AGNESIAN HEALTHCARE INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- AGNESIAN HEALTHCARE INC (EIN 39-0807236)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-13
- IRS object ID
- 201141339349303844
- Schema version
- 2009v1.7
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-13T14:06:39-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807236 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Agnesian Healthcare Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AGNE | NameControl |
| Phone | 9209264480 | Phone |
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 | 53935 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BONNIE SCHMITZ | Name |
| Title | assistant vp and controller | Title |
| Phone | 9209264480 | Phone |
| Date Signed | 2011-05-13 | DateSigned |
| Authorize Third Party | 0 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Terri Rexrode CPA MST | Name |
| Phone | 9206620016 | Phone |
| Date Prepared | 2011-05-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT FALe | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 430 East Division Street | AddressLine1 |
| City | Fond du Lac | City |
| State | WI | State |
| ZIP Code | 53935 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 350340440 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| All Affiliates Included | 1 | AllAffiliatesIncluded |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c | X | Organization501c |
| Web Site | WWW.AGNESIAN.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1892 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | INTEGRATED HEALTHCARE DELIVERY SYSTEM - 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3014 | TotalNbrEmployees |
| Total Nbr Volunteers | 650 | TotalNbrVolunteers |
| Total Gross UBI | 63449 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 353111 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 265091471 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 266316587 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -1762795 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2946481 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 13310389 | OtherRevenuePriorYear |
| Other Revenue Current Year | 12501754 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 276639065 | TotalRevenuePriorYear |
| Total Revenue Current Year | 281764822 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 112066725 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 110609444 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 160966189 | OtherExpensePriorYear |
| Other Expenses Current Year | 159878453 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 273032914 | TotalExpensesPriorYear |
| Total Expenses Current Year | 270487897 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3606151 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 11276925 | RevenuesLessExpensesCY |
| Total Assets BOY | 300829435 | TotalAssetsBOY |
| Total Assets EOY | 321294193 | TotalAssetsEOY |
| Total Liabilities BOY | 176251809 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 159519424 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 124577626 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 161774769 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 180873762 | Expense |
| Revenue | 254523197 | Revenue |
| Description | HOSPITAL, CLINIC AND HOME HEALTH SERVICES PROVIDING DIAGNOSTIC AND THERAPEUTIC HEALTHCARE | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 11141381 | Expense |
| Revenue | 14339765 | Revenue |
| Description | LABORATORY SERVICES PROVIDING DIAGNOSTIC HEALTHCARE FOR CENTRAL WISCONSIN | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6203740 | Expense |
| Revenue | 5476187 | Revenue |
| Description | RETAIL PHARMACY AND HOME MEDICAL EQUIPMENT SALES TO SERVICE POPULATION FOR HOSPITAL (INPATIENT AND OUTPATIENT), CLINIC AND HOME HEALTH | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1135353 | Expense |
| Revenue | 1383176 | Revenue |
| Description | FOND DU LAC SURGERY CENTER - PROVIDING OUTPATIENT SURGERY TO THE FOND DU LAC COMMUNITY AND SURROUNDING AREAS | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 1135353 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 1383176 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 199354236 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 192 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 3014 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 1 | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 1 | Form8899Filed |
