGOS, AGNESIAN HEALTHCARE; JENNIFER WALTERS, AURORA HEALTHCARE; ERIC TONEY, FOND DU LAC COUNTY; ALAN HATHAWAY, BROWN BOOTS INTERACTIVE.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 33 TO RANK OF 20 IN THE STATE. IN ORDER TO FURTHER HELP COMMUNITY MEMBERS TAKE POSITIVE STEPS IN IMPROVING THEIR HEALTH, AGNESIAN HEALTHCARE DISTRIBUTED 2015 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 FAP HAVE BEEN MADE.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 22D: UNINSURED PATIENTS AUTOMATICALLY RECEIVE A 15% DISCOUNT OFF GROSS CHARGES.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
ST. AGNES HOSPITAL PART V, SECTION B, LINE 16A WEBSITE:	WWW.AGNESIAN.COM
ST. AGNES HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	WWW.AGNESIAN.COM

Field	Value	IRS element (for citing)
Facility	3	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
FOND DU LAC REGIONAL CLINIC
420 E DIVISION STREET	FOND DU LAC	WI	54935	OUTPATIENT PHYSICIAN CLINIC
CONSULTANTS LAB OF WISCONSIN LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	LABORATORY AND TESTING
AGNESIAN HEALTHCARE ENTERPRISES LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	PHARMACEUTICALS, HOME HEALTH, MEDICAL SUPPLIES

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 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 $ 11,359,356.
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 9A	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.
PART III, LINE 9B	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 TO 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 SEVEN MINISTRIES: AGNESIAN HEALTHCARE ENTERPRISES, LLC, CONSULTANTS LAB OF WI, LLC, FOND DU LAC REGIONAL CLINIC, ST. AGNES HOSPITAL, ST. FRANCIS 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

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	Yes (1)	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
STEVEN N LITTLE
PRESIDENT AND CEO	$604,290	$0	$139,167	$0	$13,432	$0	$14,425	$0	$26,086	$0	$797,400	$0	$0	$0
JAMES P MUGAN
SR VP CLINICAL SERVICES &	$265,216	$0	$33,783	$0	$13,419	$0	$15,112	$0	$25,079	$0	$352,609	$0	$0	$0
BONNIE R SCHMITZ
CHIEF FINANCIAL OFFICER	$378,267	$0	$47,635	$0	$21,812	$0	$15,950	$0	$9,785	$0	$473,449	$0	$0	$0
DENNIS C YUNK
SR VP CLINIC ADMINISTRATOR	$120,801	$0	$13,375	$0	$46,624	$0	$10,662	$0	$10,877	$0	$202,339	$0	$0	$0
CAROL B HYLAND
PRESIDENT AND CEO - CLW	$228,880	$0	$28,749	$0	$37,197	$0	$16,204	$0	$22,190	$0	$333,220	$0	$0	$0
DOUGLAS D TROST
CEO - ST FRANCIS HOME	$183,858	$0	$24,971	$0	$23,349	$0	$10,910	$0	$29,660	$0	$272,748	$0	$0	$0
MARY J MOLLISON
VP SPIRITUALITY AND CARE T	$174,476	$0	$22,308	$0	$0	$0	$0	$0	$9,571	$0	$206,355	$0	$0	$0
SUSAN L EDMINSTER
VP - HUMAN RESOURCES	$240,530	$0	$30,356	$0	$1,099	$0	$13,801	$0	$27,998	$0	$313,784	$0	$0	$0
NANCY A BIRSCHBACH
VP - CIO	$251,381	$0	$31,099	$0	$933	$0	$12,549	$0	$29,560	$0	$325,522	$0	$0	$0
JILL A STENSON
VP NURSING	$182,330	$0	$22,041	$0	$11,853	$0	$9,637	$0	$11,611	$0	$237,472	$0	$0	$0
BARBARA L KNUTZEN
PRES AND CEO-AHE AND PERFORMANCE	$208,976	$0	$27,495	$0	$8,907	$0	$10,782	$0	$20,769	$0	$276,929	$0	$0	$0
HOLLY BRENNER
VP STRATEGIC DEVELOPMENT/MARKETING	$185,862	$0	$23,478	$0	$6,630	$0	$9,963	$0	$1,063	$0	$226,996	$0	$0	$0
JOHN CHOI MD
ANESTHESIOLOGIST - PAIN RE	$574,496	$0	$184,398	$0	$2,303	$0	$15,425	$0	$21,885	$0	$798,507	$0	$0	$0
YASIR HATAHET MD
INTENSIVIST/PULMONOLOGIST	$453,749	$0	$312,594	$0	$88,126	$0	$13,928	$0	$38,427	$0	$906,824	$0	$0	$0
PONTUS OSTMAN MD
MEDICAL DIRECTOR - PAIN MGMT	$402,942	$0	$223,163	$0	$3,535	$0	$15,425	$0	$1,160	$0	$646,225	$0	$0	$0
MICHAEL VANDERKOOY MD
RADIATION ONCOLOGIST	$584,867	$0	$0	$0	$27,312	$0	$15,425	$0	$30,776	$0	$658,380	$0	$0	$0
STEVEN FLURRY MD
ANESTHESIOLOGIST	$588,981	$0	$0	$0	$10,086	$0	$15,425	$0	$27,621	$0	$642,113	$0	$0	$0
SCOTT L GRIFFIN
CHIEF OPERATING OFFICER FDL REGIONAL	$187,341	$0	$0	$0	$11,167	$0	$3,910	$0	$1,944	$0	$204,362	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 1A	ALL GROSSUP PAYMENTS AND SOCIAL CLUB DUES ARE INCLUDED ON FORM 1099. THESE PAYMENTS ARE MADE FOR TWO MEMBERS OF THE BOARD OF DIRECTORS.
PART I, LINE 4B	ALL EXECUTIVES EXCEPT CEO PARTICIPATE IN A 457(B) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN.
PART I, LINE 5	COMPENSATION FOR SOME EMPLOYED PHYSICIANS IS BASED ON A PERCENTAGE OF GROSS BILLINGS.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
WI HEALTH AND EDUC FACILITIES AUTHORITY
A	391337855	97710BGG1	2008-12-11	$49,330,000	REFUNDING OF 2001 ISSUE, PRIVATE ROOM PROJECT	0	0	0
WI HEALTH AND EDUC FACILITIES AUTHORITY
B	391337855	97710BYW6	2010-12-01	$57,260,000	REFUNDING OF 2001 ISSUE, PRIVATE ROOM PROJECT	0	0	0
WI HEALTH AND EDUC FACILITIES AUTHORITY
C	391337855	NONEAVAIL	2011-12-15	$10,020,000	PARTIAL REFUNDING OF 1998 ISSUE	0	0	0
WI HEALTH AND EDUC FACILITIES AUTHORITY
D	391337855	97710B7C0	2013-03-14	$5,705,000	CONSTRUCTION AND EXPANSION OF FACILITIES	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)

