AGNESIAN HEALTHCARE INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- AGNESIAN HEALTHCARE INC (EIN 39-0807236)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-13
- IRS object ID
- 201541339349304609
- Schema version
- 2013v4.0
- 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 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 | 2015-05-13T15:06:12-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | 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 | BusinessNameLine1 |
| 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 | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 53935 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BONNIE SCHMITZ | PersonNm |
| Person Title | VP AND CFO | PersonTitleTxt |
| Phone | 9209264512 | PhoneNum |
| Signature | 2015-05-11 | 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 | 2015-05-11 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | 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 | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 53935 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $408,183,012 | 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 | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 3615 | TotalEmployeeCnt |
| Total Volunteers | 479 | TotalVolunteersCnt |
| Total Gross UBI | $4,406,882 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$148,611 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $309,916,813 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $313,130,739 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,489,027 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,711,309 | CYInvestmentIncomeAmt |
| PY Other Revenue | $15,364,161 | PYOtherRevenueAmt |
| CY Other Revenue | $18,516,764 | CYOtherRevenueAmt |
| PY Total Revenue | $333,770,001 | PYTotalRevenueAmt |
| CY Total Revenue | $339,358,812 | 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 | $136,508,008 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $141,083,903 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $173,932,625 | PYOtherExpensesAmt |
| CY Other Expenses | $182,688,316 | CYOtherExpensesAmt |
| PY Total Expenses | $310,440,633 | PYTotalExpensesAmt |
| CY Total Expenses | $323,772,219 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $23,329,368 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $15,586,593 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $470,805,863 | TotalAssetsBOYAmt |
| Total Assets EOY | $513,745,283 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $208,582,531 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $212,513,802 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $262,223,332 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $301,231,481 | 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 | $225,692,096 | ExpenseAmt |
| Revenue | $304,554,184 | 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 2014, ST. AGNES HOSPITAL HAD 6,691 INPATIENT ADMISSIONS, WITH TOTAL PATIENT DAYS OF 26,919. THERE WAS A TOTAL OF 27,971 EMERGENCY ROOM VISITS AND 12,637 SURGERIES PERFORMED IN FY14. IN ADDITION, ST. AGNES HOSPITAL PROVIDED 405,537 PHYSICIAN CLINIC VISITS, 74,477 MEDICAL IMAGING PROCEDURES, AND 1,304,445 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY UNITS. THERE WERE 1,586 CARDIAC CATH LAB VISITS AND 37,102 HOSPICE DAYS. THE HOSPITAL ALSO OPERATES SAMARITAN CLINIC, A FREE CLINIC OFFERING MEDICAL SERVICES TO QUALIFIED INDIVIDUALS. SAMARITAN CLINIC PROVIDED 3,997 VISITS TO PATIENTS, AT A COST OF $338,275 FOR FY14. 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 $3,710,222. 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 $3,631,888. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,526,868 | ExpenseAmt |
| Revenue | $14,321,671 | 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 1,104,797 TESTS DURING FISCAL YEAR 2014. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $287,562. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY WAS $106,348. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,349,736 | ExpenseAmt |
| Revenue | $7,169,370 | 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 437,466 PRESCRIPTIONS DURING FY14. 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 $8,019. AGNESIAN HEALTHCARE ENTERPRISES CONTRIBUTES TO COMMUNITY BENEFIT WITH SEVERAL SUPPORT GROUPS. THE COST OF COMMUNITY BENEFIT WAS $2,878. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $235,568,700 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 | Yes (1) | 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 | 309 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3615 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9209264512 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 EAST DIVISION STREET | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 54935 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| STEVEN N LITTLE | ||||||||