| Form1098 C Filed | 1 | Form1098CFiled |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BONNIE SCHMITZ | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9209264480 | TelephoneNumber |
Address US AddressUS
| 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 Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ROBERT A FALE | |||||||
| PRESIDENT AND CEO | 50.00 | X | X | 617752 | 0 | 24315 | |
| SISTER ANN KOERNER | |||||||
| EX-OFFICIO | 1.00 | X | 0 | 0 | 0 | ||
| SISTER MARY NOEL BROWN | |||||||
| EX-OFFICIO | 1.00 | X | 0 | 0 | 0 | ||
| DEBRA HELLER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| PATRICIA MILLER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| Dr STEPHEN MASSICK MD | |||||||
| DIRECTOR | 1.00 | X | 31956 | 0 | 0 | ||
| WAYNE MATZKE | |||||||
| VICE CHAIRPERSON | 1.00 | X | 0 | 0 | 0 | ||
| DrMICHAEL STRIGENZ MD | |||||||
| DIRECTOR | 1.00 | X | 761 | 0 | 0 | ||
| DRJEFFREY STRONG MD | |||||||
| CHAIRPERSON | 1.00 | X | 171 | 0 | 0 | ||
| JAMES B SIMON | |||||||
| SECRETARY/TREASURER | 1.00 | X | 6710 | 0 | 0 | ||
| DRBRIAN CHRISTENSON MD | |||||||
| EX-OFFICIO | 1.00 | X | 302265 | 0 | 24315 | ||
| JAMES R CHATTERTON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| STEVEN LITTLE | |||||||
| SR VP AND CHIEF FINANCIAL | 50.00 | X | 341010 | 0 | 25455 | ||
| NORMA TIRADO | |||||||
| SR VP EMPLOYEE SERVICES | 50.00 | X | 238457 | 0 | 7718 | ||
| JANE HYDE | |||||||
| SR VP COMMUNITY AFFAIRS | 50.00 | X | 217477 | 0 | 13753 | ||
| DENNIS YUNK | |||||||
| VP CLINIC ADMINISTRATION | 50.00 | X | 214402 | 0 | 20056 | ||
| CAROL HYLAND | |||||||
| VP CEO CONSULTANTS LABORAT | 50.00 | X | 197308 | 0 | 21528 | ||
| JAMES MUGAN | |||||||
| SR VP CLINICAL SERVICES | 50.00 | X | 190708 | 0 | 27312 | ||
| BARBARA KNUTZEN | |||||||
| VP CLINIC ADMINISTRATION | 50.00 | X | 163720 | 0 | 18972 | ||
| DOUGLAS TROST | |||||||
| VP - COO ST FRANCIS HOME | 50.00 | X | 129362 | 0 | 21674 | ||
| JOHN CHOI MD | |||||||
| ANESTHESIOLOGIST - PAIN RE | 50.00 | 1047516 | 0 | 22215 | X | ||
| DENNIS FITZPATRICK MD | |||||||
| INTENSIVIST | 50.00 | 840291 | 0 | 22388 | X | ||
| PONTUS OSTMAN MD | |||||||
| ANESTHESIOLOGIST - PAIN RE | 50.00 | 769520 | 0 | 9625 | X | ||
| ISAM HABIB MD | |||||||
| INTENSIVIST/PULMONOLOGIST | 50.00 | 761222 | 0 | 28424 | X | ||
| YASIR HATAHET MD | |||||||
| INTENSIVIST | 50.00 | 709771 | 0 | 30306 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 6780379 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 318056 | TotalOtherCompensation |
| Number Individuals GT100 K | 111 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FOND DU LAC REGIONAL CLINIC SC | |||||
| 420 EAST DIVISION STREET | FOND DU LAC | WI | 54935 | PHYSICIAN SERVICES | 43055064 |
| IBM CORPORATION | |||||
| 1 NEW ORCHARD ROAD | ARMONK | NY | 105041722 | COMPUTER SERVICES | 7237130 |
| CERNER CORPORATION | |||||
| 2800 ROCKCREEK PARKWAY | KANSAS CITY | MO | 64141 | COMPUTER SERVICES | 5466419 |
| CD SMITH CONSTRUCTION | |||||
| PO BOX 1006 | FOND DU LAC | WI | 54935 | CONTRACTOR | 1207514 |
| AMERICAN HEALTHCARE SERVICES | |||||
| PO BOX 945 | TRAVERSE CITY | MI | 49685 | TEMPORARY STAFFING | 789815 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 46 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE RE | 621400 | 177419986 | 177419986 |
| MEDICARE/MEDICAID SERV | 621400 | 88896601 | 88896601 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 266316587 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1550852 | TotalRevenueColumn |
| Exclusion | $1,550,852 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 48962667 | Securities |
| Other | 146000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 47496543 | Securities |
| Other | 216495 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1466124 | Securities |
| Other | -70495 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1395629 | TotalRevenueColumn |
| Exclusion | $1,395,629 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 28803840 | GrossSalesOfInventory |
| Cost Of Goods Sold | 20862580 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7941260 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7941260 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| CLINIC REIMBURSEMENT | 621110 | 851260 | 851260 | ||
