2024-11-15T11:09:42-06:00 2023-12-31 990 2023-01-01 391684956 AGNESIAN HEALTHCARE FOUNDATION INC AGNE 9209264998 430 E DIVISION ST FOND DU LAC WI 54935 STEPHANIE KING VP FINANCE 9209292300 2024-11-15 0 2023 2024-10-15 13:58:12Z STEPHANIE KING 430 E DIVISION ST FOND DU LAC WI 54935 2870472 0 X WWW.GIVETOSSMHEALTH.ORG/FOUNDATIONS/WISCONSIN/AGN X 1990 WI THE EFFECTIVE AND EFFICIENT DEVELOPMENT, FINANCIAL MANAGEMENT AND GRANTING OF PHILANTHROPIC SUPPORT FOR ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, RIPON MEDICAL CENTER, ST. FRANCIS HOME OF FDL, SISTERS SERVANTS OF CHRIST THE KING VILLA LORETTO, VILLA ROSA, AND THE CHRISTIAN HOME. 12 11 0 42 0 0 4187047 1613039 0 0 364986 730603 1232684 80539 5784717 2424181 1417815 2463770 0 0 0 0 0 0 204758 56340 204758 1474155 2668528 4310562 -244347 25862506 26936247 1080779 395658 24781727 26540589 THE EFFECTIVE AND EFFICIENT DEVELOPMENT, FINANCIAL MANAGEMENT AND GRANTING OF PHILANTHROPIC SUPPORT FOR ST. AGNES HOSP, WAUPUN MEMORIAL HOSP, RIPON MEDICAL CENTER, ST. FRANCIS HOME OF FDL, SISTERS SERVANTS OF CHRIST THE KING VILLA LORETTO, VILLA ROSA, AND THE CHRISTIAN HOME. 0 0 2463770 2463770 THE AGNESIAN HEALTHCARE FOUNDATION PROVIDES SUPPORT TO AGNESIAN HEALTHCARE INC, WAUPUN MEMORIAL HOSPITAL, RIPON MEDICAL CENTER, ST. FRANCIS HOME OF FOND DU LAC, SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO, VILLA ROSA, AND THE CHRISTIAN HOME & REHABILITATION CENTER FOR OPERATIONS AND CAPITAL EQUIPMENT. 2463770 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 9 12 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X JACKIE TAYLOR 6082416949 1808 W BELTLINE HWY MADISON WI 53713 SHAWN FISHER DIRECTOR, EXECUTIVE DIRECTOR 40.00 0.00 X X 138868 0 21706 JACK E TWOHIG DIRECTOR, CHAIRPERSON 1.00 0.00 X X 0 0 0 JOSEPH A BIRD DIRECTOR, VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 BOB FALE DIRECTOR, SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SR MARY NOEL BROWN DIRECTOR 1.00 0.00 X 0 0 0 DR BRENDA GRASS DIRECTOR 1.00 0.00 X 0 0 0 JEFF NUSS DIRECTOR 1.00 0.00 X 0 0 0 KATHY SCHLIEVE DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL R SHANNON DIRECTOR 1.00 0.00 X 0 0 0 MAGGIE SHELL DIRECTOR 1.00 0.00 X 0 0 0 ADAM STONE DIRECTOR 1.00 0.00 X 0 0 0 DR CATHERINE TWOHIG-MCGALLOWAY DIRECTOR 1.00 0.00 X 0 0 0 138868 0 21706 1 0 1 0 0 236076 1376963 34891 1613039 607910 607910 122693 0 122693 122693 122693 1399 236076 76374 -74975 -74975 186150 82144 104006 104006 339281 287773 51508 51508 2424181 0 0 811142 2417440 2417440 46330 46330 13702 13702 3407 3407 130913 130913 893 893 BANK CHARGES 55843 55843 2668528 2463770 0 204758 3718065 2758870 6441416 9355986 859988 644988 43199 50119 14799838 14126284 25862506 26936247 1080779 395658 1080779 395658 X 9981889 12414305 14799838 14126284 24781727 26540589 25862506 26936247 -244347 1968318 34891 0 X 0 1 X 1 0 X X 8 AGNESIAN HEALTHCARE INC 390807236 3 1 2525867 0 ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC 391029998 10 1 8409 0 WAUPUN MEMORIAL HOSPITAL 390806265 3 1 1000 0 SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO 391022770 10 1 0 0 SSM HEALTH CARE CORPORATE 466029223 3 1 1700 0 THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED 390884514 10 1 0 0 VILLA ROSA INC 421670962 10 1 0 0 RIPON MEDICAL CENTER INC 391101287 3 1 0 0 8 2536976 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2562797 2562797 1487797 1075000 2562797 1487797 1487797 1487797 1487797 1487297 500 1487797 0.00000 1.00000 0.00000 1 0 0 PROGRAM-RELATED INVESTMENTS 14126284 F 14126284 DUE TO AFFILIATES 395658 395658 X PART V, LINE 4: ENDOWMENTS ARE DESIGNATED FOR