TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) BRIAN BACHHUBER........................................................................ PT YR DIRECTOR	1.00 .......................0.00	X		0	0	0
(2) KAY BARRETT MD........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(3) MICHELLE BEHNKE........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(4) RANDY KRSZYZANIEK MD........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(5) KATHRYN LILLEY MD........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(6) MARK MCDADE MD........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(7) GAUROV DAYAL MD........................................................................ DIRECTOR AND PRESIDENT	30.00 .......................10.00	X	X	0	775,353	124,266
(8) MARY SCHMOEGER........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(9) DAVID SORBER MD........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(10) WESLEY SPARKMAN........................................................................ DIRECTOR	1.00 .......................0.00	X		0	0	0
(11) STEVEN BARNEY........................................................................ PT YR DIRECTOR AND PRES	30.00 .......................10.00	X	X	0	592,443	-223,953
(12) SR MARY JEAN RYAN FSM........................................................................ DIRECTOR AND CHAIRPERSON	1.00 .......................0.00	X	X	0	0	0
(13) WILLIAM THOMPSON........................................................................ DIRECTOR AND VICE CHAIR	1.00 .......................40.00	X	X	0	2,421,072	841,970
(14) KRIS ZIMMER........................................................................ TREASURER	1.00 .......................40.00		X	0	836,253	68,008
(15) JUNE PICKETT........................................................................ SECRETARY	1.00 .......................40.00		X	0	256,054	-96,872
(16) LAURA BOWERS........................................................................ ASST SECRETARY	40.00 .......................0.00		X	78,096	0	18,135
(17) CHARLES JOHNSON........................................................................ PT YR REG VP FINANCE	40.00 .......................0.00		X	539,751	0	39,633

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) STEVEN CALDWELL........................................................................ SENIOR VICE PRES AND CFO	20.00 .......................20.00	X				0	797,407	25,448
(19) FRANK BYRNE MD........................................................................ HOSPITAL PRESIDENT	40.00 .......................0.00		X			0	601,058	75,664
(20) SANDRA ANDERSON........................................................................ HOSPITAL PRESIDENT	40.00 .......................0.00		X			0	389,504	50,156
(21) KERRY SWANSON........................................................................ HOSPITAL PRESIDENT	40.00 .......................0.00		X			0	329,496	63,540
(22) JOAN BEGLINGER........................................................................ VP PAITIENT SERVICES	40.00 .......................0.00		X			310,096	0	15,774
(23) ALICE FACEY........................................................................ VP PATIENT CARE	40.00 .......................0.00		X			93,312	0	14,237
(24) MARILYN BIROS........................................................................ REG VP STRATEGIC DEV	40.00 .......................0.00		X			107,730	0	30,570
(25) LINDA STATZ........................................................................ REG VP HUMAN RESOURCES	40.00 .......................0.00		X			306,995	0	44,980
(26) TODD BURCHILL........................................................................ SYSTEM VP, STRATEGY	40.00 .......................0.00		X			267,729	0	25,412
(27) GREG BURNETT........................................................................ REG VP MEDICAL AFFAIRS	40.00 .......................0.00		X			330,271	0	27,147
(28) KRISTIN MCMANMON........................................................................ EXECUTIVE VP/COO	40.00 .......................0.00		X			322,689	0	51,740
(29) JEFF WELCH........................................................................ PHYSICIAN	40.00 .......................0.00			X		333,642	0	-13,251
(30) SHAHIN SHAHNIA........................................................................ PHYSICIAN	40.00 .......................0.00			X		277,935	0	3,179
(31) KANSAS DUBRAY........................................................................ PHYSICIAN	40.00 .......................0.00			X		246,059	0	24,003
(32) RICHARD STOUGHTON........................................................................ PROJECT MGMT DIRECTOR	40.00 .......................0.00			X		223,788	0	11,027
(33) JOHN STAPELMAN........................................................................ CRNA SUPERVISOR	40.00 .......................0.00			X		221,583	0	38,516
(34) WILLIAM SCHOENHARD........................................................................ FORMER OFFICER	0.00 .......................0.00				X	0	274,359	-277,636

(A) Name and business address	(B) Description of services	(C) Compensation
DEAN HEALTH SYSTEMS INC1808 W BELTLINE HWYMADISONWI53713	PHYSICIAN SERVICES	7,886,857
BOARD OF REGENTS OF THE UNIV OF WI1100 DELAPLAINE CTMADISONWI53715	PHYSICIAN SERVICES	4,825,550
WISCONSIN INTEGRATED INFORMATION TECHNOL1808 W BELTLINE HWYMADISONWI53713	INFORMATION TECHNOLOGY	3,617,773
UW HOSPITAL AND CLINICS600 HIGHLAND AVEMADISONWI53792	PHYSICIAN SERVICES	3,165,111
JH FINDORFF & SON INC300 S BEDFORD STMADISONWI53703	CONSTRUCTION SERVICES	2,807,699
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 88

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	420,854	420,854
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	4,039,033	777,512	3,261,521
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	195,914,417	172,017,714	23,586,673	310,030
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	20,150,064	17,798,359	2,348,149	3,556
9	Other employee benefits .......	37,460,392	32,081,412	5,275,197	103,783
10	Payroll taxes ...........	14,506,847	12,613,113	1,874,699	19,035
11	Fees for services (non-employees):
a	Management ......	6,855,343	2,597,401	4,257,942
b	Legal .........	207,480		207,480
c	Accounting ...........	3,696,751		3,696,751
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	49,589,043	33,967,437	15,550,706	70,900
12	Advertising and promotion ....	1,021,121		963,883	57,238
13	Office expenses .......	23,713,211	21,865,943	1,823,324	23,944
14	Information technology ......	21,885,778	21,773,716	90,542	21,520
15	Royalties ..
16	Occupancy ...........	11,860,998	11,464,248	389,632	7,118
17	Travel ............	1,109,582	378,341	724,355	6,886
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	798,887	713,822	83,907	1,158
20	Interest ...........	10,216,018	10,216,018
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	31,871,619	30,940,170	931,340	109
23	Insurance ..............	978,181	860,056	118,125
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	79,840,974	79,840,974	0	0
b	PROVIDER TAXES	15,017,532	15,017,532	0	0
c	BOND RELATED FEES	1,093,243	1,093,243	0	0
d	LICENSES	391,297	354,400	36,769	128
e	All other expenses	319,485	142,130	177,165	190
25	Total functional expenses. Add lines 1 through 24e	532,958,150	466,934,395	65,398,160	625,595
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	31,782,182	2	94,865,471
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	59,556,492	4	53,020,637
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	6,662,985	8	6,479,282
9	Prepaid expenses and deferred charges ..........	1,726,710	9	2,111,121
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	625,784,157
b	Less: accumulated depreciation .....	10b	311,466,345	331,415,657	10c	314,317,812
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....	403,810,854	12	398,128,289
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	26,116,190	15	17,090,627
16	Total assets. Add lines 1 through 15 (must equal line 34)......	861,071,070	16	886,013,239
	17	Accounts payable and accrued expenses .........	50,940,428	17	50,619,479
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	275,532,722	25	280,121,492
26	Total liabilities. Add lines 17 through 25.........	326,473,150	26	330,740,971
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	528,265,022	27	547,470,127
28	Temporarily restricted net assets ...........	3,607,246	28	3,235,312
29	Permanently restricted net assets ...........	2,725,652	29	4,566,829
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	534,597,920	33	555,272,268
34	Total liabilities and net assets/fund balances ........	861,071,070	34	886,013,239

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization SSM HEALTH CARE OF WISCONSIN INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization SSM HEALTH CARE OF WISCONSIN INC

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2013

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2013

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Yes

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Yes

14,096

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

185,207

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

199,303

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	SSM HEALTH CARE OF WISCONSIN, INC. EMPLOYS LOBBYISTS WHOSE ACTIVITIES INCLUDE SERVING AS LIAISONS TO CITY, STATE, AND FEDERAL OFFICIALS. THEY TRACK AND EVALUATE HEALTH CARE AND OTHER LEGISLATION THAT MAY HAVE AN IMPACT ON THE SYSTEM, EXPLORE AND EVALUATE POSSIBLE FUNDING OPPORTUNITIES FOR SSM HEALTH CARE OF WISCONSIN, INC., AND SERVE AS THE SPOKESPERSONS TO LEGISLATIVE COMMITTEES AND STATE AGENCIES FOR THE SYSTEM ON LEGISLATIVE ISSUES. THE LOBBYIST'S ACTIVITIES INCLUDE DIRECT MAILINGS, DIRECT CONTACT WITH LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS. IN ADDITION, THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL AND STATE HOSPITAL ASSOCIATIONS AND PORTIONS OF THE DUES WERE ALLOCATED TO LOBBYING ACTIVITIES.

Return Reference

Explanation

PART II-B, LINE 1:

SSM HEALTH CARE OF WISCONSIN, INC. EMPLOYS LOBBYISTS WHOSE ACTIVITIES INCLUDE SERVING AS LIAISONS TO CITY, STATE, AND FEDERAL OFFICIALS. THEY TRACK AND EVALUATE HEALTH CARE AND OTHER LEGISLATION THAT MAY HAVE AN IMPACT ON THE SYSTEM, EXPLORE AND EVALUATE POSSIBLE FUNDING OPPORTUNITIES FOR SSM HEALTH CARE OF WISCONSIN, INC., AND SERVE AS THE SPOKESPERSONS TO LEGISLATIVE COMMITTEES AND STATE AGENCIES FOR THE SYSTEM ON LEGISLATIVE ISSUES. THE LOBBYIST'S ACTIVITIES INCLUDE DIRECT MAILINGS, DIRECT CONTACT WITH LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS. IN ADDITION, THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL AND STATE HOSPITAL ASSOCIATIONS AND PORTIONS OF THE DUES WERE ALLOCATED TO LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	11,841,917	10,885,114	9,892,874	8,884,693	8,508,695
b	Contributions ........	269,826	797,238	302,799	315,650	227,929
c	Net investment earnings, gains, and losses	440,966	320,680	782,010	763,245	237,889
d	Grants or scholarships .....	9,250
e	Other expenditures for facilities and programs ........	6,159,820	161,115	92,569	70,714	89,820
f	Administrative expenses ....
g	End of year balance ......	6,383,639	11,841,917	10,885,114	9,892,874	8,884,693

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

11.000 %

Permanent endowment SchDMd Bullet

72.000 %

Temporarily restricted endowment SchDMd Bullet

17.000 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

Yes

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	12,029,102		12,029,102
b	Buildings ................	391,198,365	174,455,885	216,742,480
c	Leasehold improvements ............	54,082,570	17,837,092	36,245,478
d	Equipment ................	162,568,638	116,504,128	46,064,510
e	Other .................	5,905,482	2,669,240	3,236,242
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				314,317,812

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) SSM COMPREHENSIVE INVESTMENT PROGRAM	309,778,599	F
(B) BENEFICIAL INTEREST IN FOUNDATION	88,349,690	F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	398,128,289

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
PENSION FUNDING LIABILITY		33,432,302
DUE TO RELATED PARTY		5,762,389
ASSET RETIREMENT LIABILITY		792,613
THIRD PARTY PAYOR		2,612,044
RABBI TRUST LIABILITY		308,655
ALLOCATED TAX EXEMPT DEBT - SSM HEALTH CARE		237,203,216
DEFERRED REVENUE		10,273


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		280,121,492
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	ENDOWMENT FUNDS WILL BE USED TO PROVIDE HEALTH CARE SERVICES.
PART X, LINE 2:	SSM HEALTH CARE OF WISCONSIN'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH CARE (SSMHC). SSMHC EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION IS RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED UPON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2013 OR 2012.