| CAFETERIA SALES | 900099 | 773597 | 63449 | $710,148 | |
| WORK INJURY - SAH | 592512 | 613218 | 613218 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2322419 | TotalRevenueColumn |
| Exclusion | $2,322,419 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 4560494 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 281764822 | TotalRevenueColumn |
| Related Or Exempt Function Income | 275722325 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 63449 | UnrelatedBusinessRevenue |
| Exclusion | $5,979,048 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2802213 | Total |
| Program Services | 327051 | ProgramServices |
| Management And General | 2475162 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95273096 | Total |
| Program Services | 75359864 | ProgramServices |
| Management And General | 19913232 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3212914 | Total |
| Program Services | 2232362 | ProgramServices |
| Management And General | 980552 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2890919 | Total |
| Program Services | 1697992 | ProgramServices |
| Management And General | 1192927 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6430302 | Total |
| Program Services | 4919242 | ProgramServices |
| Management And General | 1511060 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 427072 | Total |
| Program Services | 7760 | ProgramServices |
| Management And General | 419312 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112741 | Total |
| Program Services | 2291 | ProgramServices |
| Management And General | 110450 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 328959 | Total |
| Management And General | 328959 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54573317 | Total |
| Program Services | 51143181 | ProgramServices |
| Management And General | 3430136 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 905998 | Total |
| Program Services | 87955 | ProgramServices |
| Management And General | 818043 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48350445 | Total |
| Program Services | 40351551 | ProgramServices |
| Management And General | 7998894 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10996507 | Total |
| Program Services | 53262 | ProgramServices |
| Management And General | 10943245 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3491677 | Total |
| Program Services | 39977 | ProgramServices |
| Management And General | 3451700 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 482705 | Total |
| Program Services | 416733 | ProgramServices |
| Management And General | 65972 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 882573 | Total |
| Program Services | 720975 | ProgramServices |
| Management And General | 161598 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4774711 | Total |
| Management And General | 4774711 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15917115 | Total |
| Program Services | 5587533 | ProgramServices |
| Management And General | 10329582 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2573626 | Total |
| Program Services | 1739294 | ProgramServices |
| Management And General | 834332 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 10254858 | 9798362 | 456496 |
| HOSPITAL ASSESSMENT TAX | 4403515 | 4403515 | |
| MISCELLANEOUS | 898805 | 254890 | 643915 |
| DUES, SUBSCRIPTIONS, LI | 462104 | 210401 | 251703 |
| OTHER | 41725 | 45 | 41680 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270487897 | Total |
| Program Services | 199354236 | ProgramServices |
| Management And General | 71133661 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26223771 | BOY |
| EOY | 4270208 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6736516 | BOY |
| EOY | 20242335 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37708950 | BOY |
| EOY | 36757284 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4252709 | BOY |
| EOY | 4669760 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2497143 | BOY |
| EOY | 2502627 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 235222188 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 115808356 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124250831 | BOY |
| EOY | 119413832 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52615403 | BOY |
