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Nonprofiteer
← ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC

Form 990 for tax year 2022

Filed by ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC.

Totals

Total revenue
$11,030,271
Total expenses
$14,483,352
Contributions and grants received
$3,325
Grants paid
$0
Program service revenue
$11,078,301
Investment income
-$92,855
Other revenue
$41,500
Total assets, end of year
$17,769,918
Total liabilities, end of year
$5,610,797
Net assets or fund balances, end of year
$12,159,121
Program services expenses (Part IX)
$10,772,086
Management and general expenses
$3,711,266
Fundraising expenses
$0
Program service expenses (Part III)
$10,772,086

Program services were 74.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Barb Senn

    Director, Vice Chairperson

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Chris Thornock

    Director, VP Medical Group

    Total calculated
    $719,524
    From this org
    $0
    From related orgs
    $524,146
    Other
    $195,378
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $424,117 related
    Bonus
    $0 + $95,808 related
    Other
    $0 + $4,222 related
    Deferred
    $0 + $162,402 related
    Nontaxable benefits
    $0 + $32,976 related
    Filer's total
    $0 + $719,524 related

  • Dave Kusek

    Director, Chairperson

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Marilyn Mulder

    Director

    Total calculated
    $0
    Hours/week
    1 + 4 related

  • Matt Hanley MD

    Director, Interim Regional President - Wisconsin

    Total calculated
    $1,183,446
    From this org
    $0
    From related orgs
    $1,162,974
    Other
    $20,472
    Hours/week
    1 + 45 related

    Schedule J breakdown matched by us

    Base
    $0 + $207,940 related
    Bonus
    $0 + $954,328 related
    Other
    $0 + $706 related
    Deferred
    $0 + $11,163 related
    Nontaxable benefits
    $0 + $9,308 related
    Filer's total
    $0 + $1,183,446 related

  • Steve Franke

    Director, Secretary/Treasurer

    Total calculated
    $0
    Hours/week
    1 + 3 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

  • Carol Hyland

    Director

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Jenny Knuth

    Director

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Rick Vant Hoff

    Director

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Sr Stephen Bloesl

    Director

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Sue Buwalda

    Director

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • DG Gloede

    President-Post Acute

    Total calculated
    $370,297
    From this org
    $0
    From related orgs
    $275,003
    Other
    $95,294
    Hours/week
    1 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $255,010 related
    Bonus
    $0 + $18,675 related
    Other
    $0 + $1,318 related
    Deferred
    $0 + $67,201 related
    Nontaxable benefits
    $0 + $28,093 related
    Filer's total
    $0 + $370,297 related

  • Douglas Long

    Secretary, General Counsel 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

  • 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

  • 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

  • 1a · Tax indemnification and gross-up payments
  • 1b · Written policy on the line-1a expenses
  • 2 · Substantiation required before reimbursing expenses
  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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
Several individuals listed on Part VII, Section A, received tax indemnification/gross up payments in 2022, which were included in their taxable compensation.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
The organization's top management official (President-Post Acute) 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 4a Severance or change-of-control payment
SSM Health has adopted a severance policy to provide a financial transition in the event of involuntary termination without cause for Executive Level Positions. The amount of the compensation is based on the position held and length of service with SSMH. The following individuals listed in Part VII of the Form 990 received payments under the plan in the current year: Alison Ruehl $117,407
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. The following individuals listed on Part VII of Form 990 received distributions from the plan in 2022. Tina Johnson $31,847 Amy Lillge $6,305 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: Steve Smoot - $240,329 Randall Combs $251,115 Douglas Long $159,815 DG Gloede $24,694 Chris Thornock $43,014 Michael Topolski $11,150 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

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.

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
202333199349329898

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