Return Reference

Explanation

PART V, LINE 4:

ENDOWMENT FUNDS WILL BE USED TO PROVIDE HEALTH CARE SERVICES.

PART X, LINE 2:

SSM HEALTH CARE OF WISCONSIN'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH CARE (SSMHC). SSMHC EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION IS RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED UPON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2013 OR 2012.

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	12,490,134		12,490,134	2.340 %
b	Medicaid (from Worksheet 3, column a) ....	80,719,659	52,370,888	28,348,771	5.320 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	1,771,292	1,037,030	734,262	0.140 %
d	Total Financial Assistance and Means-Tested Government Programs .	94,981,085	53,407,918	41,573,167	7.800 %
Other Benefits		1,034,466	11,660	1,022,806	0.190 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	1,034,466	11,660	1,022,806	0.190 %
f	Health professions education (from Worksheet 5) ..	10,854,372	2,150,021	8,704,351	1.630 %
g	Subsidized health services (from Worksheet 6) ..	2,632,090	638,151	1,993,939	0.370 %
h	Research (from Worksheet 7)	65,759		65,759	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	554,442		554,442	0.100 %
j	Total. Other Benefits ..	15,141,129	2,799,832	12,341,297	2.300 %
k	Total. Add lines 7d and 7j .	110,122,214	56,207,750	53,914,464	10.100 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	2,420	2,420	0 %
3	Community support	22,963	22,963	0 %
4	Environmental improvements
5	Leadership development and training for community members	86	86	0 %
6	Coalition building	47,297	47,297	0.010 %
7	Community health improvement advocacy	30,426	30,426	0.010 %
8	Workforce development	110,284	110,284	0.020 %
9	Other
10	Total	213,476	213,476	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

8,668,832

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

179,064,118

Enter Medicare allowable costs of care relating to payments on line 5.....

218,635,891

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-39,571,773

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?3 Name, address, primary website address, and state license number
1	ST MARY'S HOSPITAL 700 SOUTH PARK STREET MADISON,WI53715 WWW.SSMHEALTH.COM 71	X	X	X	X
2	ST CLARE HOSPITAL 707 FOURTEENTH STREET BARABOO,WI53913 WWW.SSMHEALTH.COM 65	X	X	X	X
3	ST MARY'S JANESVILLE HOSPITAL 3900 E RACINE ST JANESVILLE,WI53546 WWW.SSMHEALTH.COM 318	X	X	X	X

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	ST MARY'S HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C - SUPPLEMENTAL INFO

Other website (list url): WWW.SSMHEALTH.COM

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	ST CLARE HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C - SUPPLEMENTAL INFO

Other website (list url): WWW.SSMHEALTH.COM

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	ST MARY'S JANESVILLE HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C - SUPPLEMENTAL INFO

Other website (list url): WWW.SSMHEALTH.COM

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
ST. MARY'S HOSPITAL	PART V, SECTION B, LINE 3: THE HEALTHY DANE COLLABORATIVE ENGAGED OTHER ORGANIZATIONS IN THE CHNA THROUGH THE DANE COUNTY HEALTH COUNCIL, A GROUP THAT MEETS REGULARLY TO CONSIDER ISSUES AFFECTING HEALTH IN DANE COUNTY AND WAYS TO COLLECTIVELY ADDRESS ISSUES. A LIST OF COUNCIL ORGANIZATIONS CAN BE FOUND ON PAGE 47 OF THE CHNA. THE COLLABORATIVE ALSO HOSTED FOCUS GROUPS WHICH PROVIDED INPUT FROM SEVERAL INDIVIDUAL COMMUNITY LEADERS REPRESENTING DIVERSE CONSTITUENCIES. THOSE LEADERS ARE LISTED WITH THEIR AFFILIATION IN APPENDICES B & C OF THE CHNA. IN ADDITION, THE COLLABORATIVE'S VENDOR, HEALTHY COMMUNITY INSTITUTE, UTILIZING A MULTI-DISCIPLINARY TEAM, MAINTAINS A HIGH-QUALITY DATA AND DECISION-SUPPORT INFORMATION SYSTEM TO AID IN INDICATOR TRACKING, BEST-PRACTICE SHARING AND COMMUNITY DEVELOPMENT.ST. MARY'S HOSPITAL CHNA CAN BE FOUND AT: HTTP://WWW.STMARYSMADISON.COM/DOCUMENTS/CHNA%20FULL%20101912-FINAL.PDF.
ST. CLARE HOSPITAL	PART V, SECTION B, LINE 3: AFTER EVALUATING READILY AVAILABLE PUBLIC INFORMATION, 21 KEY STAKEHOLDERS PARTICIPATED IN AN INTERVIEW PROCESS. THE 21 STAKEHOLDERS WERE COMPRISED OF PUBLIC HEALTH EXPERTS, INDIVIDUALS FROM HEALTH OR OTHER DEPARTMENTS AND AGENCIES, LEADERS OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AND OTHER COMMUNITY MEMBERS. A LIST OF INDIVIDUALS INTERVIEWED CAN BE FOUND IN EXHIBIT 20 (PAGES A-42 AND A-43) OF THE CHNA. ADDITIONALLY, 32 STAKEHOLDERS PARTICIPATED IN A SERIES OF FOCUS GROUPS AND INTERVIEWS. A LIST OF FOCUS GROUP PARTICIPANTS CAN BE FOUND IN EXHIBIT 21 (PAGES A-44 AND A-45) OF THE CHNA. ST. CLARE HOSPITAL'S CHNA CAN BE FOUND AT: HTTP://WWW.STCLARE.COM/PAGES/CHNA%202%20PAGER%20HOMEPAGE.PDF.
ST. MARY'S JANESVILLE HOSPITAL	PART V, SECTION B, LINE 3: INFORMATION WAS OBTAINED FROM INTERVIEWS WITH STAKEHOLDERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING PUBLIC HEALTH OFFICIALS AND EXPERTS, AND ST. MARY'S JANESVILLE AFFILIATED CLINICIANS, ADMINISTRATORS AND STAFF. A LIST OF INDIVIDUALS INTERVIEWED CAN BE FOUND IN EXHIBIT 20 (PAGE A-42) OF THE CHNA. ST. MARY'S JANESVILLE HOSPITAL'S CHNA CAN BE FOUND AT: HTTP://WWW.STMARYSJANESVILLE.COM/ABOUTUS/DOCUMENTS/SSM%20ST.%20MARY%27S%20JANESVILLE%20CHNA%20-%20FINAL.PDF.
ST. MARY'S HOSPITAL	PART V, SECTION B, LINE 4: ST MARY'S HOSPITAL COLLABORATED WITH THREE OTHER HOSPITAL ORGANIZATIONS TO FACILITATE THE CHNA PROCESS. THE THREE HOSPITAL ORGANIZATIONS WERE MERITOR HEALTH SERVICES, STOUGHTON HOSPITAL, AND UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS.
ST. MARY'S JANESVILLE HOSPITAL	PART V, SECTION B, LINE 4: ST MARY'S JANESVILLE COLLABORATED WITH THREE HOSPITAL ORGANIZATIONS TO FACILITATE THE CHNA PROCESS. THE THREE HOSPITAL ORGANIZATIONS WERE BELOIT MEMORIAL HOSPITAL, EDGERTON HOSPITAL, AND MERCY HEALTH SYSTEM.
ST. MARY'S HOSPITAL	PART V, SECTION B, LINE 7: PRIOR TO THE REVIEW OF THE DATA COLLECTED BY THE CHNA PROCESS, A LIST OF CRITERIA WAS DEVELOPED TO AID IN THE SELECTION OF PRIORITY AREAS. DURING THE DATA-REVIEW PROCESS, ATTENTION WAS DIRECTED TO HEALTH ISSUES THAT MET ANY OF THESE CRITERIA. AFTER REVIEW AND CONSIDERATION OF DATA, THE COLLABORATIVE IDENTIFIED SIX HEALTH ISSUES THAT SHOWED EVIDENCE OF NEED IN THE COMMUNITY. ADDITIONAL INFORMATION CONCERNING THIS PROCESS CAN BE FOUND ON PAGES 9 AND 10 OF THE CHNA. WITH THE TOP SIX COMMUNITY-SPECIFIC HEALTH ISSUES IDENTIFIED, THE COLLABORATIVE EVALUATED EACH ISSUE UTILIZING A PRIORITIZATION PROCESS WHICH INCLUDED INPUT FROM COMMUNITY MEMBERS TO DETERMINE THE TOP COMMUNITY HEALTH NEEDS. THE CHNA-IDENTIFIED HEALTH NEEDS PROCESS CAN BE FOUND ON PAGES 45, 46 AND APPENDIX F OF THE CHNA.
ST. CLARE HOSPITAL	PART V, SECTION B, LINE 7: BASED ON AN ANALYSIS OF THE PRIMARY DATE COLLECTED, THE CHNA IDENTIFIED THE PRIORITY COMMUNITY HEALTH NEEDS OF THE HOSPITAL'S SERVICE AREA. A COMPLETE LIST OF IDENTIFIED NEEDS LISTED BY CATEGORY IN ALPHABETICAL ORDER CAN BE FOUND ON PAGES 5 AND 6 OF THE CHNA. ST CLARE HOSPITAL THEN APPLIED A RANKING METHODOLOGY TO HELP PRIORITIZE THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE ASSESSMENT. ADDITIONAL INFORMATION ON THE PRIORITIZATION PROCESS AND CRITERIA CAN BE FOUND ON PAGES A-2 AND A-3 OF THE CHNA.
ST. MARY'S JANESVILLE HOSPITAL	PART V, SECTION B, LINE 7: BASED ON AN ANALYSIS OF THE PRIMARY DATA COLLECTED, THE CHNA IDENTIFIED THE PRIORITY COMMUNITY HEALTH NEEDS OF THE HOSPITAL'S SERVICE AREA. A COMPLETE LIST OF IDENTIFIED NEEDS LISTED BY CATEGORY IN ALPHABETICAL ORDER CAN BE FOUND ON PAGES 5 AND 6 OF THE CHNA. ST MARY'S JANESVILLE HOSPITAL THEN APPLIED A RANKING METHODOLOGY TO HELP PRIORITIZE THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE ASSESSMENT. ADDITIONAL INFORMATION ON THE PRIORITIZATION PROCESS AND CRITERIA CAN BE FOUND ON PAGES A-2 AND A-3 OF THE CHNA.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address		Type of Facility (describe)
1	ST MARY'S RENAL SERVICES CENTER 2840 INDEX ROAD FITCHBURH,WI53713	RENAL DIALYSIS CENTER
2	ST MARY'S CARE CENTER 3401 MAPLE GROVE DRIVE MADISON,WI53719	LONG-TERM CARE
3	ST MARY'S SUN PRAIRIE EMERGENCY CENTER 2840 OKEEFE AVENUE SUN PRAIRIE,WI53590	EMERGENCY CENTER
4	ST CLARE MEADOWS CARE CENTER 1414 JEFFERSON BARABOO,WI53913	LONG-TERM CARE
5	ST CLARE DIALYSIS 1600 JEFFERSON STREET SUITE 200 BARABOO,WI53913	DIALYSIS CENTER
6	ST MARY'S SLEEP CENTER 2844 INDEX ROAD FITCHBURG,WI53713	SLEEP CENTER
7	ST CLARE CENTER 1510 JEFFERSON STREET BARABOO,WI53913	AODA TREATMENT
8	ST CLARE URGENT CARE 530 WISCONSIN DELLS PARKWAY LAKE DELTON,WI53965	URGENT CARE CENTER
9	ST MARY'S CHILD CARE CENTER 723 S ORCHARD STREET MADISON,WI53715	CHILD CARE CENTER
10	ADULT DAY HEALTH CENTER 2440 ATWOOD AVENUE MADISON,WI53704	ADULT DAY CARE
11	WI DELLS URGENT CARE 1306 BRAODWAY ROAD WISCONSIN DELLS,WI53965	URGENT CARE CENTER
12	ST CLARE CHILD CARE CENTER 1605 JEFFERSON ST BARABOO,WI53913	CHILD DAY CARE