Bond ReferenceBondReferenceCd	RetiredRetiredAmt	Total ProceedsTotalProceedsAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Working Capital ExpendituresWorkingCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Current RefundingCurrentRefundingInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	In Reserve FundInReserveFundAmt	Refunding EscrowRefundingEscrowAmt	Capital ExpendituresCapitalExpendituresAmt	Capitalized InterestCapitalizedInterestAmt	UnspentUnspentAmt
A	$3,850,000	$49,330,000	$430,000	$48,900,000	2005	Yes (1)	Yes (1)	Yes (1)
B	$4,835,000	$57,260,000	$767,686		2014	Yes (1)	0	Yes (1)	$4,518,399	$31,465,565	$20,498,350
C	$3,920,000	$10,020,000	$90,000		2011	Yes (1)	Yes (1)	Yes (1)		$9,930,000
D		$5,705,000	$32,111			0	0	Yes (1)			$5,459,727	$61,653	$213,162

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)

Bond ReferenceBondReferenceCd	Private Bus Use By OthersPrivateBusUseByOthersPct	Total Private Business UseTotalPrivateBusinessUsePct	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	0.01470	0.01470	Yes (1)	Yes (1)
B			Yes (1)	Yes (1)
C			Yes (1)	Yes (1)
D			Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
PIPER JAFFRAY
A	Yes (1)	Yes (1)	Yes (1)	28.000000000000	0	0	0	0	Yes (1)
(no name)
B	Yes (1)	0	0				0	0	Yes (1)
(no name)
C	Yes (1)	0	0				0	0	Yes (1)
(no name)
D	Yes (1)	0	0				0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	Yes (1)
B	Yes (1)
C	Yes (1)
D	Yes (1)

