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Nonprofiteer
← AGNESIAN HEALTHCARE FOUNDATION INC

Form 990 for tax year 2022

Filed by AGNESIAN HEALTHCARE FOUNDATION INC.

Totals

Total revenue
$5,784,717
Total expenses
$1,474,155
Contributions and grants received
$4,187,047
Grants paid
$1,417,815
Program service revenue
$0
Investment income
$1,404,334
Other revenue
$193,336
Total assets, end of year
$25,862,506
Total liabilities, end of year
$1,080,779
Net assets or fund balances, end of year
$24,781,727
Program services expenses (Part IX)
$1,417,815
Management and general expenses
$0
Fundraising expenses
$56,340
Program service expenses (Part III)
$1,417,815

Program services were 96.2% 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

    $311,462

  • 1d · Related organizations

    $21,058

  • 1f · All other contributions, gifts and grants

    $3,854,527

  • 1g · Noncash contributions included above

    $60,214

  • 2f · All other program service revenue

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

  • 3 · Investment income

    total $364,986 · excluded $364,986

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7a · Gross sales of assets other than inventory

    securities $1,039,348

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

    securities $0

  • 7c · Gain or loss

    securities $1,039,348 · other assets $0

  • 7d · Net gain or loss

    total $1,039,348 · excluded $1,039,348

  • 8a · Fundraising events: gross income

    $117,511

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

    $311,462

  • 8b · Fundraising events: direct expenses

    $71,898

  • 8c · Net income from fundraising events

    total $45,613 · excluded $45,613

  • 9a · Gaming: gross income

    $207,040

  • 9b · Gaming: direct expenses

    $83,121

  • 9c · Net income from gaming

    total $123,919 · excluded $123,919

  • 10a · Gross sales of inventory

    $294,907

  • 10b · Cost of goods sold

    $271,103

  • 10c · Net income from sales of inventory

    total $23,804 · excluded $23,804

  • 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 $1,375,980 · program services $1,375,980

  • 2 · Grants to domestic individuals

    total $41,835 · program services $41,835

  • 11g · Fees: other

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

  • 12 · Advertising and promotion

    total $1,159 · fundraising $1,159

  • 13 · Office expenses

    total $3,640 · fundraising $3,640

  • 17 · Travel

    total $138 · fundraising $138

  • 24a · Other expenses: Bank service charges

    total $51,403 · fundraising $51,403

  • 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 $2,721,008 · end of year $3,718,065

  • 2 · Savings and temporary cash investments

    beginning of year $11,878,841 · end of year $6,441,416

  • 3 · Pledges and grants receivable

    end of year $859,988

  • 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 $44,258 · end of year $43,199

  • 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

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $11,597,737 · end of year $14,799,838

  • 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 $562,780 · end of year $1,080,779

  • 27 · Net assets without donor restrictions

    beginning of year $14,065,899 · end of year $9,981,889

  • 28 · Net assets with donor restrictions

    beginning of year $11,613,165 · end of year $14,799,838

Mission and programs · 2022

Mission

THE EFFECTIVE AND EFFICIENT DEVELOPMENT, FINANCIAL MANAGEMENT AND GRANTING OF PHILANTHROPIC SUPPORT FOR ST. AGNES HOSP, WAUPUN MEMORIAL HOSP, RIPON MEDICAL CENTER, ST. FRANCIS HOME OF FDL, SISTERS SERVANTS OF CHRIST THE KING VILLA LORETTO, VILLA ROSA, AND THE CHRISTIAN HOME.

  • THE AGNESIAN HEALTHCARE FOUNDATION PROVIDES SUPPORT TO AGNESIAN HEALTHCARE INC, WAUPUN MEMORIAL HOSPITAL, RIPON MEDICAL CENTER, ST. FRANCIS HOME OF FOND DU LAC, SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO, VILLA ROSA, AND THE CHRISTIAN HOME & REHABILITATION CENTER FOR OPERATIONS AND CAPITAL EQUIPMENT.

    Expenses $1,417,815 · Grants $1,417,815

As filed on the 2022 return.

Listed in Part VII

  • Jack Twohig

    Director, Chairperson

    Total calculated
    $0
    Hours/week
    1

  • Joseph Bird

    Director, Vice Chairperson

    Total calculated
    $0
    Hours/week
    1

  • Robert Fale

    Director, Treasurer

    Total calculated
    $0
    Hours/week
    1

  • Shawn Fisher

    Director, Executive Director

    Total calculated
    $146,790
    From this org
    $0
    From related orgs
    $124,258
    Other
    $22,532
    Hours/week
    40

  • Adam Stone

    Director

    Total calculated
    $0
    Hours/week
    1

  • Brenda Grass MD

    Director

    Total calculated
    $0
    Hours/week
    1

  • Catherine Twohig MD

    Director

    Total calculated
    $0
    Hours/week
    1

  • John St Peter

    Director

    Total calculated
    $0
    Hours/week
    1

  • Kate Bresser

    Director

    Total calculated
    $0
    Hours/week
    1

  • Kathy Schlieve

    Director

    Total calculated
    $0
    Hours/week
    1

  • Michael Shannon

    Director

    Total calculated
    $0
    Hours/week
    1

  • Sr Mary Noel Brown CSA

    Director

    Total calculated
    $0
    Hours/week
    1 + 1 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, 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.
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. NO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2022. No 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.