| EOY | 97433513 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1020134 | BOY |
| EOY | 996299 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45523978 | BOY |
| EOY | 35008335 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300829435 | BOY |
| EOY | 321294193 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26085701 | BOY |
| EOY | 29413460 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115592174 | BOY |
| EOY | 100125807 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34573934 | BOY |
| EOY | 29980157 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 176251809 | BOY |
| EOY | 159519424 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116865506 | BOY |
| EOY | 153297329 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5608756 | BOY |
| EOY | 6338229 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2103364 | BOY |
| EOY | 2139211 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 124577626 | BOY |
| EOY | 161774769 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300829435 | BOY |
| EOY | 321294193 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1020134 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 23156 | InvestmentEarningsOrLosses |
| Other Expenditures | 45000 | OtherExpenditures |
| Administrative Expenses | 1991 | AdministrativeExpenses |
| End Of Year Balance | 996299 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1014822 | BeginningOfYearBalance |
| Contributions | 45000 | Contributions |
| Investment Earnings Or Losses | -37548 | InvestmentEarningsOrLosses |
| Administrative Expenses | 2140 | AdministrativeExpenses |
| End Of Year Balance | 1020134 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6252636 | OtherCostOrOtherBasis |
| Book Value | 6252636 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 112607633 | OtherCostOrOtherBasis |
| Depreciation | 41517746 | Depreciation |
| Book Value | 71089887 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1988981 | OtherCostOrOtherBasis |
| Depreciation | 602374 | Depreciation |
| Book Value | 1386607 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 113118108 | OtherCostOrOtherBasis |
| Depreciation | 73688236 | Depreciation |
| Book Value | 39429872 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1254830 | OtherCostOrOtherBasis |
| Book Value | 1254830 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 119413832 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (9 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| RECEIVABLE FROM FDLRC SC | 357843 |
| RECEIVABLE FROM AFFILIATED ENTITIES | 490689 |
| AMOUNTS DUE FROM THIRD PARTIES | 626947 |
| LONG-TERM DEBT RECEIVABLE FROM RELATED ENTITIES | 5000000 |
| DUE FROM FOUNDATION | 552134 |
| ASSETS WHOSE USE IS LIMITED - DEBT SVC AND PHYSICIAN SUPP. BENEFIT PLAN | 14837462 |
| INVESTMENT - MERCURY CLINIC | 3005130 |
| INVESTMENT - SAH FOUNDATION | 7333092 |
| OTHER ASSETS | 2805038 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 35008335 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE PAYABLE | $12,443,994 |
| PHYSICIANS SUPPLEMENTAL LIFE | $12,236,761 |
| DUE TO WAUPUN MEMORIAL HOSPITAL | $3,326,477 |
| FUND BALANCE SWAP MKT ADJUSTMENT | $1,972,925 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 29980157 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | 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: | Description of Uncertain Tax Positions Under FIN 48: | In order to account for any uncertain tax positions, ASC Topic 740-10, Accounting for Uncertainty in Income Taxes, requires an organization to assess 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 recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits. Federal returns for the years ended 2007, 2008, and 2009 remain subject to examination by the Internal Revenue Service. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 165.