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	WI HEALTH AND EDUC FACILITIES AUTHORITY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	391337855	BondIssuerEIN
CUSIP	97710B7C0	CUSIPNum
Bond Issued	2013-03-14	BondIssuedDt
Issue Price	$53,276,496	IssuePriceAmt
Purpose	CONSTRUCTION AND EXPANSION OF FACILITIES	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	$53,276,496	TotalProceedsAmt
Capitalized Interest	$569,394	CapitalizedInterestAmt
Issuance Costs From Proceeds	$296,559	IssuanceCostsFromProceedsAmt
Capital Expenditures	$50,406,150	CapitalExpendituresAmt
Unspent	$2,570,787	UnspentAmt
Current Refunding	0	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	0	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test	Yes (1)	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	Yes (1)	Form8038TFiledInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (6 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
JOSEPH REITEMEIER
DIRECTOR	$382,058	JOSEPH REITEMEIER IS PRESIDENT OF FOND DU LAC ASSOCIATION OF COMMERCE. AGNESIAN HEALTHCARE, INC. PROVIDED OCCUPATIONAL HEALTH SERVICES TO THE ASSOCIATION OF COMMERCE, BILLING $4,221 FOR THESE SERVICES IN FISCAL YEAR 2015. IN ADDITION, AGNESIAN HEALTHCARE, INC. PURCHASED SERVICES TOTALING $377,837 FROM THE ASSOCIATION OF COMMERCE DURING FISCAL YEAR 2015.	0
JOSEPH REITEMEIER
DIRECTOR	$47,369	JOSEPH REITEMEIER'S DAUGHTER-IN-LAW, JENNIFER REITEMEIER IS EMPLOYED AS AN RN AT AGNESIAN HEALTHCARE, INC., EARNING AN ANNUAL SALARY OF $47,369.	0
WAYNE MATZKE
DIRECTOR	$1,851,790	WAYNE MATZKE IS CEO OF GRANDE CHEESE. AGNESIAN HEALTHCARE PROVIDED OCCUPATIONAL HEALTH SERVICES TO GRANDE CHEESE, BILLING $1,851,790 IN FISCAL YEAR 2015.	0
DENISE DEVERAUX
DIRECTOR	$611,336	DENISE DEVERAUX IS VICE PRESIDENT OF HUMAN RESOURCES AT MERCURY MARINE. AGNESIAN HEALTHCARE PROVIDED OCCUPATIONAL HEALTH SERVICES TO MERCURY MARINE, BILLING $611,336 IN FISCAL YEAR 2015.	0
ROBERT MIKKELSEN MD
DIRECTOR	$41,490	ROBERT MIKKELSEN'S STEP-DAUGHTER, KAYLA AVILA, IS EMPLOYED AS AN RN AT AGNESIAN HEALTHCARE, EARNING AN ANNUAL SALARY OF $41,490.	0
JAMES CHATTERTON
DIRECTOR	$4,412	JAMES CHATTERTON IS PRESIDENT OF AMERICAN BANK. AGNESIAN HEALTHCARE, INC PROVIDED OCCUPATIONAL HEALTH SERVICES TO AMERICAN BANK, BILING $4,412 OF THESE SERVICES IN FISCAL YEAR 2015.	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 2014 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	WE HAVE A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY THAT 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 57,007,929. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,007,929. PURCHASED SERVICES - LABORATORY: PROGRAM SERVICE EXPENSES 157,939. MANAGEMENT AND GENERAL EXPENSES 5,938. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 163,877. PURCHASED SERVICES - LAUNDRY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 706,375. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 706,375. PURCHASED SERVICES - ELEVATOR: PROGRAM SERVICE EXPENSES 1,756. MANAGEMENT AND GENERAL EXPENSES 142,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 144,150. PURCHASED SERVICES - MISCELLANEOUS: PROGRAM SERVICE EXPENSES 2,088,149. MANAGEMENT AND GENERAL EXPENSES 1,091,965. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,180,114. PURCHASED SERVICES - TEMPORARY STAFF: PROGRAM SERVICE EXPENSES 267,967. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 267,967. PURCHASED SERVICES - REFERENCE TESTS: PROGRAM SERVICE EXPENSES 920,840. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 920,840. PURCHASED SERVICES - HOUSEKEEPING: PROGRAM SERVICE EXPENSES 71,683. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,683. PURCHASED SERVICES - TRANSCRIPTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 281,584. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 281,584. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 688,195. MANAGEMENT AND GENERAL EXPENSES 672,467. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,360,662. PROFESSIONAL FEES - MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 256,164. MANAGEMENT AND GENERAL EXPENSES 12,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 268,164. PROFESSIONAL FEES - COLLECTION: PROGRAM SERVICE EXPENSES 6,217. MANAGEMENT AND GENERAL EXPENSES 983,761. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 989,978.
FORM 990, PART XI, LINE 9:	CAPITAL CONTRIBUTIONS FROM AFFILIATES 6,500,000. CHANGE IN SWAP FUND BALANCE -120,668. CHANGE IN FUND BALANCE - SAH FOUNDATION 155,096. CAPITAL CONTRIBUTIONS - FOUNDATION 237,291. CAPITAL CONTRIBUTIONS - OTHER -5,500.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Direct Controlling NADirectControllingNACd
CONSULTANTS LABORATORY OF WISCONSIN LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	391528550	LAB SERVICES	WI	$27,216,161	$15,365,001	N/A
AGNESIAN HEALTHCARE ENTERPRISES LLC
430 E DIVISION STREET	FOND DU LAC	WI	54935	392038757	RETAIL PHARMACY	WI	$9,927,565	$10,033,627	N/A

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd
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)	11	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

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

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
AGNESIAN HEALTHCARE FOUNDATION INC
C	$637,210	CASH RECEIPTS
ST FRANCIS HOME
D	$5,000,000	BOND VALUE
ST FRANCIS HOME
M	$41,686	CASH PAYMENTS
CONGREGATION OF SISTERS OF ST AGNES
M	$318,695	CASH PAYMENTS
CONGREGATION OF SISTERS OF ST AGNES
O	$410,479	CASH PAYMENTS
WAUPUN MEMORIAL HOSPITAL
P	$421,984	CASH TRANSFER
RIPON MEDICAL CENTER
P	$9,199	CASH TRANSFER