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

    N/A · Surgery Services · MO

    Directly controlled by NA

  • St Clare Imaging Services LLC

    N/A · Diag. Services · WI

    Directly controlled by NA

  • Mt Vernon Radiation Therapy Center LLC

    N/A · Radiation Therapy · IL

    Directly controlled by NA

  • Sleep & Neurology Center of Southern Illinois LLC

    N/A · Diag. Services · IL

    Directly controlled by NA

  • CHOWSMGSI Office Building LLC

    N/A · MOB · IL

    Directly controlled by NA

  • Oza Cancer Center LLC

    N/A · MOB · IL

    Directly controlled by NA

  • Shawnee Real Estate Holdings LLC

    N/A · MOB · OK

    Directly controlled by NA

  • Dean Clinic & St Mary's Hospital Accountable Care Organization LLC

    N/A · Accountable Care Organization · WI

    Directly controlled by NA

  • Wisconsin Integrated Information Technology and Telemedicine Systems LLC

    N/A · Information Technology Services · WI

    Directly controlled by NA

  • Wingra Building Group

    N/A · MOB · WI

    Directly controlled by NA

  • Janesville Riverview Clinic Building Partnership

    N/A · MOB · WI

    Directly controlled by NA

  • 1110 N Classen Blvd LLC

    N/A · MOB · OK

    Directly controlled by NA

  • SSM St Clare Surgical Center LLC

    N/A · Surgery Services · MO

    Directly controlled by NA

  • Windmill LLP

    N/A · Investments · MO

    Directly controlled by NA

  • Navitus Health Solutions LLC

    N/A · Pharmacy Benefits · WI

    Directly controlled by NA

  • SSM Select Rehab St Louis LLC

    N/A · Health Care · DE

    Directly controlled by NA

  • Epiphany Rx LLC

    N/A · Pharmacy Benefits · DE

    Directly controlled by NA

  • Bain Capital Global Direct Lending 2021 (L Offshore) LP

    N/A · Investments · DE

    Directly controlled by NA

  • Bloom Tree Long-Only Fund QP LP fka Bloom Tree Ponderosa Funds QP LP

    N/A · Investments · DE

    Directly controlled by NA

  • Carlyle Property Investors LP

    N/A · Investments · DE

    Directly controlled by NA

  • NECICF II AIV2-B LP

    N/A · Investments · DE

    Directly controlled by NA

Related corporations and trusts

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

  • SSM Managed Care Organization LLC

    C Corporation · Health Promotion · MO

    Directly controlled by NA

  • FPP INC & Subs

    C Corporation · Health Care · MO

    Directly controlled by NA

  • Diversified Health Services Corp

    C Corporation · Medical Equipment · MO

    Directly controlled by NA

  • SSM Properties Inc

    C Corporation · Property Services · MO

    Directly controlled by NA

  • HealthFirst Physician Management Services

    C Corporation · Medical Services · OK

    Directly controlled by NA

  • SSMHC Liability Trust II

    C Corporation · Insurance · MO

    Directly controlled by NA

  • SSM Medical Group Inc

    C Corporation · Physician Offices · MO

    Directly controlled by NA

  • SSMHC Insurance Company

    C Corporation · Insurance · CJ

    Directly controlled by NA

  • Physicians Services Corp of Southern Illinois Inc

    C Corporation · Health Care · IL

    Directly controlled by NA

  • Dean Health Systems Inc

    C Corporation · Physician Offices · WI

    Directly controlled by NA

  • Dean Health Insurance Inc

    C Corporation · Insurance · WI

    Directly controlled by NA

  • Dean Retail Services Inc

    C Corporation · Property Services · WI

    Directly controlled by NA

  • Oza Oncology Inc

    S Corporation · Physician Offices · IL

    Directly controlled by NA

  • SSM Health Janesville Campus Condominium Association Inc

    C Corporation · Condo association · WI

    Directly controlled by NA

  • SSM Health Pharmacy LLC

    C Corporation · Pharmacy · MO

    Directly controlled by NA

  • Navitus Holdings LLC

    C Corporation · Pharmacy · WI

    Directly controlled by NA

  • MS Community JV LLC

    C Corporation · Insurance · DE

    Directly controlled by NA

  • Quality Drug Corporation

    C Corporation · Pharmacy benefits · CA

    Directly controlled by NA

  • St Mary's Hospital Campus Condominium Owners Association Inc

    C Corporation · Condo association · WI

    Directly controlled by NA

  • Partners Group PMC Private Credit LP

    C Corporation · Investment · CJ

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2022
Filed
15 November 2023
IRS schema version
2022v5.0
Source object
202303199349326870

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