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Nonprofiteer
← ST CLARE MEMORIAL HOSPITAL INC

Form 990 for tax year 2022

Filed by ST CLARE MEMORIAL HOSPITAL INC.

Totals

Total revenue
$39,767,580
Total expenses
$39,528,290
Contributions and grants received
$181,081
Grants paid
$0
Program service revenue
$39,085,580
Investment income
$366,475
Other revenue
$134,444
Total assets, end of year
$38,428,753
Total liabilities, end of year
$26,522,008
Net assets or fund balances, end of year
$11,906,745
Program services expenses (Part IX)
$36,794,379
Management and general expenses
$2,733,911
Fundraising expenses
$0
Program service expenses (Part III)
$36,794,379

Program services were 93.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $64,372

  • 1e · Government grants (contributions)

    $116,709

  • 2a · Program service revenue: PATIENT SERVICE REVENUE

    total $18,233,876 · related or exempt $18,233,876

  • 2b · Program service revenue: PHARMACY REVENUE

    total $20,851,704 · related or exempt $13,735,588 · unrelated business $7,116,116

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $294,031 · excluded $294,031

  • 6a · Gross rents

    real property $8,714

  • 6b · Less rental expenses

    real property $24,599

  • 6c · Rental income or loss

    real property -$15,885 · personal property $0

  • 6d · Net rental income or loss

    total -$15,885 · excluded -$15,885

  • 7a · Gross sales of assets other than inventory

    securities $72,444

  • 7c · Gain or loss

    securities $72,444 · other assets $0

  • 7d · Net gain or loss

    total $72,444 · excluded $72,444

  • 11a · Other revenue: OTHER OPERATING REVENUE

    total $27,994 · excluded $27,994

  • 11b · Other revenue: HPG Core Trust Settlement

    total $122,335 · excluded $122,335

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $150,329

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $376,114 · program services $369,591 · management and general $6,523

  • 7 · Other salaries and wages

    total $8,411,043 · program services $8,265,169 · management and general $145,874

  • 8 · Pension plan contributions

    total $337,611 · program services $331,770 · management and general $5,841

  • 9 · Other employee benefits

    total $1,453,869 · program services $1,428,717 · management and general $25,152

  • 10 · Payroll taxes

    total $671,798 · program services $660,176 · management and general $11,622

  • 11a · Fees: management

    total $2,677,248 · program services $1,228,368 · management and general $1,448,880

  • 11f · Fees: investment management

    total $212,413 · management and general $212,413

  • 11g · Fees: other

    total $1,664,617 · program services $1,663,171 · management and general $1,446 · fundraising $0

  • 12 · Advertising and promotion

    total $2,698 · management and general $2,698

  • 13 · Office expenses

    total $11,705,276 · program services $11,677,613 · management and general $27,663

  • 14 · Information technology

    total $82,417 · program services $78,853 · management and general $3,564

  • 16 · Occupancy

    total $1,681,627 · program services $1,617,058 · management and general $64,569

  • 17 · Travel

    total $1,249 · program services $196 · management and general $1,053

  • 19 · Conferences, conventions and meetings

    total $56,305 · program services $54,253 · management and general $2,052

  • 20 · Interest

    total $87,769 · management and general $87,769

  • 22 · Depreciation, depletion and amortization

    total $1,389,833 · program services $958,983 · management and general $430,850

  • 23 · Insurance

    total $89,033 · program services $2,170 · management and general $86,863

  • 24a · Other expenses: Purchased Services

    total $8,159,057 · program services $8,032,250 · management and general $126,807

  • 24b · Other expenses: Equipment Rental

    total $197,787 · program services $197,787

  • 24c · Other expenses: Medicaid Assessment

    total $45,280 · program services $45,280

  • 24e · All other expenses

    total $225,246 · program services $182,974 · management and general $42,272 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $2,856,378 · end of year $1,358,822

  • 2 · Savings and temporary cash investments

    beginning of year $33,597 · end of year $35,150

  • 4 · Accounts receivable

    beginning of year $7,753,383 · end of year $6,244,989

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $1,470,487 · end of year $1,534,088

  • 9 · Prepaid expenses and deferred charges

    beginning of year $68,039 · end of year $68,479

  • 10a · Land, buildings and equipment: cost or other basis

    $29,562,471

  • 10b · Land, buildings and equipment: accumulated depreciation

    $19,154,735

  • 10c · Land, buildings and equipment, net

    beginning of year $11,358,765 · end of year $10,407,736

  • 11 · Investments: publicly traded securities

    beginning of year $21,709,107 · end of year $17,751,810

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $889,822 · end of year $1,027,679

  • 17 · Accounts payable and accrued expenses

    beginning of year $27,682,713 · end of year $25,556,664

  • 20 · Tax-exempt bond liabilities

    beginning of year $5,456,000

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 24 · Unsecured notes and loans payable

    beginning of year $910,265 · end of year $822,378

  • 25 · Other liabilities

    beginning of year $998,474 · end of year $142,966

  • 27 · Net assets without donor restrictions

    beginning of year $11,092,126 · end of year $11,906,745

Mission and programs · 2022

Mission

ST. CLARE MEMORIAL HOSPITAL'S MISSION IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS.