| PRESIDENT AND CEO | 50.00 | Yes (X) | Yes (X) | $680,469 | $0 | $35,642 | ||
| SR MARY NOEL BROWN | ||||||||
| EX-OFFICIO | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES R CHATTERTON | ||||||||
| VICE CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DENISE DEVERAUX | ||||||||
| DIRECTOR | 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 | |||
| H JACK POLLEI | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $11,316 | $0 | $0 | |||
| JOSEPH REITEMEIER | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JAMES B SIMON | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $5,092 | $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 | |||
| JAMES P MUGAN | ||||||||
| SR VP CLINICAL SERVICES & | 50.00 | $303,520 | $0 | $35,425 | Yes (X) | |||
| BONNIE R SCHMITZ | ||||||||
| CHIEF FINANCIAL OFFICER | 50.00 | $357,438 | $0 | $22,639 | Yes (X) | |||
| DENNIS C YUNK | ||||||||
| SR VP CLINIC ADMINISTRATOR | 50.00 | $265,491 | $0 | $49,938 | Yes (X) | |||
| CAROL B HYLAND | ||||||||
| PRESIDENT AND CEO - CLW | 50.00 | $268,861 | $0 | $33,240 | Yes (X) | |||
| DOUGLAS D TROST | ||||||||
| CEO - ST FRANCIS HOME | 50.00 | $205,078 | $0 | $38,332 | Yes (X) | |||
| MARY J MOLLISON | ||||||||
| VP SPIRITUALITY AND CARE T | 50.00 | $192,064 | $0 | $19,766 | Yes (X) | |||
| BARBARA L KNUTZEN | ||||||||
| PRES AND CEO-AHE AND PERFO | 50.00 | $219,302 | $0 | $28,115 | Yes (X) | |||
| SUSAN L EDMINSTER | ||||||||
| VP - HUMAN RESOURCES | 50.00 | $251,105 | $0 | $34,770 | Yes (X) | |||
| NANCY A BIRSCHBACH | ||||||||
| VP - CIO | 50.00 | $241,261 | $0 | $37,041 | Yes (X) | |||
| JILL A STENSON | ||||||||
| VP NURSING | 50.00 | $193,854 | $0 | $18,247 | Yes (X) | |||
| JOHN CHOI MD | ||||||||
| ANESTHESIOLOGIST - PAIN RE | 50.00 | $867,117 | $0 | $33,177 | Yes (X) | |||
| YASIR HATAHET MD | ||||||||
| INTENSIVIST | 50.00 | $768,342 | $0 | $42,260 | Yes (X) | |||
| PONTUS OSTMAN MD | ||||||||
| ANESTHESIOLOGIST - PAIN RE | 50.00 | $667,220 | $0 | $16,460 | Yes (X) | |||
| MICHAEL VANDERKOOY MD | ||||||||
| RADIATION ONCOLOGIST | 50.00 | $601,616 | $0 | $39,208 | Yes (X) | |||
| STEVEN FLURRY MD | ||||||||
| ANESTHESIOLOGIST | 50.00 | $599,198 | $0 | $32,100 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,698,344 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $516,360 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 154 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FOND DU LAC REGIONAL CLINIC | |||||
| 420 E DIVISION ST | FOND DU LAC | WI | 54935 | PHYSICIAN SERVICES | $47,326,998 |
| CERNER CORP | |||||
| 2800 ROCKCREEK PKWY | KANSAS CITY | MO | 64141 | COMPUTER SERVICES | $10,373,567 |
| IBM CORPORATION | |||||
| 1 NEW ORCHARD RD | ARMONK | NY | 105041722 | COMPUTER SERVICES | $9,703,957 |
| CD SMITH CONSTRUCTION | |||||
| PO BOX 1066 | FOND DU LAC | WI | 54935 | CONSTRUCTION | $6,350,286 |
| AMERICAN HEALTHCARE SERVICES | |||||
| PO BOX 945 | TRAVERSE CITY | MI | 49685 | TEMPORARY STAFFING | $1,319,671 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 70 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $193,543,594 | $191,548,167 | $1,995,427 |
| MEDICARE/MEDICAID REVENUE | 621400 | $119,587,145 | $119,587,145 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $313,130,739 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,604,040 | TotalRevenueColumnAmt |
| Exclusion | $4,604,040 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $160,961 | TotalRevenueColumnAmt |
| Exclusion | $160,961 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $49,808,313 | SecuritiesAmt |
| Other | $70,832 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $46,842,642 | SecuritiesAmt |
| Other | $90,195 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,965,671 | SecuritiesAmt |
| Other | -$19,363 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,946,308 | TotalRevenueColumnAmt |
| Exclusion | $2,946,308 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $31,450,575 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $21,891,363 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,559,212 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,169,370 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,389,842 | UnrelatedBusinessRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| MEDICARE EHR | 900099 | $3,163,529 | $3,163,529 | ||