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
ST. MARY'S HOSPITAL	PART V, SECTION B, LINE 3: THE HEALTHY DANE COLLABORATIVE ENGAGED OTHER ORGANIZATIONS IN THE CHNA THROUGH THE DANE COUNTY HEALTH COUNCIL, A GROUP THAT MEETS REGULARLY TO CONSIDER ISSUES AFFECTING HEALTH IN DANE COUNTY AND WAYS TO COLLECTIVELY ADDRESS ISSUES. A LIST OF COUNCIL ORGANIZATIONS CAN BE FOUND ON PAGE 47 OF THE CHNA. THE COLLABORATIVE ALSO HOSTED FOCUS GROUPS WHICH PROVIDED INPUT FROM SEVERAL INDIVIDUAL COMMUNITY LEADERS REPRESENTING DIVERSE CONSTITUENCIES. THOSE LEADERS ARE LISTED WITH THEIR AFFILIATION IN APPENDICES B & C OF THE CHNA. IN ADDITION, THE COLLABORATIVE'S VENDOR, HEALTHY COMMUNITY INSTITUTE, UTILIZING A MULTI-DISCIPLINARY TEAM, MAINTAINS A HIGH-QUALITY DATA AND DECISION-SUPPORT INFORMATION SYSTEM TO AID IN INDICATOR TRACKING, BEST-PRACTICE SHARING AND COMMUNITY DEVELOPMENT.ST. MARY'S HOSPITAL CHNA CAN BE FOUND AT: HTTP://WWW.STMARYSMADISON.COM/DOCUMENTS/CHNA%20FULL%20101912-FINAL.PDF.
ST. CLARE HOSPITAL	PART V, SECTION B, LINE 3: AFTER EVALUATING READILY AVAILABLE PUBLIC INFORMATION, 21 KEY STAKEHOLDERS PARTICIPATED IN AN INTERVIEW PROCESS. THE 21 STAKEHOLDERS WERE COMPRISED OF PUBLIC HEALTH EXPERTS, INDIVIDUALS FROM HEALTH OR OTHER DEPARTMENTS AND AGENCIES, LEADERS OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, AND OTHER COMMUNITY MEMBERS. A LIST OF INDIVIDUALS INTERVIEWED CAN BE FOUND IN EXHIBIT 20 (PAGES A-42 AND A-43) OF THE CHNA. ADDITIONALLY, 32 STAKEHOLDERS PARTICIPATED IN A SERIES OF FOCUS GROUPS AND INTERVIEWS. A LIST OF FOCUS GROUP PARTICIPANTS CAN BE FOUND IN EXHIBIT 21 (PAGES A-44 AND A-45) OF THE CHNA. ST. CLARE HOSPITAL'S CHNA CAN BE FOUND AT: HTTP://WWW.STCLARE.COM/PAGES/CHNA%202%20PAGER%20HOMEPAGE.PDF.
ST. MARY'S JANESVILLE HOSPITAL	PART V, SECTION B, LINE 3: INFORMATION WAS OBTAINED FROM INTERVIEWS WITH STAKEHOLDERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING PUBLIC HEALTH OFFICIALS AND EXPERTS, AND ST. MARY'S JANESVILLE AFFILIATED CLINICIANS, ADMINISTRATORS AND STAFF. A LIST OF INDIVIDUALS INTERVIEWED CAN BE FOUND IN EXHIBIT 20 (PAGE A-42) OF THE CHNA. ST. MARY'S JANESVILLE HOSPITAL'S CHNA CAN BE FOUND AT: HTTP://WWW.STMARYSJANESVILLE.COM/ABOUTUS/DOCUMENTS/SSM%20ST.%20MARY%27S%20JANESVILLE%20CHNA%20-%20FINAL.PDF.
ST. MARY'S HOSPITAL	PART V, SECTION B, LINE 4: ST MARY'S HOSPITAL COLLABORATED WITH THREE OTHER HOSPITAL ORGANIZATIONS TO FACILITATE THE CHNA PROCESS. THE THREE HOSPITAL ORGANIZATIONS WERE MERITOR HEALTH SERVICES, STOUGHTON HOSPITAL, AND UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS.
ST. MARY'S JANESVILLE HOSPITAL	PART V, SECTION B, LINE 4: ST MARY'S JANESVILLE COLLABORATED WITH THREE HOSPITAL ORGANIZATIONS TO FACILITATE THE CHNA PROCESS. THE THREE HOSPITAL ORGANIZATIONS WERE BELOIT MEMORIAL HOSPITAL, EDGERTON HOSPITAL, AND MERCY HEALTH SYSTEM.
ST. MARY'S HOSPITAL	PART V, SECTION B, LINE 7: PRIOR TO THE REVIEW OF THE DATA COLLECTED BY THE CHNA PROCESS, A LIST OF CRITERIA WAS DEVELOPED TO AID IN THE SELECTION OF PRIORITY AREAS. DURING THE DATA-REVIEW PROCESS, ATTENTION WAS DIRECTED TO HEALTH ISSUES THAT MET ANY OF THESE CRITERIA. AFTER REVIEW AND CONSIDERATION OF DATA, THE COLLABORATIVE IDENTIFIED SIX HEALTH ISSUES THAT SHOWED EVIDENCE OF NEED IN THE COMMUNITY. ADDITIONAL INFORMATION CONCERNING THIS PROCESS CAN BE FOUND ON PAGES 9 AND 10 OF THE CHNA. WITH THE TOP SIX COMMUNITY-SPECIFIC HEALTH ISSUES IDENTIFIED, THE COLLABORATIVE EVALUATED EACH ISSUE UTILIZING A PRIORITIZATION PROCESS WHICH INCLUDED INPUT FROM COMMUNITY MEMBERS TO DETERMINE THE TOP COMMUNITY HEALTH NEEDS. THE CHNA-IDENTIFIED HEALTH NEEDS PROCESS CAN BE FOUND ON PAGES 45, 46 AND APPENDIX F OF THE CHNA.
ST. CLARE HOSPITAL	PART V, SECTION B, LINE 7: BASED ON AN ANALYSIS OF THE PRIMARY DATE COLLECTED, THE CHNA IDENTIFIED THE PRIORITY COMMUNITY HEALTH NEEDS OF THE HOSPITAL'S SERVICE AREA. A COMPLETE LIST OF IDENTIFIED NEEDS LISTED BY CATEGORY IN ALPHABETICAL ORDER CAN BE FOUND ON PAGES 5 AND 6 OF THE CHNA. ST CLARE HOSPITAL THEN APPLIED A RANKING METHODOLOGY TO HELP PRIORITIZE THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE ASSESSMENT. ADDITIONAL INFORMATION ON THE PRIORITIZATION PROCESS AND CRITERIA CAN BE FOUND ON PAGES A-2 AND A-3 OF THE CHNA.
ST. MARY'S JANESVILLE HOSPITAL	PART V, SECTION B, LINE 7: BASED ON AN ANALYSIS OF THE PRIMARY DATA COLLECTED, THE CHNA IDENTIFIED THE PRIORITY COMMUNITY HEALTH NEEDS OF THE HOSPITAL'S SERVICE AREA. A COMPLETE LIST OF IDENTIFIED NEEDS LISTED BY CATEGORY IN ALPHABETICAL ORDER CAN BE FOUND ON PAGES 5 AND 6 OF THE CHNA. ST MARY'S JANESVILLE HOSPITAL THEN APPLIED A RANKING METHODOLOGY TO HELP PRIORITIZE THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE ASSESSMENT. ADDITIONAL INFORMATION ON THE PRIORITIZATION PROCESS AND CRITERIA CAN BE FOUND ON PAGES A-2 AND A-3 OF THE CHNA.