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2638000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2638000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01010 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11888000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11888000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04570 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14526000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 14526000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05580 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1119476 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 103737 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1015739 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 228673 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 228673 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 312518 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 312518 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 209651 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 209651 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1870318 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 103737 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1766581 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00680 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16396318 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 103737 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16292581 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06260 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 85375 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 85375 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 85375 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 85375 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,905,802 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 73764593 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 113812280 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -40047687 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (3 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| AGNESIAN HEALTHCARE | |||
| DIALYSIS | 0.50000 | 0.00000 | 0.00000 |
| BEAVER DAM COMMUNITY | |||
| HOSPITAL VENTURE LLC | |||
Form990 Schedule H Part V Form990ScheduleHPartV (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|
| ST AGNES HOSPITAL | |||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | X | X | X | |
| FOND DU LAC REGIONAL CLINIC | |||||||
| 420 E DIVISION STREET | FOND DU LAC | WI | 54935 | OUTPATIENT PHYSICIAN CLINIC | |||
| CONSULTANTS LAB OF WISCONSIN | |||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | LABORATORY AND TESTING | |||
| AGNESIAN HEALTHCARE ENTERPRISES | |||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | PHARMACEUTICALS, HOME HEALTH, MEDICAL EQUIPMENT | |||
| FOND DU LAC SURGERY CENTER | |||||||
| 421 CAMELOT DRIVE | FOND DU LAC | WI | 54935 | X | |||
| AGNESIAN HOSBEAVER DAM COMM HOS | |||||||
| 110 MONROE STREET | BEAVER DAM | WI | 53916 | DIALYSIS SERVICES | |||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Annual Community Benefit Expln | 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. | AnnualCommunityBenefitExpln |
| Costing Method Used | 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. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: SUBSIDIZED HEALTH SERVICES INCLUDES SAMARITAN CLINIC, A CLINIC OFFERING FREE MEDICAL SERVICES TO QUALIFIED INDIVIDUALS, AND COUNSELING SERVICES THROUGH BEHAVIORAL HEALTH SERVICES, SAMARITAN CLINIC COSTS WERE $301,842 FOR FY10. THE SAMARITAN HEALTH CLINIC PROVIDES PATIENTS WITH IMPORTANT BASIC HEALTH SERVICES, MEDICATIONS AND URGENT DENTAL NEEDS AT NO CHARGE TO THE PATIENT. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX, LINE 25 WAS $10,254,858 AND WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | 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. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES, THE TOTAL EXPENSES LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | 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 EXPENSE FROM BAD DEBT TO CHARITY CARE. | DebtCollectionPolicy |
| General Explanation | 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 TYPICALLY BILLED AT A REDUCED RATE), OR GUARANTEED BANK LOANS. | GeneralExplanation |
| Needs Assessment | Part VI, Line 2: AGNESIAN HEALTHCARE 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'S KEY COMMUNITIES. THROUGH AGNESIAN'S PARTICIPATION IN THESE ACTIVITIES, COMMUNITY MEMBERS LEARN OF AGNESIAN'S COMMITTMENT TO COMMUNITY-WIDE HEALTHCARE AND PROVIDE AGNESIAN WITH INSIGHT INTO COMMUNITY HEALTH NEEDS AND DESIRES. | NeedsAssessment |