| WORK INJURY/OCC HEALTH | 592512 | $1,616,754 | $1,616,754 | ||
| CAFETERIA SALES | 900099 | $1,217,009 | $21,613 | $1,195,396 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,960,260 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,960,260 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $8,957,552 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $339,358,812 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $326,045,225 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $4,406,882 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,906,705 | 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 | $3,342,500 | TotalAmt |
| Management And General | $3,342,500 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,733,885 | TotalAmt |
| Program Services | $97,747,198 | ProgramServicesAmt |
| Management And General | $21,986,687 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,297,085 | TotalAmt |
| Program Services | $4,692,774 | ProgramServicesAmt |
| Management And General | $1,604,311 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,495,840 | TotalAmt |
| Program Services | $2,010,148 | ProgramServicesAmt |
| Management And General | $1,485,692 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,214,593 | TotalAmt |
| Program Services | $6,354,310 | ProgramServicesAmt |
| Management And General | $1,860,283 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,011 | TotalAmt |
| Management And General | $97,011 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,186 | TotalAmt |
| Program Services | $4,889 | ProgramServicesAmt |
| Management And General | $361,297 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,244,674 | TotalAmt |
| Program Services | $61,048,909 | ProgramServicesAmt |
| Management And General | $4,195,765 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,419,472 | TotalAmt |
| Program Services | $13,527 | ProgramServicesAmt |
| Management And General | $1,405,945 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,501,003 | TotalAmt |
| Program Services | $42,476,274 | ProgramServicesAmt |
| Management And General | $2,024,729 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,455,169 | TotalAmt |
| Program Services | $60,746 | ProgramServicesAmt |
| Management And General | $27,394,423 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,788,650 | TotalAmt |
| Program Services | $6,792,334 | ProgramServicesAmt |
| Management And General | $5,996,316 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $668,839 | TotalAmt |
| Program Services | $562,493 | ProgramServicesAmt |
| Management And General | $106,346 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $712,676 | TotalAmt |
| Program Services | $490,173 | ProgramServicesAmt |
| Management And General | $222,503 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,435,893 | TotalAmt |
| Management And General | $4,435,893 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,877,805 | TotalAmt |
| Program Services | $6,216,019 | ProgramServicesAmt |
| Management And General | $7,661,786 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,294,508 | TotalAmt |
| Program Services | $1,429,907 | ProgramServicesAmt |
| Management And General | $864,601 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| HOSPITAL ASSESSMENT | $5,247,092 | $5,247,092 | |
| MISCELLANEOUS | $2,206,323 | $206,354 | $1,999,969 |
| INVESTMENT FEES | $717,204 | $717,204 | |
| DUES, SUBSCRIPTIONS, LI | $555,485 | $215,553 | $339,932 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,326 | TotalAmt |
| Management And General | $100,326 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $323,772,219 | TotalAmt |
| Program Services | $235,568,700 | ProgramServicesAmt |
| Management And General | $88,203,519 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,477,558 | BOYAmt |
| EOY | $7,438,109 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,801,713 | BOYAmt |
| EOY | $13,047,839 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,131,908 | BOYAmt |
| EOY | $51,052,051 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,643,411 | BOYAmt |
| EOY | $6,001,404 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,771,241 | BOYAmt |
| EOY | $3,174,934 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $331,229,781 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $174,861,343 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,449,044 | BOYAmt |
| EOY | $156,368,438 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,914,673 | BOYAmt |
| EOY | $204,474,059 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,616,315 | BOYAmt |
