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Nonprofiteer
← ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD

Form 990 for tax year 2022

Filed by ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD.

Totals

Total revenue
$116,212,567
Total expenses
$123,028,970
Contributions and grants received
$275,503
Grants paid
$0
Program service revenue
$114,715,303
Investment income
$935,639
Other revenue
$286,122
Total assets, end of year
$145,059,867
Total liabilities, end of year
$25,804,464
Net assets or fund balances, end of year
$119,255,403
Program services expenses (Part IX)
$111,982,792
Management and general expenses
$11,046,178
Fundraising expenses
$0
Program service expenses (Part III)
$111,982,792

Program services were 91.0% 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.

  • 1d · Related organizations

    $49,555

  • 1e · Government grants (contributions)

    $225,948

  • 2a · Program service revenue: PATIENT SERVICE REVENUE

    total $114,684,562 · related or exempt $114,684,562

  • 2b · Program service revenue: REFERENCE LAB

    total $30,741 · unrelated business $30,741

  • 2f · All other program service revenue

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

  • 3 · Investment income

    total $822,218 · excluded $822,218

  • 6a · Gross rents

    real property $992,179

  • 6b · Less rental expenses

    real property $1,527,782

  • 6c · Rental income or loss

    real property -$535,603 · personal property $0

  • 6d · Net rental income or loss

    total -$535,603 · excluded -$535,603

  • 7a · Gross sales of assets other than inventory

    securities $112,588 · other assets $237,708

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

    securities $0 · other assets $236,875

  • 7c · Gain or loss

    securities $112,588 · other assets $833

  • 7d · Net gain or loss

    total $113,421 · excluded $113,421

  • 10c · Net income from sales of inventory

    total $0 · excluded $0

  • 11a · Other revenue: Gift Shop

    total $29,713 · excluded $29,713

  • 11b · Other revenue: HPG Core Trust Settlement

    total $433,451 · excluded $433,451

  • 11c · Other revenue: Orange Cross Ambulance

    total $223,712 · excluded $223,712

  • 11d · All other revenue

    total $134,849 · related or exempt $0 · unrelated business $0 · excluded $134,849

  • 11e · Other revenue, total

    $821,725

Functional expenses

Part IX, the statement of functional expenses.

  • 5 · Compensation of officers, directors and key employees

    total $518,057 · program services $507,296 · management and general $10,761

  • 7 · Other salaries and wages

    total $18,140,340 · program services $17,763,531 · management and general $376,809

  • 8 · Pension plan contributions

    total $1,048,223 · program services $1,026,421 · management and general $21,802

  • 9 · Other employee benefits

    total $3,365,144 · program services $3,295,149 · management and general $69,995

  • 10 · Payroll taxes

    total $1,538,026 · program services $1,506,035 · management and general $31,991

  • 11f · Fees: investment management

    total $636,869 · management and general $636,869

  • 11g · Fees: other

    total $4,516,443 · program services $1,333,562 · management and general $3,182,881 · fundraising $0

  • 12 · Advertising and promotion

    total $315,395 · program services $314,820 · management and general $575

  • 13 · Office expenses

    total $18,727,215 · program services $18,697,494 · management and general $29,721

  • 14 · Information technology

    total $108,096 · program services $99,294 · management and general $8,802

  • 16 · Occupancy

    total $4,705,500 · program services $4,633,095 · management and general $72,405

  • 17 · Travel

    total $4,735 · program services $4,049 · management and general $686

  • 19 · Conferences, conventions and meetings

    total $242,071 · program services $240,347 · management and general $1,724

  • 20 · Interest

    total $316,776 · program services $105,143 · management and general $211,633

  • 22 · Depreciation, depletion and amortization

    total $4,858,250 · program services $4,852,970 · management and general $5,280

  • 23 · Insurance

    total $340,608 · program services $157,751 · management and general $182,857

  • 24a · Other expenses: Purchased Services

    total $60,420,290 · program services $54,331,124 · management and general $6,089,166

  • 24b · Other expenses: MEDICAID ASSESSMENT TAX

    total $1,656,908 · program services $1,656,908 · management and general $0

  • 24c · Other expenses: Equipment Rental

    total $347,626 · program services $347,626

  • 24e · All other expenses

    total $1,222,398 · program services $1,110,177 · management and general $112,221 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $13,713,874 · end of year $1,972,671