MEDICAL CARE FOR THOSE IN FINANCIAL NEED, HEART AND CANCER CARE, AND OTHER HEALTH-RELATED NEEDS. PART X, LINE 2: FORM 990, SCHEDULE D, PART X, LINE 2 - FIN 48 (ASC 740) FOOTNOTE AGNESIAN HEALTHCARE FOUNDATION INC'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2023 OR 2022. CHARITY GOLF OPEN 216325 215252 1073 1850 18287 15274 18625 10182 HOLIDAY LUNCHEON 21150 20824 326 6159 250 5747 237475 236076 1399 1850 18287 21433 18875 15929 76374 -74975 186150 80000 2144 0 186150 80000 2144 82144 104006 WI 1 0 0 0 0.00000 1.00000 SHAWN FISHER 430 E DIVISION STREET FOND DU LAC WI 54935 0 SHAWN FISHER 0 EXECUTIVE DIRECTOR X 0 1 AGNESIAN HEALTHCARE INC 430 E DIVISION STREET FOND DU LAC WI 54935 390807236 501(C)(3) 48 2525867 SUPPORT ST. AGNES CLINIC, FOND DU LAC CLINIC, AGNESIAN HEALTHCARE ENTERPRISE SUPPORT ST. AGNES CLINIC, GFDLM POST ACUTE SERVICES, FOND DU LAC CLINIC & AGNESIAN HEALTHCARE ENTERPRISE ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC 33 EVERETT STREET FOND DU LAC WI 54935 391029998 501(C)(3) 2 8409 SUPPORT ST. FRANCIS HOME OF FOND DU LAC WISCONSIN, INC. SUPPORT ST. FRANCIS HOME OF FOND DU LAC SSM HEALTH CARE OF WISCONSIN INC 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 430688874 501(C)(3) 1 5824 SUPPORT ST. MARY'S HOSPITAL - MADISON COLOGUARD SCREENING KITS 3 0 CAROL HYLAND CARING FOR YOU FUND AND EMPLOYEE RELIEF FUND 241 46330 PATIENT INSURANCE, FAMILY ASSISTANCE AND EMPLOYEE ASSISTANCE PART I, LINE 2: THE PROCEDURES USED TO MONITOR THE USE OF GRANT FUNDING VARIES BASED ON THE GRANT RECIPIENT. GRANTS TO RELATED ENTITIES ARE MONITORED DIRECTLY BY THE ORGANIZATION WHEREBY THE RECIPIENT REPORTS ON THE SPECIFIC USE OF THE FUNDING. FOR GRANTS TO UNRELATED ENTITIES, THE ORGANIZATION UTILIZES THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) TO TRACK, STORE AND REPORT A WIDE RANGE OF INFORMATION RELATED TO GRANTS AND OVERALL COMMUNITY IMPACT. 0 1 0 0 0 0 0 0 0 SHAWN FISHER DIRECTOR, EXECUTIVE DIRECTOR 126168 0 12376 0 324 0 17001 0 4705 0 160574 0 0 0 PART I, LINE 3 SCHEDULE J, PART I, LINE 3 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, PRESIDENT, IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B PENSION RESTORATION PLAN: SSM HEALTH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2023. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. NO PERSONS LISTED ON PART VII OF THE FORM 990 MADE DEFERRALS OR RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. X 11736 X 3 23280 0 0 1 0 SCHED M PART I - EXPLANATION OF REPORTING METHOD FOR NUMBER OF CONTRIBUTION CLOTHING AND HOUSEHOLD GOODS - NUMBER OF CONTRIBUTIONS FORM 990, PART VI, SECTION A, LINE 2 JACK TWOHIG AND CATHERINE TWOHIG - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, LINE 6 -CLASSES OF MEMBERS OR STOCKHOLDERS THE SOLE MEMBER OF THE CORPORATION IS SSM HEAL TH CARE OF WISCONSIN, INC. SSM HEAL TH CARE OF WISCONSIN, INC, IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH AGNESIAN HEALTHCARE FOUNDATION INC AND SSM HEALTH CARE OF WISCONSIN, INC. ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. FORM 990, PART VI, SECTION A, LINE 7A FORM 990 , PART VI, LINE 2-FAMILY/BUSINESS RELATIONSHIPS INTERESTED PERSONS THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER HAS THE FOLLOWING POWERS: (A) TO ADOPT OR CHANGE THE MISSION, PHILOSOPHY, AND VALUES OF THE CORPORATION. (B) TO REVIEW THE EFFECTIVENESS OF THE CORPORATION IN FULFILLING THE MISSION, PHILOSOPHY, AND VALUES OF THE CORPORATION. (C) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS WHICH AFFECT THE RESERVED POWERS OF THE MEMBER. (D) TO FIX THE NUMBER OF DIRECTORS OF THIS CORPORATION, APPOINT