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
SSM HEALTH CARE OF WISCONSIN INC

Employer identification number
43-0688874

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) ALZHEIMERS & DEMENTIA ALLIANCE OF WISCONSIN 517 N SEGOE RD 301 MADISON,WI53705	43-1237069	501(C)(3)	8,350	GENERAL SUPPORT
(2) BETHLEHEM LUTHERAN CHURCH W 8267 HWY 33 PORTAGE,WI53901	39-1045809	501(C)(3)	8,000	PARISH NURSE GRANT
(3) BOYS AND GIRLS CLUB OF DANE COUNTY 2001 TAFT ST MADISON,WI53713	39-1925617	501(C)(3)	8,000	SPECIAL EVENT SPONSORSHIPS
(4) DEAN FOUNDATION 2711 ALLEN BLVD MIDDLETON,WI53562	39-1546086	501(C)(3)	49,235	GENERAL SUPPORT
(5) MARCH OF DIMES 5100 N BROOKLINE OKLAHOMA CITY,OK73112	13-1846366	501(C)(3)	21,500	SPONSORSHIP
(6) MADISON COMMUNITY HEALTH CENTER 3434 E WASHINGTON AVENUE MADISON,WI53704	13-1846366	501(C)(3)	10,000	COMMUNITY SERVICE SUPPORT
(7) SAFE COMMUNITY COALITION OF MADISON & DANE COUNTY PO BOX 6652 MADISON,WI53716	39-1655790	501(C)(3)	15,000	GENERAL SUPPORT
(8) ST JOSEPH CATHOLIC PARISH 300 2ND ST BARABOO,WI53916	39-0810558	501(C)(3)	8,000	PARISH NURSE GRANT
(9) UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION 1685 HIGHLAND AVE MADISON,WI53705	39-1824445	501(C)(3)	9,000	SPONSORSHIP
(10) URBAN LEAGUE OF GREATER MADISON INC 2222 S PARK ST MADISON,WI53713	39-1098146	501(C)(3)	8,750	GENERAL SUPPORT
(11) WISCONSIN WOMENS HEALTH FOUNDATION 2503 TODD DRIVE MADISON,WI53713	39-1900678	501(C)(3)	17,500	NEWSLETTER SPONSORSHIP
(12) ST ANTHONY HOSPITAL FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132	73-6104300	501(C)(3)	11,575	GENERAL SUPPORT
(13) BOYS AND GIRLS CLUB OF WEST CENTRAL WISCONSIN 105 W MILWAUKEE ST TOMAH,WI54660	39-1962065	501(C)(3)	5,285	GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2013

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

THE PROCEDURES USED TO MONITOR THE USE OF GRANT FUNDING VARIES BASED ON THE GRANT RECIPIENT. GRANTS TO RELATED ENTITIES ARE MONITORED DIRECTLY BY THE ORGANIZATION WHEREBY THE RECIPIENT REPORTS ON THE SPECIFIC USE OF THE FUNDING. FOR GRANTS TO UNRELATED ENTITIES, THE ORGANIZATION UTILIZES THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) TO TRACK, STORE, AND REPORT A WIDE RANGE OF INFORMATION RELATED TO GRANTS AND OVERALL COMMUNITY IMPACT.

Schedule I (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)GAUROV DAYAL MDDIRECTOR AND PRESIDENT	(i) (ii)	0 749,382	0 0	0 25,971	0 96,224	0 28,042	0 899,619	0 0
(2)STEVEN BARNEYPT YR DIRECTOR AND PRES	(i) (ii)	0 354,279	0 0	0 238,164	0 -236,820	0 12,867	0 368,490	0 0
(3)WILLIAM THOMPSONDIRECTOR AND VICE CHAIR	(i) (ii)	0 1,404,608	0 0	0 1,016,464	0 811,381	0 30,589	0 3,263,042	0 59,150
(4)KRIS ZIMMERTREASURER	(i) (ii)	0 763,126	0 0	0 73,127	0 40,169	0 27,839	0 904,261	0 45,360
(5)JUNE PICKETTSECRETARY	(i) (ii)	0 226,100	0 0	0 29,954	0 -119,886	0 23,014	0 159,182	0 8,680
(6)CHARLES JOHNSONPT YR REG VP FINANCE	(i) (ii)	470,812 0	0 0	68,939 0	16,076 0	23,557 0	579,384 0	15,400 0
(7)STEVEN CALDWELLSENIOR VICE PRES AND CFO	(i) (ii)	0 447,765	0 0	0 349,642	0 11,475	0 13,973	0 822,855	0 0
(8)FRANK BYRNE MDHOSPITAL PRESIDENT	(i) (ii)	0 522,629	0 0	0 78,429	0 41,956	0 33,708	0 676,722	0 35,210
(9)SANDRA ANDERSONHOSPITAL PRESIDENT	(i) (ii)	0 333,498	0 0	0 56,006	0 32,492	0 17,664	0 439,660	0 21,000
(10)KERRY SWANSONHOSPITAL PRESIDENT	(i) (ii)	0 281,751	0 0	0 47,745	0 34,025	0 29,515	0 393,036	0 19,250
(11)JOAN BEGLINGERVP PAITIENT SERVICES	(i) (ii)	12,470 0	0 0	297,626 0	-3,078 0	18,852 0	325,870 0	9,224 0
(12)LINDA STATZREG VP HUMAN RESOURCES	(i) (ii)	285,468 0	0 0	21,527 0	16,245 0	28,735 0	351,975 0	9,960 0
(13)TODD BURCHILLSYSTEM VP, STRATEGY	(i) (ii)	260,401 0	0 0	7,328 0	11,600 0	13,812 0	293,141 0	0 0
(14)GREG BURNETTREG VP MEDICAL AFFAIRS	(i) (ii)	321,010 0	0 0	9,261 0	15,000 0	12,147 0	357,418 0	0 0
(15)KRISTIN MCMANMONEXECUTIVE VP/COO	(i) (ii)	312,362 0	0 0	10,327 0	27,258 0	24,482 0	374,429 0	0 0
(16)JEFF WELCHPHYSICIAN	(i) (ii)	333,642 0	0 0	0 0	-19,863 0	6,612 0	320,391 0	0 0
(17)SHAHIN SHAHNIAPHYSICIAN	(i) (ii)	277,935 0	0 0	0 0	3,179 0	0 0	281,114 0	0 0
(18)KANSAS DUBRAYPHYSICIAN	(i) (ii)	227,111 0	0 0	18,948 0	-4,320 0	28,323 0	270,062 0	0 0
(19)RICHARD STOUGHTONPROJECT MGMT DIRECTOR	(i) (ii)	213,329 0	0 0	10,459 0	763 0	10,264 0	234,815 0	0 0
(20)JOHN STAPELMANCRNA SUPERVISOR	(i) (ii)	206,285 0	0 0	15,298 0	8,216 0	30,300 0	260,099 0	0 0
(21)WILLIAM SCHOENHARDFORMER OFFICER	(i) (ii)	0 0	0 0	0 274,359	0 -296,128	0 18,492	0 -3,277	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINES 4A-B

PART I, LINE 1A THE FOLLOWING INDIVIDUALS LISTED ON PART VII SECTION A RECEIVED A TAX INDEMNIFICATION/GROSS UP PAYMENT IN 2013. THESE PAYMENTS WERE INCLUDED IN THEIR TAXABLE COMPENSATION. LINDA STATZ KRISTIN MCMANMON PART I, LINE 4A: SEVERANCE PLAN: SSMHC 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 SSMHC. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS UNDER THIS PLAN. WILLIAM SCHOENHARD $274,359 JOAN BEGLINGER $239,629 PART I, LINE 4B: SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS PENSION RESTORATION PLAN: SSM HEALTH CARE (SSMHC) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMHC 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 SSMHC'S 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 SSMHC OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMHC. NO REPORTABLE INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN DURING 2013. CAPITAL ACCUMULATION PLAN: SSMHC 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 SSMHC 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 2008 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF TWO 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 DISTRIBUTIONS FROM THIS PLAN IN 2013. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUALS' TAXABLE COMPENSATION. STEVEN BARNEY $148,902 WILLIAM THOMPSON $59,209 KRIS ZIMMER $45,405 FRANK BYRNE $43,031 JOAN BEGLINGER $20,611 KERRY SWANSON $19,269 JUNE PICKETT $19,086 CHARLES JOHNSON $15,426 LINDA STATZ $9,970

