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Nonprofiteer
← ST CLARE HEALTHCARE FOUNDATION INC

Form 990 for tax year 2023

Filed by ST CLARE HEALTHCARE FOUNDATION INC.

Totals

Total revenue
$415,145
Total expenses
$440,116
Contributions and grants received
$295,928
Grants paid
$285,499
Program service revenue
$0
Investment income
$119,453
Other revenue
-$236
Total assets, end of year
$4,201,900
Total liabilities, end of year
$2,164
Net assets or fund balances, end of year
$4,199,736
Program services expenses (Part IX)
$285,499
Management and general expenses
$0
Fundraising expenses
$154,617
Program service expenses (Part III)
$285,499

Program services were 64.9% 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

    $10,358

  • 1d · Related organizations

    $24,000

  • 1f · All other contributions, gifts and grants

    $261,570

  • 3 · Investment income

    total $94,152 · excluded $94,152

  • 7a · Gross sales of assets other than inventory

    securities $25,301

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

    securities $0

  • 7c · Gain or loss

    securities $25,301

  • 7d · Net gain or loss

    total $25,301 · excluded $25,301

  • 8a · Fundraising events: gross income

    $942

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

    $10,358

  • 8b · Fundraising events: direct expenses

    $2,020

  • 8c · Net income from fundraising events

    total -$1,078 · excluded -$1,078

  • 9a · Gaming: gross income

    $2,605

  • 9b · Gaming: direct expenses

    $1,763

  • 9c · Net income from gaming

    total $842 · excluded $842

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $267,642 · program services $267,642

  • 2 · Grants to domestic individuals

    total $17,857 · program services $17,857

  • 6 · Compensation of disqualified persons

    total $120,290 · fundraising $120,290

  • 7 · Other salaries and wages

    total $8,994 · fundraising $8,994

  • 11g · Fees: other

    total $580 · fundraising $580

  • 12 · Advertising and promotion

    total $5,089 · fundraising $5,089

  • 13 · Office expenses

    total $6,581 · fundraising $6,581

  • 15 · Royalties

    total $11,781 · fundraising $11,781

  • 17 · Travel

    total $933 · fundraising $933

  • 24a · Other expenses: BANK CHARGES

    total $264 · fundraising $264

  • 24b · Other expenses: LICENSES

    total $105 · fundraising $105

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $369,478 · end of year $419,951

  • 3 · Pledges and grants receivable

    beginning of year $154,500

  • 11 · Investments: publicly traded securities

    beginning of year $3,254,182 · end of year $3,781,949

  • 25 · Other liabilities

    beginning of year $0 · end of year $2,164

  • 27 · Net assets without donor restrictions

    beginning of year $1,740,302 · end of year $1,930,521

  • 28 · Net assets with donor restrictions

    beginning of year $2,037,858 · end of year $2,269,215

Mission and programs · 2023

Mission

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

Activities or mission (Part I)

FACILITIES 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 $227,897 · Grants $227,897

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

    Expenses $17,857 · Grants $17,857

  • 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 $39,745 · Grants $39,745

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

Listed in Part VII

  • Deann Thurmer

    HOSPITAL PRESIDENT/EX OFF W/ VOTE

    Total calculated
    $544,561
    From this org
    $0
    From related orgs
    $407,419
    Other
    $137,142
    Hours/week
    1 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $317,834 related
    Bonus
    $0 + $58,131 related
    Other
    $0 + $31,454 related
    Deferred
    $0 + $111,051 related
    Nontaxable benefits
    $0 + $26,091 related
    Filer's total
    $0 + $544,561 related

  • Sharilyn Munneke

    DIRECTOR & PHYSICIAN AT DEAN MEDICAL GROUP

    Total calculated
    $238,622
    From this org
    $0
    From related orgs
    $197,992
    Other
    $40,630
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $179,556 related
    Bonus
    $0 + $16,814 related
    Other
    $0 + $1,622 related
    Deferred
    $0 + $17,187 related
    Nontaxable benefits
    $0 + $23,443 related
    Filer's total
    $0 + $238,622 related

  • Mary Dressen

    DIRECTOR & PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • Merije Ajvazi

    DIRECTOR & VICE PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • Matt Schaefer

    DIRECTOR & TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Teresa Jacobson

    DIRECTOR & SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Dave Abangan

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Brent Gasser

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Dr Jennifer Gavinski

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Dr Sharilyn Munneke

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Shawna Marquardt

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Marcus Mitchell

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Craig Philipp

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Tiffany Sloan

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Julia Randles

    FOUNDATION DIRECTOR & ASSISTANT SECRETARY

    Total calculated
    $172,216
    From this org
    $0
    From related orgs
    $114,010
    Other
    $58,206
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $0 + $103,439 related
    Bonus
    $0 + $10,139 related
    Other
    $0 + $432 related
    Deferred
    $0 + $15,263 related
    Nontaxable benefits
    $0 + $42,943 related
    Filer's total
    $0 + $172,216 related

  • Scott Wysocki

    INTERIM HOSPITAL PRESIDENT/EX OFF W/ VOTE

    Total calculated
    $291,687
    From this org
    $0
    From related orgs
    $217,931
    Other
    $73,756
    Hours/week
    0 + 41 related

    Schedule J breakdown matched by us

    Base
    $0 + $181,495 related
    Bonus
    $0 + $27,067 related
    Other
    $0 + $9,369 related
    Deferred
    $0 + $44,674 related
    Nontaxable benefits
    $0 + $29,082 related
    Filer's total
    $0 + $291,687 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)

PART I, LINE 1A
SCHEDULE J, PART I, LINE 1A - TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SEVERAL INDIVIDUALS LISTED ON PART VII, SECTION A RECEIVED TAX INDEMNIDFICATION/GROSS UP PAYMENTS IN 2023, WHICH WERE INCLUDED IN THEIR TAXABLE COMPENSATION.
PART I, LINE 1B
SCHEDULE J, PART I, LINE 3 - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PENSION RESTORATION PLAN: SSM HEAL TH (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 DEFERRALS FROM THIS PLAN IN 2023: DEANN THURMER $29,866 SCOTT WYSOCKI $8,626 SHARILYN MUNN EKE $5,625 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. DEANN THURMER $26,741 SCOTT WYSOCKI $7,676
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 (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.

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 · INVESTMENT · CJ

Provenance

Return type
form_990
Tax year
2023
Filed
15 November 2024
IRS schema version
2023v5.1
Source object
202443209349317279

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