  • 4 · Accounts receivable

    beginning of year $14,076,547 · end of year $14,550,819

  • 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 $2,250,265 · end of year $2,623,378

  • 9 · Prepaid expenses and deferred charges

    beginning of year $449,189 · end of year $406,077

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

    $161,384,554

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

    $97,415,686

  • 10c · Land, buildings and equipment, net

    beginning of year $66,794,494 · end of year $63,968,868

  • 11 · Investments: publicly traded securities

    beginning of year $46,026,413 · end of year $50,178,395

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $6,868,808 · end of year $11,359,659

  • 17 · Accounts payable and accrued expenses

    beginning of year $10,711,486 · end of year $10,484,581

  • 19 · Deferred revenue

    beginning of year $3,479,867 · end of year $458,682

  • 20 · Tax-exempt bond liabilities

    beginning of year $9,974,624 · end of year $9,204,598

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $1,991,639 · end of year $1,547,920

  • 24 · Unsecured notes and loans payable

    beginning of year $3,684,178 · end of year $3,123,384

  • 25 · Other liabilities

    beginning of year -$389,688 · end of year $985,299

  • 27 · Net assets without donor restrictions

    beginning of year $120,727,484 · end of year $119,255,403

Mission and programs · 2022

Mission

ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE, AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. THE HOSPITAL'S CORE VALUES OF RESPECT, CARE COMPETENCE AND JOY ARE LIVED BY ALL WHO SERVE HERE, AND FELT BY ALL WHO RECEIVE HEALTHCARE SERVICES AT ST. NICHOLAS HOSPITAL.

Activities or mission (Part I)

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

  • Surgery - ST. NICHOLAS HOSPITAL SURGICAL SERVICES, INCLUDE THE FOLLOWING: AN 18 BED ONE-DAY SERVICES (PRE-PROCEDURE AND POST-PROCEDURE) DEPARTMENT, AN OPERATING ROOM (OR) WITH SIX (6) ROOMS, ONE NEGATIVE-PRESSURE BRONCHOSCOPY ROOM AND ONE C-SECTION ROOM, A FIVE (5) BAY PACU (POST ANESTHESIA CARE UNIT), A STERILE PROCESSING DEPARTMENT, AND THE SHEBOYGAN SURGERY CENTER. THE MAIN HOSPITAL'S STERILE PROCESSING DEPARTMENT NOT ONLY SUPPORTS THE OR BUT THE CENTER FOR DIGESTIVE HEALTH (CDH), INPATIENT NURSING DEPARTMENTS - MEDICAL/SURGICAL AND INTENSIVE CARE UNIT (ICU), WOMEN AND INFANT SERVICES, AND THE EMERGENCY DEPARTMENT (ED). THE SHEBOYGAN SURGERY CENTER IS A DEPARTMENT OF ST. NICHOLAS HOSPITAL BUT FUNCTIONS AS AN AMBULATORY SURGERY CENTER (ASC). THE CENTER IS COMPRISED OF FIVE (5) PRE-PROCEDURE BAYS, THREE (3) OPERATING ROOMS, TWO (2) PROCEDURE ROOMS, 10 POST-PROCEDURE BAYS,- THREE (3) OF WHICH CAN BE PRE-PROCEDURE BEDS, AND STERILE PROCESSING. BOTH LOCATIONS OFFER ANESTHESIA SERVICES. ANESTHESIA CARE IS ALSO PROVIDED IN CDH, ICU, WOMEN AND INFANTS, AND THE ED. SERVICES PROVIDED AT THE HOSPITAL ARE AVAILABLE 24H/7D EITHER BY SCHEDULE OR BY ON-CALL. THE SURGERY CENTER IS AVAILABLE MONDAY - FRIDAY.

    Expenses $27,660,637 · Revenue $25,680,589

  • EMERGENCY SERVICES - ST. NICHOLAS HOSPITAL OPERATES A LEVEL IV TRAUMA CENTER/EMERGENCY DEPARTMENT THAT IS OPEN 24/7 AND STAFFED BY BOARD-CERTIFIED EMERGENCY MEDICINE PHYSICIAN SPECIALISTS. STAFF MEMBERS ARE TRAINED IN ADVANCED CARDIAC LIFE SUPPORT, EMERGENCY NURSING FOR PEDIATRICS AND TRAUMA NURSING. IN FY2023 THERE WERE OVER 13,800 VISITS TO THE EMERGENCY CENTER. 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 $12,390,159 · Revenue $14,083,636

  • INTERNAL MEDICINE - Internal Medicine services at St Nicholas Hospital are comprised of general medicine, pulmonary, gastroenterology medical, and cardiology medical services. In FY23 a total of 1,605 patients were admitted to the hospital. The majority of these patients, 77%, are admitted through the Emergency Department.