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Return Reference	Explanation
FORM 990, PART I, DOING BUSINESS AS:	SSM HEALTH CARE OF WISCONSIN, INC. CURRENTLY CONDUCTS BUSINESS UNDER THE FOLLOWING REGISTERED NAMES: GOLDEN CARE LAKE DELTON CLINIC MEADOW LANE ST. CLARE CENTER - JEFFERSON STREET ST. CLARE HOSPITAL ST. CLARE HOSPITAL AND HEALTH SERVICES, 39-1023846 ST. CLARE MEADOWS CARE CENTER, 39-1023846 ST. CLARE URGENT CARE AT LAKE DELTON ST. CLARE URGENT CARE AT WISCONSIN DELLS ST. MARY'S CARE CENTER, 39-0806393 ST. MARY'S HOSPITAL, 39-0806393 ST. MARY'S HOSPITAL MEDICAL CENTER ST. MARY'S JANESVILLE HOSPITAL
FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	SSM HEALTH CARE OF WISCONSIN OPERATES THREE HEALTH CENTERS AND TWO SKILLED NURSING FACILITIES THAT ARE LOCATED IN MADISON, BARABOO AND JANESVILLE WISCONSIN.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:	THE COMMUNITY BENEFIT CONTRIBUTION OF SSM HEALTH CARE OF WISCONSIN, INC. INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. BRIEFLY DESCRIBE THE CORPORATION'S MISSION: SINCE IT WAS FOUNDED IN 1872 BY CATHOLIC SISTERS, SSM HEALTH CARE (SSMHC) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. AS OF NOVEMBER 15, 2013, WITH VATICAN APPROVAL, THE FRANCISCAN SISTERS OF MARY TRANSITIONED SPONSORSHIP OF SSMHC TO SSM HEALTH MINISTRIES. SSM HEALTH MINISTRIES IS AN INDEPENDENT 6-MEMBER BODY COMPRISED OF THREE FRANCISCAN SISTERS OF MARY AND THREE LAY PEOPLE WHO COLLECTIVELY HOLD CERTAIN RESERVED POWERS OVER SSMHC. HEADQUARTERED IN ST LOUIS, MISSOURI, SSMHC OWNS AND OPERATES 18 ACUTE CARE HOSPITALS, ONE CHILDREN'S HOSPITAL, TWO LONG-TERM CARE FACILITIES, AN EXTENSIVE NETWORK OF PHYSICIAN PRACTICE OPERATIONS, AND OTHER HEALTH CARE BUSINESSES LOCATED PRIMARILY IN MISSOURI, OKLAHOMA, WISCONSIN, AND ILLINOIS. THE HEALTH SYSTEM EMPLOYS APPROXIMATELY 30,000 PEOPLE AND IS AFFILIATED WITH MORE THAN 8,000 PHYSICIANS. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMHC STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL HEALTH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. DESCRIBE THE ORGANIZATION'S APPROACH TO PROVIDING COMMUNITY BENEFIT: A COMMUNITY BENEFIT ACTIVITY IS IDENTIFIED AS A SERVICE RATHER THAN AS A MARKETING TOOL AND MEETS AT LEAST TWO OF THE FOLLOWING CRITERIA: - IT IS FINANCED BY PHILANTHROPIC CONTRIBUTIONS, VOLUNTEER EFFORTS, OR AN ENDOWMENT. - IT PROVIDES A RESPONSE TO A UNIQUE OR PARTICULAR HEALTH PROBLEM IN THE COMMUNITY. - IT GENERATES A LOW OR NEGATIVE MARGIN ON A FULLY ABSORBED COST BASIS. - IT RESPONDS TO THE NEEDS OF SPECIAL POPULATIONS SUCH AS MINORITIES, WOMEN AND CHILDREN, THE FRAIL ELDERLY, LOW INCOME PERSONS WITH DISABILITIES, THE MENTALLY ILL, OR THOSE LIVING WITH CHRONIC ILLNESS. - THE DECISION TO OFFER THE SERVICE OR PROGRAM IS NOT MADE ON A PURELY FINANCIAL BASIS. - IF NOT PROVIDED BY HEALTH CARE ORGANIZATION, THE SERVICE WOULD NO LONGER BE AVAILABLE IN THE COMMUNITY OR WOULD BE THE RESPONSIBILITY OF GOVERNMENT. THE COMMUNITY BENEFIT PLAN DETAILS THE PLANNING, MEASUREMENT AND COMMUNICATION OF ITS COMMUNITY BENEFITS. THE THREE-MAIN ASPECTS OF COMMUNITY BENEFIT BEING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WHICH DETERMINES THE COMMUNITY NEEDS TO BE ADDRESSED BY THE HOSPITAL, THE COMMUNITY BENEFIT PLAN WHICH DETAILS STEPS TO BE ACCOMPLISHED TO MEET IDENTIFIED NEEDS, AND THE CBISA DATABASE WHICH DOCUMENTS ALL OF THE COMMUNITY BENEFIT ACTIVITIES FOR EACH YEAR. AT THE END OF EACH YEAR, THE CBISA COMMUNITY BENEFIT REPORT IS GIVEN TO MANAGEMENT, ADMINISTRATION AND THE SSMHC BOARD OF DIRECTORS IN ORDER TO EVALUATE AND IMPROVE THE PROGRAM. ST. MARY'S HOSPITAL - MADISON, WI: TO ASSESS THE HEALTH NEEDS OF DANE COUNTY, FOUR AREA HOSPITALS (MERITOR HOSPITAL, ST. MARY'S HOSPITAL, STOUGHTON HOSPITAL AND UW HOSPITAL AND CLINICS) JOINED WITH PUBLIC HEALTH MADISON & DANE COUNTY. AFTER A SEARCH FOR A VENDOR PARTNER, THE COLLABORATIVE GROUP, KNOWN AS HEALTHY DANE, SELECTED HEALTH COMMUNITIES INSTITUTE (HCI) TO ASSIST IN GATHERING AND ANALYZING DATA. DETAILS OF THE ST MARY'S HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS CAN BE FOUND ON PAGES 42 THROUGH 46 OF THE CHNA. THE STRATEGIC PRIORITIES OF THE ST MARY'S HOSPITAL COMMUNITY BENEFIT PLAN ARE: DIABETES, STROKE & HYPERTENSION; POOR BIRTH OUTCOMES; AND ASTHMA/COPD. DURING 2013, GOALS AND OBJECTIVES WERE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. ALL OF THE COMMUNITY BENEFIT ACTIVITIES ARE DESIGNED TO MEET THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WHICH WAS COMPLETED IN OCTOBER 2012. ST. CLARE HOSPITAL - BARABOO, WI. ST. CLARE HOSPITAL PARTNERED WITH VERITE HEALTHCARE CONSULTING, LLC, A NATIONAL RESOURCE THAT HELPS HOSPITALS CONDUCT CHNAS, TO COMPLETE A CHNA IN NOVEMBER 2012. INFORMATION CONCERNING THE CHNA METHODOLOGY CAN BE FOUND ON PAGES A-2 AND A-3 OF THE CHNA. BASED ON THE CHNA RESULTS, ST CLARE HOSPITAL IDENTIFIED THE FOLLOWING STRATEGIC PRIORITIES: OBESITY, DENTAL CARE, AND ACCESS TO CARE. DURING 2013, GOALS AND OBJECTIVES WERE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE ST MARY'S JANESVILLE HOSPITAL ST. MARY'S JANESVILLE HOSPITAL ALSO PARTNERED WITH VERITE HEALTHCARE CONSULTING, LLC TO COMPLETE A CHNA IN NOVEMBER 2012. IN ADDITION, ST MARY'S JANESVILLE COLLABORATED WITH THREE HOSPITAL ORGANIZATIONS TO FACILITATE THE CHNA PROCESS. THE THREE HOSPITAL ORGANIZATIONS WERE BELOIT MEMORIAL HOSPITAL, EDGERTON HOSPITAL, AND MERCY HEALTH SYSTEM. INFORMATION CONCERNING THE CHNA METHODOLOGY CAN BE FOUND ON PAGES A-2 AND A-3 OF THE CHNA. BASED ON THE CHNA RESULTS, ST. MARY'S JANESVILLE IDENTIFIED THE FOLLOWING STRATEGIC PRIORITIES: HEALTHY LIFESTYLES, TOBACCO USE, AND ACCESS TO CARE. DURING 2013, GOALS AND OBJECTIVES WERE ESTABLISHED TO CHANGE BEHAVIOR, PROVIDE METRICS TO MEASURE CHANGE, AND TO IMPACT THE OVERALL HEALTH OF THOSE WE SERVE. DESCRIBE THE CORPORATION'S FINANCIAL ASSISTANCE POLICIES OR PROGRAMS (E.G. CHARITY CASE, DISCOUNTING) FOR LOW-INCOME PERSONS AND HOW THEY ARE COMMUNICATED TO THE PUBLIC. ALL SSMHC FACILITIES WILL ENTITY'S CHARITY POLICIES WILL ALSO BE PROVIDED TO PUBLIC AGENCIES. ALL SSMHC FACILITIES WILL STRIVE TO PROVIDE EXCEPTIONAL HEALTH CARE SERVICES TO ALL PERSONS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. ALL BILLING AND COLLECTION POLICIES AND PRACTICES WILL REFLECT THE MISSION AND VALUES OF SSMHC, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. SSMHC FACILITIES OFFER DISCOUNTS FOR HOSPITAL SERVICES TO ALL UNINSURED PERSONS. SELF-PAY DISCOUNTS APPLY TO EVERYONE WHO DOES NOT HAVE HEALTH INSURANCE, NO MATTER THEIR ABILITY TO PAY. SSMHC WILL APPLY ITS CHARITY CARE POLICIES FAIRLY AND CONSISTENTLY. EACH PERSON WILL BE TREATED AS AN INDIVIDUAL WITH SPECIFIC NEEDS FOR ASSISTANCE WITHOUT REGARD TO PAYMENT. SSMHC EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH WE PARTICIPATE BY ESTABLISHING SOUND BUSINESS PRACTICES. CHARITY CARE IS PROVIDED TO PATIENTS BASED ON A SLIDING SCALE FOR HOUSEHOLD INCOMES UP TO FOUR TIMES THE FEDERAL POVERTY