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Nonprofiteer
← ST MARYS JANESVILLE FOUNDATION INC

Form 990 for tax year 2023

Filed by ST MARYS JANESVILLE FOUNDATION INC.

Totals

Total revenue
$283,567
Total expenses
$184,584
Contributions and grants received
$274,971
Grants paid
$4,007
Program service revenue
$0
Investment income
$14,339
Other revenue
-$5,743
Total assets, end of year
$935,252
Total liabilities, end of year
$16,271
Net assets or fund balances, end of year
$918,981
Program services expenses (Part IX)
$7,300
Management and general expenses
$95,182
Fundraising expenses
$82,102
Program service expenses (Part III)
$7,300

Program services were 4.0% 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

    $209,354

  • 1f · All other contributions, gifts and grants

    $65,617

  • 1g · Noncash contributions included above

    $8,150

  • 3 · Investment income

    total $10,628 · excluded $10,628

  • 7a · Gross sales of assets other than inventory

    securities $3,711

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

    securities $0

  • 7c · Gain or loss

    securities $3,711

  • 7d · Net gain or loss

    total $3,711 · excluded $3,711

  • 8a · Fundraising events: gross income

    $11,770

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

    $209,354

  • 8b · Fundraising events: direct expenses

    $16,226

  • 8c · Net income from fundraising events

    total -$4,456 · excluded -$4,456

  • 10a · Gross sales of inventory

    $15,785

  • 10b · Cost of goods sold

    $22,808

  • 10c · Net income from sales of inventory

    total -$7,023 · excluded -$7,023

  • 11a · Other revenue: OTHER REVENUE

    total $5,736 · excluded $5,736

  • 11e · Other revenue, total

    $5,736

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $2,331 · program services $2,331

  • 2 · Grants to domestic individuals

    total $1,676 · program services $1,676

  • 7 · Other salaries and wages

    total $131,319 · management and general $65,660 · fundraising $65,659

  • 9 · Other employee benefits

    total $10,975 · management and general $5,488 · fundraising $5,487

  • 12 · Advertising and promotion

    total $1,799 · fundraising $1,799

  • 13 · Office expenses

    total $22,838 · management and general $22,838

  • 14 · Information technology

    total $4,337 · fundraising $4,337

  • 17 · Travel

    total $2,391 · management and general $1,196 · fundraising $1,195

  • 24a · Other expenses: BANK SERVICE CHARGES

    total $3,953 · program services $328 · fundraising $3,625

  • 24b · Other expenses: DONOR APPRECIATION

    total $2,965 · program services $2,965

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $342,734 · end of year $369,758

  • 2 · Savings and temporary cash investments

    beginning of year $0 · end of year $0

  • 3 · Pledges and grants receivable

    beginning of year $4,000 · end of year $0

  • 4 · Accounts receivable

    beginning of year $230 · end of year $185

  • 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

  • 7 · Other notes and loans receivable

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $17,723 · end of year $0

  • 9 · Prepaid expenses and deferred charges

    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 $0 · end of year $0

  • 12 · Investments: other securities

    beginning of year $294,960 · end of year $565,309

  • 13 · Investments: program-related

    beginning of year $0 · end of year $0

  • 14 · Intangible assets

    beginning of year $0 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $346 · end of year $221

  • 25 · Other liabilities

    beginning of year $22,697 · end of year $16,050

  • 27 · Net assets without donor restrictions

    beginning of year $167,032 · end of year $182,939

  • 28 · Net assets with donor restrictions

    beginning of year $469,572 · end of year $736,042

Mission and programs · 2023

Mission

THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.

Activities or mission (Part I)

TO ACTIVELY BUILD AND SUSTAIN COMMUNITY SUPPORT FOR THE HEALTH AND WELLNESS INITIATIVES OF SSM HEALTH ST. MARY'S HOSPITAL JANESVILLE.

  • PROVIDED SUPPORT FOR THE HEALTH CARE INITIATIVES OF SSM HEALTH ST. MARY'S HOSPITAL - JANESVILLE AND OTHER COMMUNITY ORGANIZATIONS. PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF SUPPORT INITIATIVES.

    Expenses $7,300 · Grants $4,007

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Eric Thornton

    DIRECTOR & HOSPITAL PRESIDENT

    Total calculated
    $567,550
    From this org
    $0
    From related orgs
    $411,975
    Other
    $155,575
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $338,368 related
    Bonus
    $0 + $57,599 related
    Other
    $0 + $16,008 related
    Deferred
    $0 + $116,256 related
    Nontaxable benefits
    $0 + $39,319 related
    Filer's total
    $0 + $567,550 related

  • Timothy Axe MD

    DIRECTOR & VICE CHAIRMAN

    Total calculated
    $333,915
    From this org
    $0
    From related orgs
    $272,987
    Other
    $60,928
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $269,376 related
    Bonus
    $0
    Other
    $0 + $3,611 related
    Deferred
    $0 + $19,709 related
    Nontaxable benefits
    $0 + $41,219 related
    Filer's total
    $0 + $333,915 related

  • Mary Arndt

    DIRECTOR & TEAM MEMBER AT DEAN MEDICAL GROUP

    Total calculated
    $0
    Hours/week
    1

  • Betsy Riemer

    DIRECTOR & TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Karen Cain

    DIRECTOR & CHAIR

    Total calculated
    $0
    Hours/week
    1

  • Barbara George

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Phil Whitehead

    DIRECTOR & SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • William Schendt