| Patient Education Assistance | 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, 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. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: COMMUNITY CARE APPLICATIONS ARE ACCEPTED ONLY FROM PATIENTS OF AGNESIAN HEALTHCARE WHO RESIDE IN THE COUNTIES OF CALUMET, DODGE, FOND DU LAC, GREEN LAKE, MARQUETTE, 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. THE SAMARITAN CLINIC SERVICES PATIENTS FROM DODGE AND FOND DU LAC COUNTIES. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: 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 AND EXPERTISE TO OFFER HEALTH EDUCATION CLASSES, HEALTH SCREENINGS, SUPPORT GROUPS, AND OTHER HEALTH PROMOTION ACTIVITIES THROUGHOUT THE YEAR. OTHER COMMUNITY INCLUDE SUPPORT AND TRAINING FOR THE DODGE CORRECTIONAL INSTITUTIONAL HOSPICE PROGRAM, SHARPS DISPOSAL SERVICES, ADOPT-A-FAMILY, DONATIONS TO FOOD PANTRIES, AND LEADERSHIP PARTICIPATION IN COMMUNITY NONPROFIT ORGANIZATIONS. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: 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 SCREENINGS AND SERVICES. PROVIDING THESE SERVICES LOCALLY IS A FOCUS OF OUR COMMUNITY BENEFIT PROGRAMS. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: 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, FOND DU LAC SURGERY CENTER, ST. AGNES HOSPITAL, ST. FRANCIS HOME AND WAUPUN MEMORIAL HOSPITAL. 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. | AffiliatedHealthCareSystem |
| Reports Filed With States | WI | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT A FALE | |||||||||||||
| 494357 | 0 | 0 | 0 | 123395 | 0 | 0 | 0 | 24315 | 0 | 642067 | 0 | 0 | 0 |
| DRBRIAN CHRISTENSON MD | |||||||||||||
| 276640 | 0 | 25625 | 0 | 0 | 0 | 0 | 0 | 24315 | 0 | 326580 | 0 | 0 | 0 |
| STEVEN LITTLE | |||||||||||||
| 305042 | 0 | 0 | 0 | 35968 | 0 | 0 | 0 | 25455 | 0 | 366465 | 0 | 0 | 0 |
| NORMA TIRADO | |||||||||||||
| 209973 | 0 | 0 | 0 | 28484 | 0 | 0 | 0 | 7718 | 0 | 246175 | 0 | 0 | 0 |
| JANE HYDE | |||||||||||||
| 191414 | 0 | 0 | 0 | 26063 | 0 | 0 | 0 | 13753 | 0 | 231230 | 0 | 0 | 0 |
| DENNIS YUNK | |||||||||||||
| 178298 | 0 | 0 | 0 | 36104 | 0 | 0 | 0 | 20056 | 0 | 234458 | 0 | 0 | 0 |
| CAROL HYLAND | |||||||||||||
| 181675 | 0 | 0 | 0 | 15633 | 0 | 0 | 0 | 21528 | 0 | 218836 | 0 | 0 | 0 |
| JAMES MUGAN | |||||||||||||
| 176035 | 0 | 0 | 0 | 14673 | 0 | 0 | 0 | 27312 | 0 | 218020 | 0 | 0 | 0 |
| BARBARA KNUTZEN | |||||||||||||
| 150224 | 0 | 0 | 0 | 13496 | 0 | 0 | 0 | 18972 | 0 | 182692 | 0 | 0 | 0 |
| DOUGLAS TROST | |||||||||||||
| 118953 | 0 | 0 | 0 | 10409 | 0 | 0 | 0 | 21674 | 0 | 151036 | 0 | 0 | 0 |
| JOHN CHOI MD | |||||||||||||
| 532293 | 0 | 515223 | 0 | 0 | 0 | 0 | 0 | 22215 | 0 | 1069731 | 0 | 0 | 0 |
| DENNIS FITZPATRICK MD | |||||||||||||
| 582366 | 0 | 257925 | 0 | 0 | 0 | 0 | 0 | 22388 | 0 | 862679 | 0 | 0 | 0 |
| PONTUS OSTMAN MD | |||||||||||||
| 426563 | 0 | 342957 | 0 | 0 | 0 | 0 | 0 | 9625 | 0 | 779145 | 0 | 0 | 0 |
| ISAM HABIB MD | |||||||||||||
| 416777 | 0 | 344445 | 0 | 0 | 0 | 0 | 0 | 28424 | 0 | 789646 | 0 | 0 | 0 |
| YASIR HATAHET MD | |||||||||||||
| 491237 | 0 | 218534 | 0 | 0 | 0 | 0 | 0 | 30306 | 0 | 740077 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 1a | ALL GROSSUP PAYMENTS AND SOCIAL CLUB DUES ARE INCLUDED IN EMPLOYEE W-2, BOX 5. BENEFITS ARE PROVIDED PER THE EMPLOYMENT CONTRACT WITH EACH INDIVIDUAL EXECUTIVE. |
| Part I, Line 1b | THE SOCIAL CLUB DUES ARE DEFINED IN THE CONTRACTUAL AGREEMENT WITH THE INDIVIDUAL EXECUTIVE. GROSSUP PAYMENTS FOR ALL EXECUTIVES ARE INCLUDED IN THE EMPLOYEE W-2, LINE 5. DOCUMENTATION IS REQUIRED BEFORE REIMBURSEMENT OCCURS. |
| Part I, Line 4a | 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
Form990 Schedule K Part I Form990ScheduleKPartI
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) |
|---|---|---|
| Issuer EIN | 391337855 | IssuerEIN |
| CUSIP Number | 97710Bgg1 | CUSIPNumber |
| Date Issued | 2008-12-11 | DateIssued |
| Issue Price | 49330000 | IssuePrice |
| Description Of Purpose | REFUNDING OF 2005 ISSUE | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 49330000 | TotalProceeds |
| Amount Defeased | 48900000 | AmountDefeased |
| Issuance Costs From Proceeds | 430000 | IssuanceCostsFromProceeds |
| Year Of Subst Completion | 2005 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 1 | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Piper jaffray | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Of Hedge | 28.000000000000 | TermOfHedge |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| STEPHEN MASSICK MD | |||