LEVEL. PATIENTS WHOSE HOUSEHOLD INCOME IS NO MORE THAN TWO TIMES THE FEDERAL POVERTY LEVEL ARE ELIGIBLE FOR FREE HOSPITAL SERVICES. IN ADDITION, AN EXCEPTION TO THE SLIDING SCALE IS PROVIDED FOR A PATIENT'S BALANCE DUE IF THE AMOUNT EXCEEDS 20% OF THEIR FAMILY GROSS INCOME. EACH ENTITY PROVIDING MEDICAL SERVICES SHALL PROVIDE INFORMATION TO THE PUBLIC REGARDING ITS CHARITY CARE POLICIES AND THE QUALIFICATION REQUIREMENTS FOR EACH OF ITS FACILITIES. WHEN STANDARD SYSTEM NOTICES AND COMMUNICATIONS REGARDING CHARITY CARE ARE AVAILABLE, THESE MUST BE USED. MODIFICATIONS TO THE STANDARD MAY BE MADE TO COMPLY WITH STATE AND LOCAL LAWS, AS WELL AS REFLECT CULTURALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES WILL BE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY WILL PROVIDE INFORMATION ABOUT: - THE PATIENT'S RESPONSIBILITY FOR PAYMENT; - THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND ENTITY CHARITY CARE AND PAYMENT ARRANGEMENTS; - THE ENTITY'S CHARITY POLICY AND APPLICATION PROCESS: AND - WHOM TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELING. THE FOLLOWING TYPES OF NOTICES TO THE PUBLIC SHALL BE PROVIDED: - SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS. - BROCHURES OR FLIERS PROVIDED AT TIME OF REGISTRATION AND AVAILABLE IN THE FINANCIAL COUNSELING AREAS. - NOTICES SENT WITH OR ON PATIENT BILLS OR COMMUNICATIONS SENT TO PATIENTS AND GUARANTORS RELATED TO MEDICAL SERVICES. - APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION. THE APPLICATION FOR CHARITY CARE, TOGETHER WITH ANY INSTRUCTIONS, MUST CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES WILL ALSO BE PROVIDED TO PUBLIC AGENCIES. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION:
SSM HEALTH CARE OF WISCONSIN HOSPITALS:	- OPERATE EMERGENCY ROOMS THAT ARE OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; - HAVE AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA; - HAVE A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY; - ENGAGE IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS; - PARTICIPATE IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. - SSM HEALTH CARE OF WISCONSIN IS DEDICATED TO PROVIDING A HIGH QUALITY PATIENT CARE DELIVERY SYSTEM WHICH INCLUDES THE REINVESTMENT OF SURPLUS FUNDS. AN EXAMPLE OF THIS REINVESTMENT IS THE MULTI-MILLION DOLLAR NEW HOSPITAL IN JANESVILLE, WISCONSIN WHICH OPENED IN 2012. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS: ST. MARY'S HOSPITAL - MADISON, WI: FREE ASTHMA CLINIC: A FREE CLINIC PROVIDING FREE DIAGNOSTIC AND TREATMENT SERVICES TO ASTHMATICS OPERATES IN A STOREFRONT NEAR A LOW INCOME NEIGHBORHOOD. THE CLINIC HAD 599 VISITS IN 2013. THE CLINIC HELPS REDUCE THE NUMBER OF PATIENTS SEEKING HELP IN EMERGENCY DEPARTMENTS. PARISH NURSE PROGRAM: TO IMPROVE ACCESS AND PROVIDE ASSISTANCE IN IDENTIFYING AND FINDING CARE FOR HEALTH CARE ISSUES, THE PARISH NURSE PROGRAM PLACES REGISTERED NURSES IN SITES AROUND MADISON, MOST OF WHICH ARE CHURCHES. EACH YEAR THE PROGRAM REVIEWS HEALTH CARE NEEDS AND SETS GOALS IN SPECIFIC AREAS. THE PROGRAM ACHIEVED AN AVERAGE SATISFACTION RATING OF 5 (ON A 1 - 5 SCALE) ON CLIENT SURVEYS AND INCREASED TO 90% THE NUMBER OF PROGRAM PARTICIPANTS PLANNING TO TAKE ACTION AS RESULT OF PARTICIPATION IN THE PROGRAM. GOLDENCARE: GOLDENCARE IS A FREE PROGRAM OFFERED TO ADULTS AGE 60 AND OLDER. GOLDENCARE IS JOINTLY SPONSORED BY ST CLARE HOSPITAL AND ST. MARY'S HOSPITAL. GOLDENCARE PROVIDES OUR MEMBERS HEALTH PROGRAMS, BLOOD PRESSURE SCREENINGS, EDUCATIONAL PRESENTATIONS AND SOCIAL EVENTS. WE ALSO OFFER AN EMERGENCY RESPONSE TELEPHONE SYSTEM. MEMBERS RECEIVE A VARIETY OF DISCOUNTS; EXAMPLES ARE, MEAL DISCOUNTS AT ST. CLARE HOSPITAL AND ST. MARY'S HOSPITAL CAFETERIAS, AND THE HAIR FORCE BEAUTY SALON LOCATED IN ST. CLARE MEADOWS CARE CENTER. MEMBERS RECEIVE THE GOLDENCARE UPDATE, A NEWSLETTER THAT IS PUBLISHED FOUR TIMES PER YEAR. IT CONTAINS A WEALTH OF HEALTHCARE INFORMATION FOR ADULTS AND IS COMPLETE WITH THE GOLDENCARE CALENDAR OF EVENTS. HANDS ON HEALTH PROGRAM: ST MARY'S HOSPITAL PROVIDES EDUCATIONAL TOURS AND HEALTH PROGRAMS THROUGHOUT THE SCHOOL YEAR TO 2ND GRADE CLASSES IN AND AROUND DANE COUNTY. A TOTAL OF 621 STUDENTS PARTICIPATED IN THE PROGRAM IN 2013. ST MARY'S ADULT DAY HEALTH CENTER: AS THE ONLY DAY-TIME CARE FACILITY FOR ADULTS NEEDING SKILLED NURSING OVERSIGHT, THE ADULT DAY HEALTH CENTER PLAYS A MAJOR ROLE IN MAINTAINING THEIR CLIENTS' INDEPENDENCE AND HAPPINESS. ADOPT A SCHOOL PROGRAM: ST MARY'S HOSPITAL SUPPORTS LINCOLN ELEMENTARY SCHOOL IN ITS ADOPT-A-SCHOOL PARTNERSHIP THROUGH THE FOUNDATION FOR MADISON SCHOOLS. BECAUSE 70% OF STUDENTS AT THE SOUTH MADISON SCHOOL LIVE IN POVERTY, ST MARY'S HOSPITAL OFFERS HELP THAT IMPROVES THEIR CHANCES FOR SUCCESS. HEALTH RESOURCE CENTER: THE HEALTH RESOURCE CENTER IS OPEN TO ALL COMMUNITY MEMBERS, PATIENTS AND FAMILY MEMBERS. LIBRARIANS ARE AVAILABLE TO HELP CONSUMERS FIND HEALTH INFORMATION ON A VARIETY OF TOPICS. BOOKS AND OTHER MATERIALS ARE AVAILABLE FOR CHECKOUT. COMPUTERS AND A PRINTER/SCANNER/FAX MACHINE ARE PROVIDED AT NO CHARGE. IN 2013, THE MEDICAL LIBRARY PROVIDED 685 ARTICLES AND 20 SEARCH SERVICES TO FAMILY MEDICINE RESIDENTS AND FACULTY. IN ADDITION, THE LIBRARY PROVIDED 1,866 ARTICLES FROM OUR JOURNAL COLLECTION TO OTHER HOSPITAL LIBRARIES. EDUCATIONAL EVENTS: ST MARY'S HOSPITAL PROVIDES NUMEROUS EDUCATIONAL CLASSES TO THE COMMUNITY ON RELEVANT HEALTH TOPICS INCLUDING: WOMEN'S HEALTH, COMMUNITY SPIRITUAL CARE, HANDS ON HEARTS COCPR TRAINING, DIABETES, AND HEALTH LITERACY. ST MARY'S HOSPITAL ALSO PROVIDES HEALTH INFORMATION THROUGH THE NEIGHBORS AND COMMUNITY CONNECTIONS NEWSLETTERS. ST. CLARE HOSPITAL - BARABOO, WI: ST. CLARE HOSPITAL IS A MAJOR SPONSOR OF FARM SAFETY DAYS, WHICH TEACHES CHILDREN AND YOUNG ADULTS HOW TO BE SAFE ON THE FARM. SINCE 2000, THE HOSPITAL HAS ALSO PARTNERED WITH THE ST. CLARE FOUNDATION IN THE DEVELOPMENT OF HEALTHY COMMUNITIES PROGRAMS AND HAS SPONSORED OTHER ORGANIZATIONS' ACTIVITIES AS A WAY TO GIVE BACK TO THE COMMUNITY. THE ST. CLARE HEALTH CARE FOUNDATION, THROUGH ITS PATHWAYS TO WELLNESS INITIATIVE, HAS DEVELOPED AND SPONSORED HEALTH AND WELLNESS PROGRAMS AND ACTIVITIES AS A WAY TO GIVE BACK TO THE COMMUNITY. GOLDENCARE IS PROVIDED FOR THROUGH ST. CLARE HOSPITAL AND IS A FREE PROGRAM OFFERED TO ADULTS AGE 60 AND OLDER. GOLDENCARE IS JOINTLY SPONSORED BY ST CLARE HOSPITAL AND ST. MARY'S HOSPITAL. GOLDENCARE PROVIDES MEMBERS WITH HEALTH PROGRAMS, BLOOD PRESSURE SCREENINGS, EDUCATIONAL PRESENTATIONS AND SOCIAL EVENTS. MEMBERS ARE ALSO OFFERED AN EMERGENCY RESPONSE TELEPHONE SYSTEM AND A VARIETY OF DISCOUNTS INCLUDING, BUT NOT LIMITED TO, MEAL DISCOUNTS AT ST. CLARE HOSPITAL'S CAFETERIA AND THE HAIR FORCE BEAUTY SALON LOCATED IN ST. CLARE MEADOWS CARE CENTER. MEMBERS RECEIVE THE GOLDENCARE UPDATE, A NEWSLETTER THAT IS PUBLISHED FOUR TIMES PER YEAR. IT CONTAINS A WEALTH OF HEALTHCARE INFORMATION FOR ADULTS AND IS COMPLETE WITH THE GOLDENCARE CALENDAR OF EVENTS. ST CLARE HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY EDUCATIONAL EVENTS TO IMPROVE THE HEALTH OF THE COMMUNITY. IN ADDITION, THE HOSPITAL PROVIDES WEEKLY RADIO SHOW UPDATES PROVIDING INFORMATION TO EDUCATE AND INFORM THE PUBLIC ON COMMUNITY HEALTH NEEDS AND ISSUES. THE PARISH NURSE PROGRAM IS VITAL WITHIN THE ST. CLARE HOSPITAL SERVICE AREA AND IMPROVES ACCESS AND PROVIDES ASSISTANCE IN IDENTIFYING AND FINDING CARE FOR HEALTH CARE ISSUES. THE PARISH NURSE PROGRAM WORKS WITH NURSES AROUND THE AREA, BUT SPECIFICALLY WITHIN FAITH-BASED ORGANIZATIONS LIKE CHURCHES. ST MARY'S JANESVILLE HOSPITAL - JANESVILLE, WI ST MARY'S JANESVILLE HAS DEVELOPED THE FIT FAMILIES ROCK (FFR) PROGRAM. THE PROGRAM IS A COMPREHENSIVE PROGRAM THAT HELPS FAMILIES LOSE WEIGHT AND GET FIT TOGETHER. FFR WORKS WITH FAMILIES TO FIND THE BEHAVIORS, NUTRITION HABITS AND ACTIVITIES THAT WILL WORK BEST FOR THEM OVER A LIFETIME. THE PROGRAM WAS DEVELOPED FOR FAMILIES WITH ONE CHILD BETWEEN THE AGES OF 8 AND 12 WHO IS AT OR ABOVE THE 85 PERCENTILE OF THEIR BMI. ONE PARENT MUST ATTEND EACH SESSION WITH THEIR CHILD AND SIBLINGS ARE WELCOME TO ATTEND. ST MARY'S JANESVILLE HAS JOINED WITH THE UW-EXTENSION OF ROCK COUNTY TO OFFER THE STRONGWOMEN PROGRAM, A 12-WEEK EVIDENCE-BASED STRENGTH TRAINING PROGRAM DESIGNED FOR OLDER WOMEN DEVELOPED BY TUFTS UNIVERSITY. THE PROGRAM IS BASED ON YEARS OF RESEARCH ON HOW STRENGTH TRAINING IMPROVES BONE DENSITY, REDUCES FALLS, IMPROVES ARTHRITIS SYMPTOMS, INCREASES STRENGTH AND IMPROVES FLEXIBILITY. DURING 2013, ST MARY'S JANESVILLE PARTICIPATED IN VARIOUS COMMUNITY EVENTS PROVIDING EDUCATIONAL INFORMATION ON HEALTHY EATING HABITS. THE HOSPITAL HELD AN ANNUAL PRODUCE POWER EVENT WHERE THE EXECUTIVE CHEF PROVIDED EDUCATIONAL SESSIONS SUCH AS "SENSATIONAL SALADS" AND "RATATOUILLE ROCKS." TO ADDRESS THE ISSUE OF FALLING AS THE LEADING CAUSE OF ACCIDENTAL DEATH AMONG WISCONSINITES 65 OR OLDER, THE HOSPITAL HAD AN EMPLOYEE TRAINED TO BECOME A STEPPING ON INSTRUCTOR AND HAS DEVELOPED A COMMUNITY-BASED FALL PREVENTION INITIATIVE WITH SUPPORT FROM DEAN CLINIC AND COMMUNITY EXPERTS THAT WILL BE IMPLEMENTED IN 2014. ST MARY'S JANESVILLE PREPARES A QUARTERLY NEWSLETTER THAT IS EMAILED TO SUBSCRIBERS. THE NEWSLETTER PROVIDES HEALTH INFORMATION AS WELL AS INFORMATION ON COMMUNITY HEALTH EDUCATION ACTIVITIES AT THE HOSPITAL. THE HOSPITAL ALSO PROVIDES A WEEKLY RADIO PROGRAM, STAY HEALTHY ROCK COUNTY, TO PROVIDE HEALTH INFORMATION TO MASS AUDIENCES ON STAYING WELL AND ILLNESS/INJURY PREVENTION. ST MARY'S JANESVILLE HAS A NEW COLLABORATION WITH THE YMCA OF NORTHERN ROCK COUNTY AND MERCY HEALTH SYSTEM TO OFFER A HEALTH AND WELLNESS EDUCATION SERIES FREE TO SURROUNDING COMMUNITIES. CLASSES WILL BE HELD MONTHLY AND TOPICS WILL RANGE FROM HEALTHY EATING HABITS, THE BENEFITS OF VITAMINS AND SUPPLEMENTS, TO EXERCISE REGIMENTS FOR ACTIVE OLDER ADULTS. RESIDENTS OF ROCK COUNTY EXHIBIT HIGH RATES OF SMOKING AND TOBACCO USE COMPARED TO THE HEALTHY PEOPLE 2020 GOAL, THE WISCONSIN AVERAGE, AND WHEN COMPARED TO OTHER WISCONSIN COUNTIES. THE HOSPITAL WILL INITIATE THE FIRST BREATH SMOKING CESSATION PROGRAM FOR PREGNANT MOTHERS WHO RECEIVE THEIR PRENATAL CARE AT DEAN CLINIC AND IMPLEMENT A CHRONIC LUNG DISEASE SUPPORT GROUP FOR COPD/CHF PATIENTS AND THEIR FAMILIES.
QUANTIFIABLE COMMUNITY BENEFIT	THE FOLLOWING IS A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE INCLUDED AS COMMUNITY BENEFIT ACTIVITIES. TRADITIONAL CHARITY CARE $ 12,490,134 UNPAID COST OF MEDICAID $ 28,348,771 UNPAID COST OF MEDICARE $ 39,571,773 COST OF BAD DEBTS $ 8,668,832 COMMUNITY BENEFIT PROGRAMS $ 12,341,297 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $101,420,807
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE CORPORATE MEMBER OF THE CORPORATION IS SSM HEALTH CARE CORPORATION. SSM HEALTH CARE CORPORATION IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH SSM HEALTH CARE OF WISCONSIN, INC AND SSM HEALTH CARE CORPORATION ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH CARE.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBER AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION B. TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS C. TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION E. TO APPROVE THE AMENDMENTS TO THE CERTIFICATE OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS, TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS, AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OF THE MEMBER OR TO ANY ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY THE MEMBER OF THE MEMBER, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF THE MEMBER OF THE MEMBER AS DETERMINED BY THE MEMBER OF THE MEMBER Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER OF THE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE MEMBER WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY.
FORM 990, PART VI, SECTION B, LINE 11	ACCOUNTING/FINANCE PERSONNEL AT EACH SSMHC (SSM HEALTH CARE SYSTEM) ENTITY, IN CONJUNCTION WITH SYSTEM FINANCE PERSONNEL, PREPARE A CHECKLIST CONTAINING INFORMATION AND SUPPORTING SCHEDULES THAT ARE USED TO PREPARE THE FORM 990. THIS CHECKLIST IS THEN REVIEWED BY A SUPERVISOR/MANAGER AND SENT TO THE SYSTEM OFFICE FOR FINAL REVIEW AND COORDINATION OF THE SYSTEM LEVEL FORM 990 INFORMATION. THE INFORMATION IS SUBMITTED TO AN OUTSIDE TAX CONSULTING FIRM WHO PREPARES AND SIGNS THE FORM 990 FROM THE SSMHC INFORMATION. PRIOR TO FINALIZING THE RETURN, A DRAFT IS SENT TO PERSONNEL AT SSMHC FOR REVIEW AND APPROVAL. UPON SSMHC APPROVAL, THE OUTSIDE PREPARER FORWARDS THE COMPLETED FORM 990 FOR THE APPROPRIATE SIGNATURES AND FILING ACTION. A COMPLETE COPY OF THE RETURN IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THE PRESIDENT AND SECRETARY TO THE BOARD OVERSEE COMPLIANCE WITH THIS REQUIREMENT. ALL BOARD MEMBERS WITH AN IDENTIFIED CONFLICT OF INTEREST ABSTAIN FROM BOARD DISCUSSIONS AND VOTES WHEN APPLICABLE. EMPLOYEES WITH PURCHASING AUTHORITY AND/OR ABILITY TO INFLUENCE PURCHASING DECISIONS ARE ASSIGNED THE CONFLICT OF INTEREST DISCLOSURE COURSE (COI) WHICH MUST BE COMPLETED ON LINE. PERIODICALLY THROUGH THE YEAR, THE ENTITY'S CORPORATE RESPONSIBILITY CONTACT PERSON (WITH THE HELP OF THE ENTITY'S LEARNING MANAGEMENT SYSTEM COORDINATOR) SENDS DEPARTMENT MANAGERS A LIST OF EMPLOYEES WHO HAVE NOT YET COMPLETED THEIR COI SO THEY CAN REMIND THE EMPLOYEES AND ENSURE THE EMPLOYEES HAVE TIME IN THEIR SCHEDULE TO COMPLETE THE REQUIRED COURSE. RESOLUTION OF ANY CONFLICTS THAT ARE DISCLOSED MUST BE DOCUMENTED AND KEPT ON FILE AT THE ENTITY. SUPERVISORS VERIFY REQUIRED COURSE COMPLETION PRIOR TO YEAR END.
FORM 990, PART VI, SECTION C, LINE 19	THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENT FOR THE SSM HEALTH CARE SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH CARE'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:	BENEFICIAL INTEREST IN FOUNDATION 3,064,427. TRANSFERS TO AFFILIATES -58,350,087.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