    Expenses $8,417,873 · Revenue $6,994,646

  • OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMEN AND INFANT SERVICES, HOME HEALTH AND HOSPICE CARE, CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS, FOOT CLINICS AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY.

    Expenses $63,514,123 · Revenue $67,925,691

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
    7 + 53 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

  • DAVID VAN DE WATER JD

    CHAIR

    Total calculated
    $0
    Hours/week
    1

  • Justin Selle

    President & CEO

    Total calculated
    $518,057
    From this org
    $399,345
    From related orgs
    $0
    Other
    $118,712
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $295,069
    Bonus
    $57,539
    Other
    $46,737
    Deferred
    $78,722
    Nontaxable benefits
    $39,990
    Filer's total
    $518,057

  • Sr Maureen Fagan OSF

    Secretary

    Total calculated
    $0
    Hours/week
    1 + 2 related

  • STEPHEN WERNER MD

    Vice Chair

    Total calculated
    $0
    Hours/week
    1

  • DANNI NORLANDER

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • ELIZABETH BORGEN

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • John Brotz

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Lindsey Harrison-Eirich

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Mark Gumm

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Marla Wolfert MD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1

  • Kimberly Hodgkinson

    CFO/Foundation Treasurer

    Total calculated
    $566,249
    From this org
    $0
    From related orgs
    $508,183
    Other
    $58,066
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $338,668 related
    Bonus
    $0 + $40,000 related
    Other
    $0 + $129,515 related
    Deferred
    $0 + $46,924 related
    Nontaxable benefits
    $0 + $11,142 related
    Filer's total
    $0 + $566,249 related

  • 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

  • Jessica J Leszczynski DO

    PHYSICIAN

    Total calculated
    $391,149
    From this org
    $347,531
    From related orgs
    $0
    Other
    $43,618
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $347,531
    Bonus
    $0
    Other
    $0
    Deferred
    $42,461
    Nontaxable benefits
    $1,157
    Filer's total
    $391,149

  • MELISSA PALECEK

    PHARMACY MANAGER

    Total calculated
    $173,727
    From this org
    $168,756
    From related orgs
    $0
    Other
    $4,971
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $165,987
    Bonus
    $2,454
    Other
    $315
    Deferred
    $3,939
    Nontaxable benefits
    $1,032
    Filer's total
    $173,727

  • Robb Steenwyk

    Facilitator Physical Therapy

    Total calculated
    $167,171
    From this org
    $128,394
    From related orgs
    $0
    Other
    $38,777
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $123,834
    Bonus
    $2,350
    Other
    $2,210
    Deferred
    $1,507
    Nontaxable benefits
    $37,270
    Filer's total
    $167,171

  • SHANA MCCLONE

    CHIEF NURSING OFFICER

    Total calculated
    $204,976
    From this org
    $181,002
    From related orgs
    $0
    Other
    $23,974
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $153,848
    Bonus
    $5,566
    Other
    $21,588
    Deferred
    $3,326
    Nontaxable benefits
    $20,648
    Filer's total
    $204,976

  • Shannon Diamond

    physical therapist

    Total calculated
    $130,381
    From this org
    $125,257
    From related orgs
    $0
    Other
    $5,124
    Hours/week
    40

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
  • 3 · Independent compensation consultant
  • 3 · Form 990 of other organizations
  • 3 · Compensation survey or study
  • 3 · Approval by the board or 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)

Schedule J, Part I, Line 1a Tax indemnification and gross-up payments
DURING THE YEAR, THE FOLLOWING INTERESTED PERSONS RECEIVED A TAX GROSS-UP PAYMENT. THE RELATED AMOUNTS WERE TREATED AS TAXABLE COMPENSATION TO THE RECIPIENT. Shana McClone
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 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 Justin Selle -- $36,324 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 J BAGNALL -- $134,905 ANN M. CARR -- $140,277 MICHAEL W. COTTRELL -- $81,097 THERESE B. PANDL -- $29,985

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.

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.

  • 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
202411319349305026

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