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Nonprofiteer
← WAUPUN MEMORIAL HOSPITAL

Form 990 for tax year 2022

Filed by WAUPUN MEMORIAL HOSPITAL.

Totals

Total revenue
$65,948,911
Total expenses
$57,339,581
Contributions and grants received
$76,967
Grants paid
$63,548
Program service revenue
$65,763,727
Investment income
-$8,999
Other revenue
$117,216
Total assets, end of year
$87,097,613
Total liabilities, end of year
$5,111,773
Net assets or fund balances, end of year
$81,985,840
Program services expenses (Part IX)
$52,437,865
Management and general expenses
$4,901,716
Fundraising expenses
$0
Program service expenses (Part III)
$52,437,865

Program services were 91.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • DeAnn Thurmer

    Director, President/CNO-Waupun Memorial Hospital

    Total calculated
    $490,345
    From this org
    $0
    From related orgs
    $360,056
    Other
    $130,289
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $293,822 related
    Bonus
    $0 + $63,417 related
    Other
    $0 + $2,816 related
    Deferred
    $0 + $105,146 related
    Nontaxable benefits
    $0 + $25,143 related
    Filer's total
    $0 + $490,345 related

  • Jan Harmsen

    Director, Chair

    Total calculated
    $0
    Hours/week
    1

  • Kathy Duchac

    Director, Vice Chair

    Total calculated
    $0
    Hours/week
    1

  • Amy Mohr

    Director

    Total calculated
    $0
    Hours/week
    1

  • Breanna Nagel

    Director

    Total calculated
    $0
    Hours/week
    1

  • Brittany Page

    Director

    Total calculated
    $0
    Hours/week
    1

  • David Hopp

    Director

    Total calculated
    $0
    Hours/week
    1

  • Doug Cronin

    Director

    Total calculated
    $0
    Hours/week
    1

  • Karen Reynolds

    Director

    Total calculated
    $0
    Hours/week
    1

  • Kathleen Hendricks

    Director

    Total calculated
    $0
    Hours/week
    1

  • Robert Nagle

    Director

    Total calculated
    $0
    Hours/week
    1

  • Roxy Schouten

    Pt Yr Director

    Total calculated
    $0
    Hours/week
    1

  • Scott Hansfield

    Director

    Total calculated
    $0
    Hours/week
    1

  • Randy Combs

    Treasurer, Chief Financial Officer at SSM Health

    Total calculated
    $2,850,791
    From this org
    $0
    From related orgs
    $1,879,738
    Other
    $971,053
    Hours/week
    1 + 69 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,144,254 related
    Bonus
    $0 + $475,226 related
    Other
    $0 + $260,259 related
    Deferred
    $0 + $938,234 related
    Nontaxable benefits
    $0 + $32,819 related
    Filer's total
    $0 + $2,850,792 related

  • Douglas Long

    Secretary, Chief Legal Officer at SSM Health

    Total calculated
    $2,040,754
    From this org
    $0
    From related orgs
    $1,354,027
    Other
    $686,727
    Hours/week
    1 + 72.2 related

    Schedule J breakdown matched by us

    Base
    $0 + $724,576 related
    Bonus
    $0 + $460,492 related
    Other
    $0 + $168,959 related
    Deferred
    $0 + $664,054 related
    Nontaxable benefits
    $0 + $22,673 related
    Filer's total
    $0 + $2,040,753 related

  • Steve Smoot

    Vice President, COO of SSM Health

    Total calculated
    $2,904,291
    From this org
    $0
    From related orgs
    $1,870,292
    Other
    $1,033,999
    Hours/week
    1 + 65 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,084,584 related
    Bonus
    $0 + $672,081 related
    Other
    $0 + $113,627 related
    Deferred
    $0 + $995,370 related
    Nontaxable benefits
    $0 + $38,629 related
    Filer's total
    $0 + $2,904,291 related

  • Kris Zimmer

    Former officer

    Total calculated
    $135,402
    From this org
    $0
    From related orgs
    $135,402
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $135,402 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $135,402 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

  • 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 3 Arrangement used to establish the top management official's compensation
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;
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: Deann Thurmer $29,312 Randall Combs $251,115 Douglas Long $159,815 Steve Smoot $240,329 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. Steve Smoot $111,005

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
202313199349329691

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