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • William Springer

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • A Lasse Cullum

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Dona Hohensee

    EXECUTIVE DIRECTOR

    Total calculated
    $161,941
    From this org
    $0
    From related orgs
    $140,620
    Other
    $21,321
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $0 + $127,095 related
    Bonus
    $0 + $12,453 related
    Other
    $0 + $1,072 related
    Deferred
    $0 + $17,105 related
    Nontaxable benefits
    $0 + $4,216 related
    Filer's total
    $0 + $161,941 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
  • 3 · Compensation committee
  • 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)

PART I, LINE 1A
SCHEDULE J, PART I, LINE 1A - TAX INDEMNIFICATION AND GROSS-UP PAYMENTS INDIVIDUALS LISTED ON PART VII, SECTION A RECEIVED A TAX INDEMNIFICATION/GROSS UP PAYMENT IN 2023. THESE PAYMENTS WERE INCLUDED IN TAXABLE COMPENSATION.
PART I, LINE 3
SCHEDULE J, PART I, LINE 3 - ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION THE FOUNDATION'S TOP MANAGEMENT OFFICIAL (EXECUTIVE 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.
PART I, LINE 4B
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 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. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEGERRALS FROM THIS PLAN IN 2023: TIMOTHY AXE $X,XXX ERIC THORNTON $XX,XXX THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. ERIC THORNTON $X,XXX

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.

  • SSM ST JOSEPH ENDOSCOPY CENTER LLC

    SURGERY SERVICES · MO

  • ST CLARE IMAGING SERVICES LLC

    DIAG. SERVICES · WI

  • MT VERNON RADIATION THERAPY CENTER LLC

    RADIATION THERAPY · IL · general or managing partner

  • SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC

    DIAG. SERVICES · IL

  • CHOWSMGSI OFFICE BUILDING LLC

    MOB · IL

  • OZA CANCER CENTER LLC

    MOB · IL

  • SHAWNEE REAL ESTATE HOLDINGS LLC

    MOB · OK

  • DEAN CLINIC & ST MARY'S HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC

    ACCOUNTABLE CARE ORGANIZATION · WI

  • WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC

    INFORMATION TECHNOLOGY SERVICES · WI

  • WINGRA BUILDING GROUP

    MOB · WI

  • JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP

    MOB · WI

  • 1110 N CLASSEN BLVD LLC

    MOB · OK · general or managing partner

  • SSM ST CLARE SURGICAL CENTER LLC

    SURGERY SERVICES · MO

  • WINDMILL LLP

    INVESTMENTS · MO

  • NAVITUS HEALTH SOLUTIONS LLC

    PHARMACY BENEFIT MANAGEMENT · WI

  • SSM SELECT REHAB ST LOUIS LLC

    HEALTH CARE · DE

  • EPIPHANY RX LLC

    PHARMACY BENEFIT MANAGEMENT · DE

  • RXPRECHECK LL

    PHARMACY BENEFIT MANAGEMENT · TN

  • ARCHIMEDES LLC

    PHARMACY BENEFIT MANAGEMENT · TN

  • BLOOM TREE LONG-ONLY FUND QP LP FKA BLOOM TREE PONDEROSA FUNDS QP LP

    INVESTMENTS · DE

  • NECICF II AIV2-B LP

    INVESTMENTS · DE

  • BISON CAPITAL PARTNERS VI-A LP

    INVESTMENTS · DE

Related corporations and trusts

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

  • SSM MANAGED CARE ORGANIZATION LLC

    C · HEALTH PROMOTION · MO

  • FPP INC & SUBS

    C · HEALTH CARE · MO

  • DIVERSIFIED HEALTH SERVICES CORP

    C · MEDICAL EQUIPMENT · MO

  • SSM PROPERTIES INC

    C · PROPERTY SERVICES · MO

  • HEALTHFIRST PHYSICIAN MANAGEMENT SERVICES

    C · MEDICAL SERVICES · OK

  • SSMHC LIABILITY TRUST II

    C · INSURANCE · MO

  • SSM MEDICAL GROUP INC

    C · PHYSICIAN OFFICES · MO

  • SSMHC INSURANCE COMPANY

    C · INSURANCE · CJ

  • PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC

    C · HEALTH CARE · IL

  • DEAN HEALTH SYSTEMS INC

    C · PHYSICIAN OFFICES · WI

  • DEAN RETAIL SERVICES INC

    C · PROPERTY SERVICES · WI

  • SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC

    C · CONDO ASSOCIATION · WI

  • SSM HEALTH PHARMACY LLC

    C · PHARMACY · MO

  • NAVITUS HOLDINGS LLC

    C · PHARMACY · WI

  • MS COMMUNITY JV LLC

    C · INSURANCE · DE

  • QUALITY DRUG CORPORATION

    C · PHARMACY BENEFITS · CA

  • ST MARY'S HOSPITAL CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC

    C · CONDO ASSOCIATION · WI

  • PARTNERS GROUP PMC PRIVATE CREDIT LP

    C · INVESTMENT · CJ

  • OMNINHEALTH HOLDINGS

    C · HEALTH CARE CONSULTING · DE

  • PARTNERS GROUP PMC PRIVATE CREDIT LP

    C · CJ

Provenance

Return type
form_990
Tax year
2023
Filed
15 November 2024
IRS schema version
2023v5.1
Source object
202433209349317893

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