THE BOARD OF DIRECTORS OF THIS CORPORATION AND REMOVE SUCH DIRECTORS AT ANY TIME WITH OR WITHOUT CAUSE. (E) UPON THE RECOMMENDATION OF THE BOARD OF DIRECTORS, TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION. (F) TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS. (G) RESERVED. (H) TO APPROVE THE ESTABLISHMENT OF ANY NEW SUBSIDIARY OR AFFILIATE OF THE CORPORATION. (I) TO APPROVE ANY ACQUISITIONS, JOINT VENTURES OR OTHER CORPORATE AFFILIATIONS. (J) TO REVIEW AND APPROVE THE STRATEGIC, LONG-RANGE PLAN OF THE CORPORATION. (K) TO RECEIVE AND REVIEW THE ANNUAL REPORT PREPARED BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION. (L) TO APPROVE ANY AGREEMENT PURSUANT TO WHICH A THIRD PARTY OBTAINS THE RIGHT OR OBLIGATION TO MANAGE ALL OR SUBSTANTIALLY ALL OF THE OPERATIONS OF THE CORPORATION OR APPROVE ANY AGREEMENT PURSUANT TO WHICH THE CORPORATION MANAGES ANY ENTITY OR INSTITUTION WHICH IS NOT AN AFFILIATE OF SSMHCC. (M) TO APPROVE FOR THIS CORPORATION, OR FOR ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING SHAREHOLDER OR MEMBER, THE ACQUISITION OF LAND OR BUILDINGS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE, TRANSFER, ASSIGNMENT, OR ENCUMBRANCE OF THE ASSETS OF SUCH CORPORATION. (N) TO APPROVE THE DISSOLUTION AND/OR LIQUIDATION OF THIS CORPORATION OR ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING SHAREHOLDER OR MEMBER OR THE CONSOLIDATION OR MERGER OF THIS CORPORATION WITH ANOTHER CORPORATION OR ENTITY. (O) TO REMOVE AND APPOINT THE SECRETARY AND TREASURER OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 , PART VI, LINE 11B - REVIEW OF FORM 990 BY GOVERNING BODY THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE PARENT ORGANIZATION, SSM HEAL TH CARE CORPORATION (SSM). THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SSM PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON A 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 C, LINE 19 A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON A 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, LINE 19-REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE WISCONSIN SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART VI, LINE 15A - PROCESS FOR DETERMINING COMPENSATION THE FOUNDATION'S TOP MANAGEMENT OFFICIAL (FOUNDATION DIRECTOR) IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, LINE 15B -PROCESS FOR DETERMINING COMPENSATION THE FOUNDATION DOES NOT COMPENSATED ANY OTHER INDIVIDUALS. SSM HEALTH CARE CORPORATION 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 466029223 HEALTH CARE MO 501(C)(3) LINE 12A, I SSM HEALTH MINISTRIES 0 SSMHC LIABILITY TRUST I 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 436331003 INSURANCE MO 501(C)(3) LINE 12A, I SSM HEALTH CARE CORPORATION 0 SSM CONSOLIDATED HEALTH SERVICES 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431473657 HEALTH CARE MO 501(C)(3) LINE 10 SSM HEALTH CARE CORPORATION 0 SSM POLICY INSTITUTE 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431788151 HEALTH CARE MO 501(C)(4) SSM HEALTH CARE CORPORATION 0 SSM HEALTH CARE PORTFOLIO MANAGEMENT CO 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431825256 MANAGEMENT MO 501(C)(3) LINE 12A, I SSM HEALTH CARE CORPORATION 0 SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 430738490 HEALTH CARE MO 501(C)(3) LINE 3 SSM HEALTH CARE ST LOUIS 0 CARDINAL GLENNON CHILDREN'S FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 431754347 FUNDRAISING MO 501(C)(3) LINE 7 SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 0 SSM HEALTH FOUNDATION - 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