| EOY | $72,188,449 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $470,805,863 | BOYAmt |
| EOY | $513,745,283 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,020,630 | BOYAmt |
| EOY | $34,903,977 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,479,805 | BOYAmt |
| EOY | $139,355,158 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,082,096 | BOYAmt |
| EOY | $38,254,667 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $208,582,531 | BOYAmt |
| EOY | $212,513,802 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,329,672 | BOYAmt |
| EOY | $288,888,488 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,737,112 | BOYAmt |
| EOY | $10,189,945 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,156,548 | BOYAmt |
| EOY | $2,153,048 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $262,223,332 | BOYAmt |
| EOY | $301,231,481 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $470,805,863 | BOYAmt |
| EOY | $513,745,283 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $15,586,593 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $16,766,210 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $6,655,346 | 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 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 | $17,490 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $17,490 | 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 | $1,019,387 | 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,020,134 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $23,156 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $45,000 | OtherExpendituresAmt |
| Administrative Expenses | $1,991 | AdministrativeExpensesAmt |
| End Year Balance | $996,299 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| 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 | $6,183,390 | OtherCostOrOtherBasisAmt |
| Book Value | $6,183,390 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $152,883,487 | OtherCostOrOtherBasisAmt |
| Depreciation | $66,521,146 | DepreciationAmt |
| Book Value | $86,362,341 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,082,544 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,356,171 | DepreciationAmt |
| Book Value | $1,726,373 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $150,689,942 | OtherCostOrOtherBasisAmt |
| Depreciation | $106,682,031 | DepreciationAmt |
| Book Value | $44,007,911 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,390,418 | OtherCostOrOtherBasisAmt |
| Depreciation | $301,995 | DepreciationAmt |
| Book Value | $18,088,423 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $156,368,438 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (9 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM AFFILIATED ENTITIES | $2,478,583 |
| LONG TERM DEBT FROM AFFILIATED ENTITY | $5,000,000 |
| INVESTMENT - MERCURY CLINIC | $3,005,130 |
| INVESTMENT - SAH FOUNDATION | $10,959,256 |
| BOND DEFERRED FINANCING COSTS | $1,104,260 |
| ASSETS WHOSE USE IS LIMITED - BOND FUNDS | $16,197,973 |
| ASSETS WHOSE USE IS LIMITED - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN | $29,335,167 |
| OTHER RECEIVABLES | $2,619,790 |
| MISCELLANEOUS | $1,488,290 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $72,188,449 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE PAYABLE | $5,099,406 |
| PHYSICIANS SUPPLEMENTAL BENEFIT PLAN | $29,335,167 |
| FUND BALANCE SWAP MARKET ADJUSTMENT | $2,076,139 |
| DUE TO MEDICARE/MEDICAID | $153,067 |
| EXECUTIVE DEFERRED COMPENSATION PLAN | $759,200 |
| LAND CONTRACT - FAMILY FOOT CLINIC | $831,688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $38,254,667 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, AGNESIAN HEALTHCARE, INC. DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. AGNESIAN HEALTHCARE, INC. RECORDED NO ASSETS FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. FEDERAL RETURNS FOR THE YEARS ENDED 2011 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