| DIRECTOR OF FOND DU LAC REGIONAL CLINIC SC | 43055064 | HE IS A DIRECTOR OF FOND DU LAC REGIONAL CLINIC, SC. (FDLRC SC) AGNESIAN HEALTHCARE INC (ahc) CONTRACTS WITH FOND DU LAC REGIONAL CLINIC, SC FOR PHYSICIAN SERVICES. MEMBERS OF FDLRC SC HAVE SERVED AND CONTINUE TO SERVE ON THE BOARD OF DIRECTORS OF AGNESIAN HEALTHCARE, INC., WHILE PROVIDING PROFESSIONAL SERVICES TO AHC AND ARE COMPENSATED BY FDLRC SC FOR THOSE SERVICES. AHC COMPENSATED FDLRC SC $43,055,064 FOR PROFESSIONAL SERVICES IN FISCAL YEAR 2010. FDLRC SC DISTRIBUTES THOSE FUNDS TO PHYSICIANS BASED ON THEIR OWN CALCULATIONS. AHC DOES NOT CONTROL THE DISBURSEMENT OF FUNDS TO THE FDLRC PHYSICIANS. | 0 |
| WAYNE MATZKE | |||
| DIRECTOR | 49772 | WAYNE MATZKE IS PRESIDENT/CEO OF GRANDE CHEESE. AGNESIAN HEALTHCARE, INC. PROVIDED OCCUPATIONAL HEALTH SERVICES TO GRANDE CHEESE, BILLING $49,772 FOR THESE SERVICES IN FISCAL 2010. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 7b | THE CONGREGATION OF THE SISTERS OF ST AGNES SPONSPORED MINISTRIES IS A CLASS B MEMBER WHO IS RESPONSIBLE FOR APPROVING CERTAIN ACTIVITIES OF THE CORPORATION. THE CONGREGATION OF THE SISTERS OF ST AGNES IS A CLASS A MEMBER WHO HAS THE SAME RESERVE POWERS AS THE CLASS B MEMBER. |
| Form 990, Part VI, Section B, line 11 | THE FINANCE DEPARTMENT PREPARES THE FORM 990 AND THE RETURN IS REVIEWED BY THE CFO AND CONTROLLER. A FINAL COPY OF THE 2009 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. COPIES OF THE RETURN ARE ALSO MADE AVAILABLE TO ALL AGNESIAN HEALTHCARE BOARD MEMBERS. |
| Form 990, Part VI, Section B, line 12c | WE HAVE A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY THAT REQUIRE EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON AN ANNUAL BASIS TO THE DISIGNATED 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 COMTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION 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 XI, LINE 2B | THE CONSOLIDATED FINANCIAL STATEMENTS OF AGNESIAN HEALTHCARE SYSTEM WERE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM, WIPFLI LLP. TWO RELATED ENTITIES IN THE AGNESIAN HEALTHCARE SYSTEM, WAUPUN MEMORIAL HOSPITAL AND ST. FRANCIS HOME, FILE SEPARATE FORMS 990. REMAINING ENTITIES ARE REPRESENTED BY THE AGNESIAN HEALTHCARE TAX RETURN. |
| FORM 990, PART XI, LINE 2C | THE AUDIT COMMITTEE OF AGNESIAN HEALTHCARE, INC IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT BY THE INDEPENDENT ACCOUNTING FIRM. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| CONSULTANTS LABORATORY OF WISCONSIN LLC | |||||||||
| 430 EAST DIVISON STREET | FOND DU LAC | WI | 54935 | 391528550 | LAB SERVICES | WI | 23177879 | 10637317 | N/A |
| AGNESIAN HEALTHCARE ENTERPRISES | |||||||||
| 430 EAST DIVISON STREET | FOND DU LAC | WI | 54935 | 392038757 | RETAIL PHARMACY | WI | 28798360 | 9396155 | N/A |
| FOND DU LAC SURGERY CENTER | |||||||||
| 421 CAMELOT DRIVE | FOND DU LAC | WI | 54935 | 203947006 | OUTPATIENT SURGERY | WI | 1498343 | 0 | N/A |
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| CONGREGATION OF SISTERS OF ST AGNES | |||||||||
| 320 COUNTY ROAD K | FOND DU LAC | WI | 54935 | 390806217 | CONVENT | WI | 501(C)(3) | 1 | N/A |
| AGNESIAN HEALTHCARE FOUNDATION | |||||||||
| 430 E DIVISION STREET | FOND DU LAC | WI | 54935 | 391684956 | FOUNDATION | WI | 501(C)(3) | 11 | N/A |
| WAUPUN MEMORIAL HOSPITAL | |||||||||
| 620 WEST BROWN STREET | WAUPUN | WI | 53963 | 390806265 | HOSPITAL | WI | 501(C)(3) | 3 | N/A |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANGESIAN HCBEAVER DAM COMMUNITY HOSPITALS VENTURE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 monroe st | AddressLine1 |
| City | BEAVER DAM | City |
| State | WI | State |
| ZIP Code | 53916 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752992766 | EIN |
| Primary Activity | DIALYSIS | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 50 | ShareOfTotalIncome |
| Share Of EOY Assets | 50 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| AGNESIAN HEALTHCARE FOUNDATION INC | |
| C | 393043 |
| WAUPUN MEMORIAL HOSPITAL | |
| D | 419812 |
| ST FRANCIS HOME | |
| D | 5000000 |
| ST FRANCIS HOME | |
| L | 72397 |
| CONGREGATION OF SISTERS OF ST AGNES | |
| L | 287831 |
| CONGREGATION OF SISTERS OF ST AGNES | |
| N | 124326 |
| CONGREGATION OF SISTERS OF ST AGNES | |
| P | 390 |