Activities or mission (Part I)

TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY.

  • EMERGENCY SERVICES - St. Clare Memorial Hospital operates an Emergency Department that is staffed 24/7 by doctors and Advanced Practice Providers experienced in Emergency Medicine. Staff members are trained in advanced cardiac life support, emergency nursing for pediatrics and trauma nursing. Like all hospital services, emergency care is provided regardless of race, creed, or ability to pay, and financial assistance is available after care is provided for those in need.

    Expenses $8,083,920 · Revenue $7,367,679

  • SURGICAL SERVICES - HSHS St. Clare Memorial Hospital is equipped to handle advanced adult and pediatric procedures with state-of-the art equipment and experienced physicians. There is access to a multidisciplinary care team which includes outstanding registered nurses, certified registered nurse anesthetist (CRNA), physicians, physical and occupational therapists, clinical educators, nutritional services and spiritual advisors. In FY23 St. Clare Memorial Hospital performed approximately 800 surgical cases and 800 GI procedures. For patients who require a hospital stay, resources are available to make the stay as comfortable as possible.

    Expenses $7,014,191 · Revenue $6,467,960

  • INTERNAL MEDICINE - Internal Medicine services at St Clare Hospital Medical center are comprised of general medicine, pulmonary, gastroenterology medical, cardiology medical services and swing bed services. In FY23 a total of 368 patients were admitted to the hospital. The swing bed admissions account for 50% of the overall admissions. In addition, 24% of the overall admissions are admitted through the Emergency department.

    Expenses $4,630,362 · Revenue $4,455,426

  • OTHER PROGRAM SERVICES OTHER PROGRAM SERVICES AT ST. CLARE MEMORIAL HOSPITAL ARE COMPRISED OF MEDICAL SURGICAL, WOUND CARE, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES.

    Expenses $17,065,906 · Revenue $13,678,399

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Andrew J Bagnall

    Wisconsin PRESIDENT & Division CEO - Wisconsin (UNTIL 11/1/22)

    Total calculated
    $875,624
    From this org
    $0
    From related orgs
    $842,889
    Other
    $32,735
    Hours/week
    3 + 57 related

    Schedule J breakdown matched by us

    Base
    $0 + $416,871 related
    Bonus
    $0 + $146,870 related
    Other
    $0 + $279,148 related
    Deferred
    $0 + $5,318 related
    Nontaxable benefits
    $0 + $27,417 related
    Filer's total
    $0 + $875,624 related

  • Christopher Brabant

    PRESIDENT & CEO

    Total calculated
    $376,114
    From this org
    $303,428
    From related orgs
    $0
    Other
    $72,686
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $235,415
    Bonus
    $51,016
    Other
    $16,997
    Deferred
    $31,148
    Nontaxable benefits
    $41,538
    Filer's total
    $376,114

  • Daniel Boettcher

    Chair

    Total calculated
    $0
    Hours/week
    2

  • Jan Stranz

    Secretary

    Total calculated
    $0
    Hours/week
    2

  • Michael Nelessen

    Vice Chair

    Total calculated
    $0
    Hours/week
    2

  • Cara Peterson

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • James Clemens MD

    BOARD MEMBER (UNTIL 10/31/23)/PHYSICIAN

    Total calculated
    $0
    Hours/week
    2 + 40 related

  • Lori Dufek

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • Robert Cutlan MD

    BOARD MEMBER/PHYSICIAN

    Total calculated
    $0
    Hours/week
    2 + 40 related

  • Ron Christensen

    Board Member

    Total calculated
    $0
    Hours/week
    1

  • SR MaryAnn Falbe OSF

    BOARD MEMBER (UNTIL 10/31/22)

    Total calculated
    $0
    Hours/week
    1

  • Patricia Allen

    DIVISION CFO - WISCONSIN

    Total calculated
    $695,496
    From this org
    $0
    From related orgs
    $541,100
    Other
    $154,396
    Hours/week
    3 + 57 related

    Schedule J breakdown matched by us

    Base
    $0 + $414,598 related
    Bonus
    $0 + $44,684 related
    Other
    $0 + $81,818 related
    Deferred
    $0 + $126,563 related
    Nontaxable benefits
    $0 + $27,833 related
    Filer's total
    $0 + $695,496 related

  • TODD Smart

    Treasurer

    Total calculated
    $410,831
    From this org
    $0
    From related orgs
    $329,569
    Other
    $81,262
    Hours/week
    0.3 + 59.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $267,686 related
    Bonus
    $0 + $38,335 related
    Other
    $0 + $23,548 related
    Deferred
    $0 + $45,254 related
    Nontaxable benefits
    $0 + $36,008 related
    Filer's total
    $0 + $410,831 related