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 | $3,824,589 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,824,589 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01180 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,986,165 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,986,165 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04010 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,810,754 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $16,810,754 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05190 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,456,688 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $253,703 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,202,985 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $672,258 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $672,258 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,129,624 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,129,624 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,605 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,605 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $911,857 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $911,857 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,176,032 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $253,703 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,922,329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,986,786 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $253,703 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $20,733,083 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06400 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,398 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,398 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,717 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,717 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,661 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,661 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,454 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $26,454 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $165,120 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $165,120 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $203,350 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $203,350 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $14,270,018 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $103,757,843 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $143,784,439 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$40,026,596 | 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 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 E DIVISION STREET | AddressLine1 |
| City | FOND DU LAC | City |
| State | WI | State |
| ZIP Code | 54935 | ZIPCode |
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| 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 |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | Yes (1) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 165.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| State Regulation | Yes (X) | StateRegulationInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| 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 | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 3: THE CHNA WAS COMMISSIONED BY THE FDL COMMUNITY HEALTH ASSESSMENT TASK FORCE, WHICH INCLUDED EXECUTIVES FROM THE FOLLOWING ORGANIZATIONS: FDL AREA BUSINESS ON HEALTH, FDL COUNTY HEALTH DEPT, FDL YMCA, AGNESIAN HEALTHCARE, FDL AREA UNITED WAY, FDL SCHOOL DISTRICT, WAUPUN MEMORIAL HOSPITAL, RIPON MEDICAL CENTER, AND AURORA HEALTHCARE. 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 800 TELEPHONE INTERVIEWS WERE COMPLETED WITH COMMUNITY MEMBERS. IN ADDITION, SURVEYS WERE CONDUCTED AMONG FDL COUNTY STAKEHOLDERS. STAKEHOLDERS WERE DEFINED AS PEOPLE WHO WERE INVOLVED WITH HUMAN RESOURCE ISSUES SUCH AS BENEFITS, INSURANCE, SICK TIME OR DISABILITY ISSUES AS WELL AS PEOPLE WHO WERE INVOLVED WITH OR AWARE OF THE HEALTH ISSUES RESIDENTS AND FAMILIES FACE THROUGH THEIR PLACE OF WORK OR VOLUNTEER RELATIONSHIPS. A TOTAL OF 84 SURVEYS WERE COMPLETED AMONG STAKEHOLDERS. AFTER COMPLETION OF THE CHNA, THE FOND DU LAC COUNTY HEALTHY 2020 COALITION WAS FORMED TO ADDRESS THE NEEDS IDENTIFIED IN THE CHNA. THE HEALTHY 2020 STEERING COMMITTEE INCLUDES THE FOLLOWING MEMBERS: DR. MATT DOLL, AGNESIAN HEALTHCARE PSYCHOLOGIST; JEFF BUTZ, WELLNESS DIRECTOR OF FOND DU LAC AREA BUSINESS ON HEALTH, AN EMPLOYER-OWNED BUSINESS COALITION FOCUSING ON HEALTH; KIMBERLY MUELLER, FOND DU LAC COUNTY HEALTH DEPARTMENT NURSE; DR STEVE DI SALVO, PRESIDENT, MARIAN UNIVERSITY; ERIN GERRED, FDL COUNTY DIRECTOR OF ADMINISTRATION; GREG GILES, FDL FAMILY YMCA; BILL LAMB, CHIEF OF POLICE; STEVE LITTLE, CEO, AGNESIAN HEALTHCARE; SR. MARY MOLLISON, VP OF CARE TRANSITION, AGNESIAN HEALTHCARE; WARREN POST, MD, FDL BOARD OF HEALTH MEDICAL DIRECTOR; TINA POTTER, FDL AREA UNITED WAY EXECUTIVE DIRECTOR; SANDI ROEHRIG, FDL AREA FOUNDATION EXECUTIVE DIRECTOR; MARTY RYAN, ROTARY REPRESENTATIVE; KEVIN SHAW, ST. MARY'S SPRINGS ACADEMY PRESIDENT; MARIAN SHERIDAN, FDL SCHOOL DISTRICT HEALTH AND SAFETY COORDINATOR; MICHELLE TIDEMANN, FDL COUNTY UW-EXTENSION; DEANN THURMER, COO, WAUPUN MEMORIAL HOSPITAL; KATHERINE VERGOS, COO, RIPON MEDICAL CENTER; JENNIFER WALTERS, MANAGER OF GROWTH AND MARKET DEVELOPMENT, AURORA HEALTHCARE; DR. JOHN SHORT, CEO AND DEAN, UNIVERSITY OF WISCONSIN FOND DU LAC. THE HEALTHY 2020 COALITION HAS TAKEN THE LEAD ON DISTRIBUTION OF INFORMATION TO THE PUBLIC, AS WELL AS CONTINUING COMMUNITY UPDATES AND ASSESSMENT OF PROGRESS. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 4: 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 5D: IN ADDITION TO THE HOSPITAL'S WEBSITE, THE HEALTHY 2020 COALITION MADE THE RESULTS OF THE CHNA WIDELY AVAILABLE THROUGH A SERIES OF COMMUNITY MEETINGS, DISTRIBUTION OF COMMUNITY HEALTH IMPROVEMENT PLAN FLYERS, NEWSPAPER ARTICLES, AND THE HEALTHY 2020 WEBSITE, WWW.LIVINGWELLFDL.ORG. IN ADDITION, THE FULL REPORT IS AVAILABLE ON THE FOND DU LAC COUNTY WEBSITE. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 6I: AS A RESULT OF THE CHNA, 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 OVER-CONSUMPTION OF ALCOHOL AMONG YOUTH AND ADULTS - AGNESIAN HEALTHCARE HAS PARTICIPATED ON A TASK FORCE TO ASSIST THE POLICE DEPARMENT IN OBTAINING A GRANT TO INCREASE OWI PATROLS. THE TASK FORCE IS ALSO DEVELOPING A DRUG COURT, AND PARTICIPATING IN MEDIA MARKETING CAMPAIGNS TO DISCOURAGE BINGE DRINKING. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 7: THE HOSPITAL IS PARTICIPATING IN THE INITIATIVES NOTED IN QUESTION 6 TO ADDRESS THE NEEDS IDENTIFIED IN THE 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 18 IN THE STATE. IN ORDER TO FURTHER HELP COMMUNITY MEMBERS TAKE POSITIVE STEPS IN IMPROVING THEIR HEALTH, AGNESIAN HEALTCARE DISTRIBUTED 2015 WELLNESS CALENDARS TO 78,000 RESIDENTS. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 12I: UNINSURED PATIENTS ARE AUTOMATICALLY GIVEN A 15% DISCOUNT. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 16E: 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 20D: UNINSURED PATIENTS AUTOMATICALLY RECEIVE A 15% DISCOUNT OFF GROSS CHARGES. |
| ST. AGNES HOSPITAL | PART V, SECTION B, LINE 22: UNINSURED PATIENTS WOULD AUTOMATICALLY RECEIVE A 15% DISCOUNT. INSURED PATIENTS WHO ARE PART OF AN INSURANCE PLAN WITHOUT A NEGOTIATED RATE WITH THE HOSPITAL MIGHT PAY FULL CHARGES IF THE ENTIRE CHARGE WAS APPLIED TO THEIR DEDUCTIBLE. |
| 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/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | 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 (14 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 $ 14,270,018. |
| PART II, LINE 8 | WORKFORCE DEVELOPMENT INCLUDES JOB SHADOWING, CAREERS CAMP, AND THE HEALTHCARE YOUTH APPRENTICE PROGRAM. THESE PROGRAMS ALLOW STUDENTS AND OTHERS TO LEARN ABOUT DIFFERENT OCCUPATIONS IN THE HEALTHCARE INDUSTRY BY BECOMING CERTIFIED AND GAINING ACTUAL WORK EXPERIENCE. THE PROGRAMS ALSO PROMOTE THESE STUDENTS TO BRING VALUABLE HEALTHCARE KNOWLEDGE BACK TO THEIR FAMILIES AND THE COMMUNITY. |
| 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: | 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 III, LINE 9A | AGNESIAN HEALTHCARE, INC. 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 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 AGNESIAN HEALTHCARE INC.'S KEY COMMUNITIES. THROUGH THE HOSPITAL'S PARTICIPATION IN THESE ACTIVITIES, COMMUNITY MEMBERS LEARN OF THE HOSPITAL'S COMMITTMENT TO COMMUNITY-WIDE HEALTHCARE AND PROVIDE AGNESIAN HEALTHCARE WITH INSIGHTS INTO COMMMUNITY HEALTH NEEDS AND DESIRES. |
| PART VI, LINE 3: | FINANCIAL COUNSELORS AT AGNESIAN HEALTHCARE ASSIST PATIENTS WITH APPLICATION TO COMMUNITY CARE. PATIENTS CAN BE REFERRED TO COMMUNITY CARE BY CLERGY, DEPARTMENTS OF AGNESIAN HEALTHCARE, 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 AGNESIAN HEALTHCARE 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: | AGNESIAN HEALTHCARE LEADERS DEVELOP GRANT APPLICATIONS IN SUPPORT OF PROGRAMS AND SERVICES SERVING THE GREATER NEEDS OF THE COMMUNITY, INCLUDING HOSPICE HOPE, DOMESTIC VIOLENCE PROGRAMS, CARDIAC CARE, AND PREVENTIVE HEALTH SERVICES AND SCREENINGS. PROVIDING THESE SERVICES LOCALLY IS A FOCUS OF OUR COMMUNITY BENEFIT PROGRAM. AGNESIAN HEALTHCARE OFFERS PROGRAMS TO THE COMMUNITY THAT ALLOW STUDENTS AND OTHERS TO LEARN ABOUT DIFFERENT OCCUPATIONS IN THE HEALTHCARE INDUSTRY BY BECOMING CERTIFIED AND GAINING ACTUAL WORK EXPERIENCE. THE DIFFERENT PROGRAMS PROVIDE HANDS-ON OPPORTUNITIES AND ALLOW JOB SHADOWING SO THE FUTURE OF THE PROFESSION CAN GAIN CONFIDENCE AND SKILLS. IN ADDITION, AGNESIAN HEALTHCARE SHARES ITS PROFESSIONAL STAFF EXPERTISE TO OFFER HEALTH EDUCATION CLASSES, HEALTH SCREENINGS, SUPPORT GROUPS, AND OTHER HEALTH PROMOTION ACTIVITIES THROUGHOUT THE YEAR. OTHER COMMUNITY ACTIVITIES INCLUDE SUPPORT AND TRAINING FOR THE DODGE CORRECTIONAL INSTITUTIONAL HOSPICE PROGRAM, SHARPS DISPOSAL SERVICE, ADOPT-A-FAMILY, DONATIONS TO FOOD PANTRIES, AND LEADERSHIP PARTICIPATION IN COMMUNITY NONPROFIT ORGANIZATIONS. |
