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Nonprofiteer
← ST CLARE HEALTHCARE FOUNDATION INC

Form 990 for tax year 2022

Filed by ST CLARE HEALTHCARE FOUNDATION INC.

Totals

Total revenue
$431,438
Total expenses
$385,708
Contributions and grants received
$310,627
Grants paid
$251,657
Program service revenue
$0
Investment income
$121,076
Other revenue
-$265
Total assets, end of year
$3,778,160
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$3,778,160
Program services expenses (Part IX)
$251,657
Management and general expenses
$0
Fundraising expenses
$134,051
Program service expenses (Part III)
$251,657

Program services were 65.2% 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.

  • 1c · Fundraising events

    $8,250

  • 1d · Related organizations

    $38,611

  • 1f · All other contributions, gifts and grants

    $263,766

  • 2f · All other program service revenue

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

  • 3 · Investment income

    total $57,856 · excluded $57,856

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7a · Gross sales of assets other than inventory

    securities $63,220

  • 7b · Less cost or other basis and sales expenses

    securities $0

  • 7c · Gain or loss

    securities $63,220 · other assets $0

  • 7d · Net gain or loss

    total $63,220 · excluded $63,220

  • 8a · Fundraising events: gross income

    $1,682

  • 8a · Fundraising events: contributions included on line 1c

    $8,250

  • 8b · Fundraising events: direct expenses

    $2,024

  • 8c · Net income from fundraising events

    total -$342 · excluded -$342

  • 9a · Gaming: gross income

    $1,565

  • 9b · Gaming: direct expenses

    $1,488

  • 9c · Net income from gaming

    total $77 · excluded $77

  • 11d · All other revenue

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

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $231,409 · program services $231,409

  • 2 · Grants to domestic individuals

    total $20,248 · program services $20,248

  • 7 · Other salaries and wages

    total $103,688 · fundraising $103,688

  • 8 · Pension plan contributions

    total $5,675 · fundraising $5,675

  • 11g · Fees: other

    total $15,129 · program services $0 · management and general $0 · fundraising $15,129

  • 12 · Advertising and promotion

    total $2,312 · fundraising $2,312

  • 13 · Office expenses

    total -$3,763 · fundraising -$3,763

  • 14 · Information technology

    total $9,839 · fundraising $9,839

  • 17 · Travel

    total $815 · fundraising $815

  • 24a · Other expenses: BANK CHARGES

    total $241 · fundraising $241

  • 24b · Other expenses: Licenses

    total $115 · fundraising $115

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $2,330,392 · end of year $369,478

  • 3 · Pledges and grants receivable

    beginning of year $225,000 · end of year $154,500

  • 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

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

    $0

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

    $0

  • 10c · Land, buildings and equipment, net

    beginning of year $0 · end of year $0

  • 11 · Investments: publicly traded securities

    beginning of year $1,734,609 · end of year $3,254,182

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $0 · end of year $0

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $0 · end of year $0

  • 27 · Net assets without donor restrictions

    beginning of year $2,037,094 · end of year $1,740,302

  • 28 · Net assets with donor restrictions

    beginning of year $2,252,907 · end of year $2,037,858

Mission and programs · 2022

Mission

Through our exceptional health care services, we reveal the healing presence of God.

Activities or mission (Part I)

Facilitate strategic partnerships and community investment that will result in the highest quality health care facilities, technology and services; innovative programs; optimal health literacy; and access to health care.

  • PROVIDED FUNDING TO SSM HEALTH ST CLARE HOSPITAL - BARABOO TO SUPPORT HEALTHCARE AND WELLNESS INITIATIVES. SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

    Expenses $211,978 · Grants $211,978

  • PROVIDED CLINICAL SCHOLARSHIPS AND LOAN REIMBURSEMENT FOR STUDENTS. ALSO ASSISTANCE FOR INDIVIDUALS WITH HOUSING AND UTILITIES. SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

    Expenses $20,248 · Grants $20,248

  • PROVIDED GRANTS TO SUPPORT PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN THE COMMUNITIES SERVED BY SSM HEALTH ST CLARE HOSPITAL - BARABOO. SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

    Expenses $19,431 · Grants $19,431

As filed on the 2022 return.

Listed in Part VII

  • John Alt

    Director & President

    Total calculated
    $0
    Hours/week
    1

  • Kyle Nondorf

    Hospital President/ Ex off w/ vote

    Total calculated
    $920,457
    From this org
    $0
    From related orgs
    $662,981
    Other
    $257,476
    Hours/week
    1 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $506,982 related
    Bonus
    $0 + $142,267 related
    Other
    $0 + $13,732 related
    Deferred
    $0 + $215,272 related
    Nontaxable benefits
    $0 + $42,204 related
    Filer's total
    $0 + $920,457 related

  • Mary Dressen

    Director

    Total calculated
    $0
    Hours/week
    1

  • Matt Schaefer

    Director & Treasurer

    Total calculated
    $0
    Hours/week
    1

  • Merije Ajvazi

    Director & Vice President

    Total calculated
    $0
    Hours/week
    1

  • Brent Gasser

    Director

    Total calculated
    $0
    Hours/week
    1

  • Craig Philipp

    Director

    Total calculated
    $0
    Hours/week
    1

  • Dave Abangan

    Director

    Total calculated
    $0
    Hours/week
    1

  • Jennifer Gavinski

    Director

    Total calculated
    $0
    Hours/week
    1

  • Sharilyn Munneke

    Director & Physician at Dean Medical Group

    Total calculated
    $224,084
    From this org
    $0
    From related orgs
    $182,678
    Other
    $41,406
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $180,278 related
    Bonus
    $0 + $500 related
    Other
    $0 + $1,900 related
    Deferred
    $0 + $17,625 related
    Nontaxable benefits
    $0 + $23,781 related
    Filer's total
    $0 + $224,084 related

  • Teresa Jacobson

    Director

    Total calculated
    $0
    Hours/week
    1

  • Tiffany Sloan

    Director

    Total calculated
    $0
    Hours/week
    1

  • Julia Randles

    Foundation Director & Assist Secretary

    Total calculated
    $144,997
    From this org
    $0
    From related orgs
    $87,096
    Other
    $57,901
    Hours/week
    40

  • Scott Wysocki

    Interim Hospital President/ Ex off w/ vote

    Total calculated
    $290,323
    From this org
    $0
    From related orgs
    $215,618
    Other
    $74,705
    Hours/week
    0 + 41 related

    Schedule J breakdown matched by us

    Base
    $0 + $178,314 related
    Bonus
    $0 + $29,197 related
    Other
    $0 + $8,107 related
    Deferred
    $0 + $47,232 related
    Nontaxable benefits
    $0 + $27,473 related
    Filer's total
    $0 + $290,323 related

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

  • 1a · Tax indemnification and gross-up payments
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 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 1a Tax indemnification and gross-up payments
Several individuals listed on Part VII, Section A, received tax indemnification/gross up payments in 2022, which were included in their taxable compensation.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's 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.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
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 2022. 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. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2022: Scott Wysocki $8,711 Kyle Nondorf $48,758 Sharilyn Munneke $6,050 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2022. All distributions received from the plan in the current year were included in the individual's taxable compensation. Scott Wysocki $7,151 Kyle Nondorf $12,653

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

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.

Related partnerships

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

Related corporations and trusts

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

Provenance

Return type
form_990
Tax year
2022
Filed
16 November 2023
IRS schema version
2022v5.0
Source object
202343199349330579

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