  • Cheryl Burkel Emmers

    CRNA

    Total calculated
    $329,338
    From this org
    $282,672
    From related orgs
    $0
    Other
    $46,666
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $271,897
    Bonus
    $5,950
    Other
    $4,825
    Deferred
    $8,499
    Nontaxable benefits
    $38,167
    Filer's total
    $329,338

  • David Miskulin

    PHARMACIST

    Total calculated
    $222,225
    From this org
    $143,128
    From related orgs
    $0
    Other
    $79,097
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $139,586
    Bonus
    $2,677
    Other
    $865
    Deferred
    $46,536
    Nontaxable benefits
    $32,561
    Filer's total
    $222,225

  • Glenn White

    CRNA

    Total calculated
    $348,034
    From this org
    $286,783
    From related orgs
    $0
    Other
    $61,251
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $277,363
    Bonus
    $4,805
    Other
    $4,615
    Deferred
    $21,413
    Nontaxable benefits
    $39,838
    Filer's total
    $348,034

  • Maura May White

    CRNA

    Total calculated
    $339,594
    From this org
    $290,974
    From related orgs
    $0
    Other
    $48,620
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $275,754
    Bonus
    $9,950
    Other
    $5,270
    Deferred
    $6,013
    Nontaxable benefits
    $42,607
    Filer's total
    $339,594

  • Richard McNutt MD

    Physician

    Total calculated
    $346,014
    From this org
    $334,014
    From related orgs
    $0
    Other
    $12,000
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $92,098
    Bonus
    $0
    Other
    $241,916
    Deferred
    $5,400
    Nontaxable benefits
    $6,600
    Filer's total
    $346,014

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Form 990 of other organizations
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O.
Schedule J, Part I, Line 4a Severance or change-of-control payment
ORGANIZATION: St. Clare Memorial Hospital, Inc. EIN: 39-0848401 INTERESTED PERSON: Richard McNutt AMOUNT: $202,950 TERMS: COMPENSATION PAID AS A RESULT OF A SEVERANCE FROM THE POSITION OF Physician.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS; THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUMENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED and TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Patricia Allen -- $37,240 CHRISTOPHER BRABANT -- $29,783 Todd Smart -- $25,135 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2022; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANDREW BAGNALL -- $134,905

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

  • KIARA CLINICAL INTEGRATION NETWORK LLC

    HEALTHCARE · IL · income -$105,950 · assets $447,864

    Directly controlled by HSSI

  • PHYSICIAN CLINICAL INTEGRATION NETWORK LLC

    HEALTHCARE · IL · income $554,315 · assets $15,980,466

    Directly controlled by KCIN

  • HSHS ACO LLC

    HEALTHCARE & SOCIAL ASSISTANCE · IL · income $1,805,698 · assets $3,189,003

    Directly controlled by KCIN

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • SPRINGFIELD URGENT CARE REAL ESTATE LLC

    N/A · RENTAL REAL ESTATE · IL · 0% owned

    Directly controlled by LASANTE INC

  • PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC

    Related · MEDICAL · IL · 100% owned · share of income -$7,032 · share of assets $12,572 · general or managing partner

    Directly controlled by HSHS

  • SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP

    Related · REAL ESTATE · IL · 50% owned · share of income -$126,650 · share of assets $1,434,911

    Directly controlled by St John's

  • REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC

    Related · Medical · DE · 50% owned · share of income -$80,505 · share of assets $4,187,830

    Directly controlled by HSHS

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • KIARA INC

    C Corporation · HEALTHCARE · IL · 100% owned · share of income $601,904 · share of assets $18,670,450 · controlled entity

    Directly controlled by HSHS

  • LASANTE WISCONSIN INC

    C Corporation · HEALTHCARE · IL · controlled entity

    Directly controlled by KIARA INC

  • LASANTE INC

    C Corporation · HEALTHCARE · IL · controlled entity

    Directly controlled by KIARA INC

  • PREVEA HEALTH SERVICES INC

    C Corporation · HEALTHCARE · WI · 50% owned · share of income -$1,641,640 · share of assets $24,425,128 · controlled entity

    Directly controlled by HSSI

  • PREVEA CLINIC INC

    C Corporation · HEALTHCARE · WI · controlled entity

    Directly controlled by PHSI

  • RENAISSANCE QUALITY INSURANCE LTD

    C Corporation · INSURANCE · CJ · 100% owned · share of income $0 · share of assets $156,895,227 · controlled entity

    Directly controlled by HSSI

  • OJV INC

    C Corporation · HEALTHCARE · IL · controlled entity

    Directly controlled by LASANTE INC

Provenance

Return type
form_990
Tax year
2022
Filed
10 May 2024
IRS schema version
2022v5.0
Source object
202421319349304977

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