| PART VI, LINE 6: | AGNESIAN HEALTHCARE, INC. IS 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 SERVICES FROM BIRTH TO END OF LIFE, PREVENTIVE HEALTHCARE, DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT AND SKILL 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 (16 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 | $542,742 | $0 | $120,262 | $0 | $17,465 | $0 | $14,500 | $0 | $21,142 | $0 | $716,111 | $0 | $0 | $0 |
| JAMES P MUGAN | ||||||||||||||
| SR VP CLINICAL SERVICES & | $261,109 | $0 | $31,640 | $0 | $10,771 | $0 | $14,746 | $0 | $20,679 | $0 | $338,945 | $0 | $0 | $0 |
| BONNIE R SCHMITZ | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $307,220 | $0 | $32,216 | $0 | $18,002 | $0 | $14,768 | $0 | $7,871 | $0 | $380,077 | $0 | $0 | $0 |
| DENNIS C YUNK | ||||||||||||||
| SR VP CLINIC ADMINISTRATOR | $231,699 | $0 | $27,038 | $0 | $6,754 | $0 | $32,400 | $0 | $17,538 | $0 | $315,429 | $0 | $0 | $0 |
| CAROL B HYLAND | ||||||||||||||
| PRESIDENT AND CEO - CLW | $230,342 | $0 | $28,488 | $0 | $10,031 | $0 | $16,094 | $0 | $17,146 | $0 | $302,101 | $0 | $0 | $0 |
| DOUGLAS D TROST | ||||||||||||||
| CEO - ST FRANCIS HOME | $169,517 | $0 | $19,706 | $0 | $15,855 | $0 | $15,512 | $0 | $22,820 | $0 | $243,410 | $0 | $0 | $0 |
| MARY J MOLLISON | ||||||||||||||
| VP SPIRITUALITY AND CARE T | $171,210 | $0 | $20,854 | $0 | $0 | $0 | $9,947 | $0 | $9,819 | $0 | $211,830 | $0 | $0 | $0 |
| BARBARA L KNUTZEN | ||||||||||||||
| PRES AND CEO-AHE AND PERFO | $193,906 | $0 | $23,828 | $0 | $1,568 | $0 | $10,465 | $0 | $17,650 | $0 | $247,417 | $0 | $0 | $0 |
| SUSAN L EDMINSTER | ||||||||||||||
| VP - HUMAN RESOURCES | $223,049 | $0 | $27,040 | $0 | $1,016 | $0 | $13,247 | $0 | $21,523 | $0 | $285,875 | $0 | $0 | $0 |
| NANCY A BIRSCHBACH | ||||||||||||||
| VP - CIO | $216,306 | $0 | $24,150 | $0 | $805 | $0 | $12,669 | $0 | $24,372 | $0 | $278,302 | $0 | $0 | $0 |
| JILL A STENSON | ||||||||||||||
| VP NURSING | $167,173 | $0 | $19,919 | $0 | $6,762 | $0 | $9,709 | $0 | $8,538 | $0 | $212,101 | $0 | $0 | $0 |
| JOHN CHOI MD | ||||||||||||||
| ANESTHESIOLOGIST - PAIN RE | $561,596 | $0 | $303,199 | $0 | $2,322 | $0 | $15,300 | $0 | $17,877 | $0 | $900,294 | $0 | $0 | $0 |
| YASIR HATAHET MD | ||||||||||||||
| INTENSIVIST | $522,171 | $0 | $226,313 | $0 | $19,858 | $0 | $14,801 | $0 | $27,459 | $0 | $810,602 | $0 | $0 | $0 |
| PONTUS OSTMAN MD | ||||||||||||||
| ANESTHESIOLOGIST - PAIN RE | $403,962 | $0 | $260,936 | $0 | $2,322 | $0 | $15,300 | $0 | $1,160 | $0 | $683,680 | $0 | $0 | $0 |
| MICHAEL VANDERKOOY MD | ||||||||||||||
| RADIATION ONCOLOGIST | $578,123 | $0 | $600 | $0 | $22,893 | $0 | $15,300 | $0 | $23,908 | $0 | $640,824 | $0 | $0 | $0 |
| STEVEN FLURRY MD | ||||||||||||||
| ANESTHESIOLOGIST | $589,045 | $0 | $600 | $0 | $9,553 | $0 | $15,300 | $0 | $16,800 | $0 | $631,298 | $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 | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | In Reserve FundInReserveFundAmt | Refunding EscrowRefundingEscrowAmt | Capital ExpendituresCapitalExpendituresAmt | Capitalized InterestCapitalizedInterestAmt | UnspentUnspentAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,925,000 | $49,330,000 | $430,000 | $48,900,000 | 2005 | Yes (1) | 0 | Yes (1) | Yes (1) | |||||
| B | $2,715,000 | $57,260,000 | $767,686 | 2014 | Yes (1) | 0 | 0 | Yes (1) | $4,518,399 | $31,465,565 | $20,498,350 | |||
| C | $1,862,000 | $10,020,000 | $90,000 | 2011 | Yes (1) | 0 | Yes (1) | Yes (1) | $9,930,000 | |||||
| D | $5,705,000 | $32,111 | 0 | 0 | 0 | Yes (1) | $2,965,178 | $61,653 | $2,707,711 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.01470 | 0.01470 | Yes (1) | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | Yes (1) | 0 | Yes (1) | ||
| C | 0 | 0 | 0 | 0 | Yes (1) | 0 | Yes (1) | ||
| D | 0 | 0 | 0 | 0 | Yes (1) | 0 | 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 | 0 |
| (no name) | |||||||||
| B | Yes (1) | 0 | 0 | 0 | 0 | 0 | |||
| (no name) | |||||||||
| C | Yes (1) | 0 | 0 | 0 | 0 | 0 | |||
| (no name) | |||||||||
| D | Yes (1) | 0 | 0 | 0 | 0 | 0 | |||
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 | BusinessNameLine1 |
| 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 | $27,384,650 | CapitalExpendituresAmt |
