2025-11-17T14:05:24-06:00 2024-12-31 990 2024-01-01 391684956 AGNESIAN HEALTHCARE FOUNDATION INC AGNE 9209264998 430 E DIVISION ST FOND DU LAC WI 54935 STEPHANIE KING VP FINANCE 9209264998 2025-11-17 0 2024 2025-03-06 01:10:19Z DINA BOYLE 430 E DIVISION ST FOND DU LAC WI 54935 3494024 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. 13 12 0 12 0 0 1613039 1173096 0 0 730603 1770145 80539 203362 2424181 3146603 2463770 1698651 0 0 0 0 0 0 22785 204758 22785 2668528 1721436 -244347 1425167 26936247 29382922 395658 62003 26540589 29320919 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 1698651 1698651 0 THE AGNESIAN HEALTHCARE FOUNDATION PROVIDES SUPPORT FOR OPERATIONS AND CAPITAL EQUIPMENT TO AGNESIAN HEALTHCARE INC, WAUPUN MEMORIAL HOSPITAL, RIPON COMMUNITY HOSPITAL, ST. FRANCIS HOME OF FOND DU LAC AND VILLA ROSA. 1698651 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 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 1 X 8 3 1 0 0 0 0 0 0 1 1 0 0 0 0 X 13 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DINA BOYLE 6082603568 430 E DIVISION ST FOND DU LAC WI 54935 JACK E TWOHIG DIRECTOR & CHAIRPERSON 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 & SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 DR CATHERINE TWOHIG-MCGALLOWAY DIRECTOR & VICE CHAIR 1.00 0.00 X X 0 0 0 KIMBERLY LAWS DIRECTOR & EXEC DIRECTOR 40.00 0.00 X X 0 100290 26093 GARY BORN DIRECTOR 1.00 0.00 X 0 0 0 KATIE GAVIN DIRECTOR 1.00 0.00 X 0 0 0 ELIZABETH ROY DIRECTOR 1.00 0.00 X 0 0 0 BOB FALE PT YR DIRECTOR & SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 0 100290 26093 0 0 0 0 0 481817 1063 1558 688658 27600 1173096 659660 659660 1110485 0 1110485 1110485 1110485 145368 481817 102596 42772 42772 204876 92624 112252 112252 200539 152201 48338 48338 3146603 0 0 1973507 1609733 1609733 88918 88918 TAXES 16250 16250 BANK CHARGES 5977 5977 LICENSES, DUES AND SUBS 558 558 1721436 1698651 0 22785 2758870 1427165 9355986 1262954 644988 50119 0 14126284 26692803 26936247 29382922 395658 62003 395658 62003 X 12414305 13487374 14126284 15833545 26540589 29320919 26936247 29382922 X 1425167 41896 1313268 X 0 1 X 1 0 X X 8 AGNESIAN HEALTHCARE INC 390807236 3 1 1168630 0 ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC 391029998 10 1 355219 0 WAUPUN MEMORIAL HOSPITAL 390806265 3 1 46595 0 SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO 391022770 10 1 0 0 SSM HEALTH CARE CORPORATION 466029223 3 1 0 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 1570444 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 -824 2266182 -1858 4826297 2562797 2562797 1487797 1075000 2562797 1487797 1487797 1487797 1487797 0.00000 1.00000 0.00000 1 0 0 PROGRAM-RELATED INVESTMENTS 26692803 F 26692803 DUE TO AFFILIATES 62003 62003 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 2024 OR 2023. SCHEDULE D, PART V, LINE 3A(I) ENDOWMENT FUNDS ARE HELD AND ADMINISTERED BY NEBAT INVESTMENTS, AN UNRELATED ORGANIZATION. CHARITY GOLF OPEN 564690 438762 125928 11394 25694 20564 15429 10832 HOLIDAY LUNCHEON 62495 43055 19440 0 6225 0 7095 5363 2 0 0 0 627185 481817 145368 17619 25694 27659 15429 16195 102596 42772 204876 92624 0 204876 92624 92624 112252 WI 1 0 0 0 1.00000 KIMBERLY LAWS 430 E DIVISION STREET FOND DU LAC WI 54935 0 KIMBERLY LAWS EXECUTIVE DIRECTOR X 0 1 AGNESIAN HEALTHCARE INC 430 E DIVISION STREET FOND DU LAC WI 54935 390807236 501(C)(3) 955756 27600 FMV SUPPORT HOSPITAL OPERATIONS SUPPORT ST. AGNES CLINIC, GFDLM POST ACUTE SERVICES, FOND DU LAC CLINIC & AGNESIAN HEALTHCARE ENTERPRISE WAUPUN MEMORIAL HOSPITAL 620 WEST BROWN STREET WAUPUN WI 53963 390806265 501(C)(3) 91145 0 SUPPORT HOSPITAL OPERATIONS REBUILDING TOGETHER FOX VALLEY 2416 INDUSTRIAL DRIVE UNIT E NEENAH WI 54956 392013200 501(C)(3) 79498 0 SUPPORT HOME REPAIR FOR INCOME QUALIFIED COMMUNITY MEMBERS BOYS AND GIRLS CLUB OF FOND DU LAC 76 W 2ND ST FOND DU LAC WI 54936 391896496 501(C)(3) 50000 0 SUPPORT FALL PREVENTION EFFORTS FOR ELDERLY INDIVIDUALS HOLY FAMILY WARMING SHELTER 271 FOURTH STREET WAY FOND DU LAC WI 54937 474758057 501(C)(3) 25000 0 PROVIDE SHELTER AND MEALS TO INDIVIDUALS IN NEED TREFFERT WAY SCHOOL 706 MINNESOTA AVE NORTH FOND DU LAC WI 54937 832394427 501(C)(3) 10000 0 SUPPORT SCHOOL OPERATIONS ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC 33 EVERETT STREET FOND DU LAC WI 54935 391029998 501(C)(3) 355219 0 SUPPORT HOSPITAL OPERATIONS 7 0 CAROL HYLAND CARING FOR YOU FUND AND EMPLOYEE RELIEF FUND 104 88918 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. BOARD MEMBER DAUGHTER OF BOARD MEMBER 2000 VOLUNTEER SCHOLARSHIP CONTINUED EDUCATION X 6200 27600 FMV 0 0 1 0 PART I, COLUMN (B): DRUGS AND MEDICAL SUPPLIES - NUMBER OF CONTRIBUTIONS SCHED M PART I - EXPLANATION OF REPORTING METHOD FOR NUMBER OF CONTRIBUTION CLOTHING AND HOUSEHOLD GOODS - NUMBER OF CONTRIBUTIONS FORM 990, PART V, LINE 1A ALL APPLICABLE 1099 AND 1096 IRS FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223. FORM 990, PART VI, SECTION A, LINE 2 JACK TWOHIG AND DR. CATHERINE TWOHIG-MCGALLOWAY - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH 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 SSM HEALTH CARE CORPORATION, THE SOLE MEMBER OF SSM HEALTH CARE OF WISCONSIN, INC, THE MEMBER OF AGNESIAN HEALTHCARE FOUNDATION INC, HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS ARE RESERVED FOR SSM HEALTH CARE CORPORATION, THE SOLE MEMBER OF SSM HEALTH CARE OF WISCONSIN, INC., THE SOLE MEMBER OF AGNESIAN HEALTHCARE FOUNDATION, INC. (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 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 B, LINE 15 THE ORGANIZATION'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THE COMMITTEE REVIEWS COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY THE POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER. ADDITIONALLY, THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. 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 XI, LINE 9: INTERCOMPANY TRANSFERS 1,313,269. ROUNDING -1. 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