| Unspent | $25,595,287 | 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 | 0 | 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 | $470,363 | JOSEPH REITEMEIER IS PRESIDENT OF FOND DU LAC ASSOCIATION OF COMMERCE. AGNESIAN HEALTHCARE, INC. PROVIDED OCCUPATIONAL HEALTH SERVICES TO THE ASSOCIATION OF COMMERCE, BILLING $3,221 FOR THESE SERVICES IN FISCAL YEAR 2014. IN ADDITION, AGNESIAN HEALTHCARE, INC. PURCHASED SERVICES TOTALING $467,142 FROM THE ASSOCIATION OF COMMERCE DURING FISCAL YEAR 2014. | 0 |
| JOSEPH REITEMEIER | |||
| DIRECTOR | $47,460 | JOSEPH REITEMEIER'S DAUGHTER-IN-LAW, JENNIFER REITEMEIER IS EMPLOYED AS AN RN AT AGNESIAN HEALTHCARE, INC., EARNING AN ANNUAL SALARY OF $47,460. | 0 |
| WAYNE MATZKE | |||
| DIRECTOR | $995,416 | WAYNE MATZKE IS CEO OF GRANDE CHEESE. AGNESIAN HEALTHCARE PROVIDED OCCUPATIONAL HEALTH SERVICES TO GRANDE CHEESE, BILLING $995,416 IN FISCAL YEAR 2014. | 0 |
| DENISE DEVERAUX | |||
| DIRECTOR | $536,727 | DENISE DEVERAUX IS VICE PRESIDENT OF HUMAN RESOURCES AT MERCURY MARINE. AGNESIAN HEALTHCARE PROVIDED OCCUPATIONAL HEALTH SERVICES TO MERCURY MARINE, BILLING $536,727 IN FISCAL YEAR 2014. | 0 |
| ROBERT MIKKELSEN MD | |||
| DIRECTOR | $44,036 | ROBERT MIKKELSEN'S STEP-DAUGHTER, KAYLA AVILA, IS EMPLOYED AS AN RN AT AGNESIAN HEALTHCARE, EARNING AN ANNUAL SALARY OF $44,036. | 0 |
| JAMES CHATTERTON | |||
| DIRECTOR | $3,576 | JAMES CHATTERTON IS PRESIDENT OF AMERICAN BANK. AGNESIAN HEALTHCARE, INC PROVIDED OCCUPATIONAL HEALTH SERVICES TO AMERICAN BANK, BILING $3,576 OF THESE SERVICES IN FISCAL YEAR 2014. | 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 2013 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 56,353,718. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,353,718. PURCHASED SERVICES - LABORATORY: PROGRAM SERVICE EXPENSES 142,151. MANAGEMENT AND GENERAL EXPENSES 53. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 142,204. PURCHASED SERVICES - LAUNDRY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 686,097. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 686,097. PURCHASED SERVICES - ELEVATOR: PROGRAM SERVICE EXPENSES 3,319. MANAGEMENT AND GENERAL EXPENSES 132,455. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 135,774. PURCHASED SERVICES - MISCELLANEOUS: PROGRAM SERVICE EXPENSES 1,907,386. MANAGEMENT AND GENERAL EXPENSES 1,646,436. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,553,822. PURCHASED SERVICES - TEMPORARY STAFF: PROGRAM SERVICE EXPENSES 1,234,574. MANAGEMENT AND GENERAL EXPENSES 27,035. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,261,609. PURCHASED SERVICES - REFERENCE TESTS: PROGRAM SERVICE EXPENSES 897,009. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 897,009. PURCHASED SERVICES - HOUSEKEEPING: PROGRAM SERVICE EXPENSES 64,613. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,613. PURCHASED SERVICES - TRANSCRIPTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 243,322. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 243,322. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 81,232. MANAGEMENT AND GENERAL EXPENSES 606,051. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 687,283. PROFESSIONAL FEES - MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 359,344. MANAGEMENT AND GENERAL EXPENSES 12,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 371,344. PROFESSIONAL FEES - COLLECTION: PROGRAM SERVICE EXPENSES 5,563. MANAGEMENT AND GENERAL EXPENSES 842,316. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 847,879. |
| FORM 990, PART XI, LINE 9: | CAPITAL CONTRIBUTIONS FROM AFFILIATES 5,000,000. CHANGE IN SWAP FUND BALANCE -20,988. CHANGE IN FUND BALANCE - SAH FOUNDATION 1,455,428. CAPITAL CONTRIBUTIONS - FOUNDATION 218,906. CAPITAL CONTRIBUTIONS - OTHER 2,000. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | 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 | $26,565,994 | $14,795,092 | N/A |
| AGNESIAN HEALTHCARE ENTERPRISES LLC | |||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 392038757 | RETAIL PHARMACY | WI | $9,517,540 | $9,425,531 | N/A |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | 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 | ||||||||||
| 933 NEWBURY 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 | $1,308,785 | CASH RECEIPTS |
| ST FRANCIS HOME | ||
| D | $5,000,000 | BOND VALUE |
| ST FRANCIS HOME | ||
| M | $61,411 | CASH PAYMENTS |
| CONGREGATION OF SISTERS OF ST AGNES | ||
| M | $331,751 | CASH PAYMENTS |
| CONGREGATION OF SISTERS OF ST AGNES | ||
| O | $390,677 | CASH PAYMENTS |
| WAUPUN MEMORIAL HOSPITAL | ||
| P | $377,095 | CASH TRANSFER |
| RIPON MEDICAL CENTER | ||
| P | $6,760 | CASH TRANSFER |