SSM HEALTH CARE OF WISCONSIN INC

Employer identification number

43-0688874

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) SSM HEALTH CARE CORPORATION 10101 WOODFIELD LANE ST LOUIS,MO63132 46-6029223	HEALTH CARE	MO	501(C)(3)	LINE 11A, I	FRANCISCAN SISTERS OF MARY		No
(2) SSMHC LIABILITY TRUST I 10101 WOODFIELD LANE ST LOUIS,MO63132 43-6331003	INSURANCE	MO	501(C)(3)	LINE 11A, I	SSM HEALTH CARE CORPORATION		No
(3) SSM CONSOLIDATED HEALTH SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1473657	HEALTH CARE	MO	501(C)(3)	LINE 11A, I	SSM HEALTH CARE CORPORATION		No
(4) SSM POLICY INSTITUTE 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1788151	HEALTH CARE	MO	501(C)(4)		SSM HEALTH CARE CORPORATION		No
(5) SSM HEALTH CARE PORTFOLIO MANAGEMENT CO 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1825256	MANAGEMENT	MO	501(C)(3)	LINE 11A, I	SSM HEALTH CARE CORPORATION		No
(6) SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0738490	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS		No
(7) CARDINAL GLENNON CHILDREN'S FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1754347	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM CARDINAL GLENNON CHILDREN'S HOSPITAL		No
(8) SSM DEPAUL HEALTH CENTER FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1776109	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(9) SSM ST JOSEPH FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1591556	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(10) SSM ST CLARE HEALTH CENTER FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1273310	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(11) SSM ST MARY'S HEALTH CENTER FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1552945	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(12) SSM HEALTH CARE OF OKLAHOMA INC 10101 WOODFIELD LANE ST LOUIS,MO63132 73-0657693	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(13) ST ANTHONY HOSPITAL FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 73-6104300	FUNDRAISING	OK	501(C)(3)	LINE 7	SSM HEALTH CARE OF OKLAHOMA		No
(14) DELLS MEDICAL BUILDING INC 10101 WOODFIELD LANE ST LOUIS,MO63132 39-1613292	MOB	WI	501(C)(2)		SSM HEALTH CARE OF WISCONSIN	Yes
(15) ST MARY'S FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1940686	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(16) ST CLARE HEALTH CARE FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1940683	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(17) HOME HEALTH UNITED INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1539827	HEALTH CARE	WI	501(C)(3)	LINE 9	SSM HEALTH CARE OF WISCONSIN	Yes
(18) HOME CARE UNITED INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1776340	HEALTH CARE	WI	501(C)(3)	LINE 9	SSM HEALTH CARE OF WISCONSIN	Yes
(19) HHU XTRA CARE INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1705111	HEALTH CARE	WI	501(C)(3)	LINE 9	SSM HEALTH CARE OF WISCONSIN	Yes
(20) HOME HEALTH UNITED - VNS FOUNDATION INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1839309	FUNDRAISING	WI	501(C)(3)	LINE 11B, II	N/A		No
(21) SSM REGIONAL HEALTH SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 44-0579850	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(22) ST FRANCIS HOSPITAL FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1099253	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM REGIONAL HEALTH SERVICES		No
(23) ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1575307	FUNDRAISING	MO	501(C)(3)	LINE 11B, II	N/A		No
(24) GOOD SAMARITAN REGIONAL HEALTH CENTER 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0653587	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES		No
(25) ST MARY'S HOSPITAL CENTRALIA ILLINOIS 10101 WOODFIELD LANE ST LOUIS,MO63132 37-0662580	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES		No
(26) ST MARY'S - GOOD SAMARITAN INC 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4170833	HEALTH CARE	IL	501(C)(3)	LINE 11A, I	SSM REGIONAL HEALTH SERVICES		No
(27) GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 26-2884795	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S-GOOD SAMARITAN INC		No
(28) ST MARY'S HOSPITAL FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4636691	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S-GOOD SAMARITAN INC		No
(29) ST MARY'S HOSPITAL AUXILIARY 400 N PLEASANT CENTRALIA,IL62801 23-7126345	FUNDRAISING	IL	501(C)(3)	LINE 9	ST MARY'S HOSPITAL FOUNDATION		No
(30) SSM HEALTH BUSINESSES 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1333488	HEALTH CARE	MO	501(C)(3)	LINE 9	SSM HEALTH CARE CORPORATION		No
(31) SSM HEALTH CARE ST LOUIS 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1343281	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(32) CENTRALIA MEDICAL SERVICES BLDG ASSOC 10101 WOODFIELD LANE ST LOUIS,MO63132 23-7408025	MOB	IL	501(C)(3)	LINE 11B, II	N/A		No
(33) ST MARY'S JANESVILLE FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-3439133	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(34) FRANCISCAN SISTERS OF MARY 3221 MCKELVEY ROAD SUITE 107 BRIDGETON,MO63044 43-1012492	RELIGIOUS ORGANIZATION	MO	501(C)(3)	LINE 1	N/A		No
(35) LEE DEWEY CORPORATION 10101 WOODFIELD LANE ST LOUIS,MO63132 73-1279603	MOB	OK	501(C)(3)	LINE 11A, I	SSM HEALTH CARE OF OKLAHOMA		No
(36) SSM HOSPICE & HOME CARE FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 30-0012246	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH BUSINESSES		No
(37) ST MARY'S HOSPITAL AUXILIARY 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 43-6049878	FUNDRAISING	MO	501(C)(3)	LINE 11B, II	N/A		No
(38) GOOD SAMARITAN HOSPITAL AUXILIARY 1 GOOD SAMARITAN WAY MOUNT VERNON,IL62864 23-7049599	FUNDRAISING	IL	501(C)(3)	LINE 11C, III-FI	N/A		No
(39) ST ANTHONY SHAWNEE HOSPITAL INC 10101 WOODFIELD LANE ST LOUIS,MO63132 45-5055149	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE OF OKLAHOMA		No
(40) SSM AUDRAIN HEALTH CARE INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1550298	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES		No
(41) AUDRAIN MEDICAL CENTER FOUNDATION INC 620 E MONROE ST MEXICO,MO65265 43-1265060	FUNDRAISING	MO	501(C)(3)	LINE 11A, I	SSM AUDRAIN HEALTH CARE INC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SSM ST JOSEPH ENDOSCOPY CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-0046559	SURGERY SERVICES	MO	N/A
(2) ST CLARE IMAGING SERVICES 707 14TH STREET SUITE A BARABOO,WI53913 20-0122365	DIAG. SERVICES	WI	SSM HEALTH CARE OF WISCONSIN	RELATED	465,972	1,210,334		No			No	50.000 %
(3) MT VERNON RADIATION THERAPY CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-1382620	RADIATION THERAPY	IL	N/A
(4) SLEEP & NEUROLOGY CENTER CENTER OF S ILLINOIS LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-8468195	DIAG. SERVICES	IL	N/A
(5) SMHC SURGICAL CO-MGMT COMPANY LLC 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 20-8929305	MANAGEMENT	MO	N/A
(6) SMHC CARDIOVASCULAR CO-MGMT COMPANY LLC 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 20-8929381	MANAGEMENT	MO	N/A
(7) SMHC MUSCULOSKELETAL CO-MGMT COMPANY LLC 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 20-8929237	MANAGEMENT	MO	N/A
(8) CHOWSMGSI OFFICE BUILDING LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 37-1383861	MOB	IL	N/A
(9) CENTER FOR COMPREHENSIVE CANCER CARE LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-1382727	MOB	IL	N/A
(10) SHAWNEE REAL ESTATE HOLDINGS LLC 1000 N LEE AVE OKLAHOMA CITY,OK73102 45-5458304	MOB	OK	N/A
(11) SSM RX EXPRESS LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-4031708	PHARMACY	MO	N/A
(12) DEAN CLINIC & ST MARY'S HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 45-2995500	MEDICAL SERVICES	WI	SSM HEALTH CARE OF WISCONSIN	RELATED				No			No	50.000 %
(13) WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-2016715	INFORMATION TECHNOLOGY SERVICES	WI	SSM HEALTH CARE OF WISCONSIN	RELATED	-7,307,918	3,420,569		No			No	50.000 %
(14) DEAN HEALTH HOLDINGS LLC 1277 DEMING WAY MADISON,WI53717 26-1594709	SUPPORT SERVICES	WI	SSM HEALTH CARE OF WISCONSIN	RELATED	4,264,701	17,135,193		No			No	50.000 %
(15) WINGRA BUILDING GROUP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-0237060	MOB	WI	N/A
(16) JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-6220698	MOB	WI	N/A
(17) NAVITUS HEALTH SOLUTIONS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 04-3608530	PHARMACY BENEFITS	WI	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) SSM MANAGED CARE ORGANIZATION LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1708511	HEALTH PROMOTION	MO	N/A	C				No
(2) FPP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1465174	HEALTH CARE	MO	N/A	C				No
(3) DIVERSIFIED HEALTH SERVICES CORP 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1369305	MEDICAL EQUIPMENT	MO	N/A	C				No
(4) SSM CARDIO AND THORACIC SERVICES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-0286559	PHYSICIAN OFFICES	MO	N/A	C				No
(5) SSM PROPERTIES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1462486	PROPERTY SERVICES	MO	N/A	C				No
(6) SSM DEPAUL MEDICAL GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1715106	PHYSICIAN OFFICES	MO	N/A	C				No
(7) SSM ST CHARLES CLINIC MED GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0626408	PHYSICIAN OFFICES	MO	N/A	C				No
(8) HEALTH FIRST PHYS MANAGEMENT SERVICES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 73-1534336	MEDICAL SERVICES	OK	N/A	C				No
(9) SSMHCS LIABILITY TRUST II 10101 WOODFIELD LANE ST LOUIS,MO63132 81-6128118	INSURANCE	MO	N/A	C				No
(10) SSM NEUROSCIENCES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-3413981	PHYSICIAN OFFICES	MO	N/A	C				No
(11) SSM MEDICAL GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1664107	PHYSICIAN OFFICES	MO	N/A	C				No
(12) SSMHC INSURANCE COMPANY 10101 WOODFIELD LANE ST LOUIS,MO63132 03-0310431	INSURANCE	CA	N/A	C				No
(13) SSM ORTHOPEDIC INC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-1557033	PHYSICIAN OFFICES	MO	N/A	C				No
(14) SSM CANCER CARE INC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-1557324	PHYSICIAN OFFICES	MO	N/A	C				No
(15) PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4161526	PHYSICIAN OFFICES	IL	N/A	C				No
(16) DEAN HEALTH SYSTEMS INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1128616	PHYSICIAN OFFICES	WI	N/A	C				No
(17) DEAN HEALTH INSURANCE INC PO BOX 56099 MADISON,WI53705 39-1830837	INSURANCE	WI	N/A	C				No
(18) DEAN HEALTH PLAN INC PO BOX 56099 MADISON,WI53705 39-1535024	INSURANCE	WI	N/A	C				No
(19) ST MARY'S DEAN VENTURES INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1628491	PHYSICIAN OFFICES	WI	N/A	C				No
(20) DEAN RETAIL SERVICES INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1717636	PROPERTY MANAGEMENT	WI	N/A	C				No
(21) TEN TWENTY FIVE REGENT STREET 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1089309	MOB	WI	N/A	C				No
(22) DEAN SOLUTIONS INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1876092	MANAGEMENT	WI	N/A	C				No
(23) DEANCARE INSURANCE AGENCY INC PO BOX 56099 MADISON,WI53705 39-1637828	INSURANCE	WI	N/A	C				No
(24) NAVITUS HOLDINGS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 80-0968174	PHARMACY BENEFITS	WI	N/A	C				No

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST MARY'S FOUNDATION INC	C	921,020	CASH
(2) ST CLARE HEALTH CENTER FOUNDATION	C	200,943	CASH
(3) DELLS MEDICAL BUILDING INC	A	37,244	CASH
(4) DELLS MEDICAL BUILDING INC	R	850,000	CASH

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: OPERATES THREE HEALTH CENTERS AND TWO SKILLED NURSING FACILITIES IN WISCONSIN.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	4,769
6	Total number of volunteers (estimate if necessary) .............	6	786
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	17,095,905
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,448,449	1,315,931
9	Program service revenue (Part VIII, line 2g) .........	537,659,109	552,618,171
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	11,722,132	17,512,826
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	19,554,502	16,831,060
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	571,384,192	588,277,988
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	334,744	420,854
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	275,671,957	272,070,753
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 625,595
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	254,724,824	260,466,543
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	530,731,525	532,958,150
19	Revenue less expenses. Subtract line 18 from line 12.......	40,652,667	55,319,838
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	861,071,070	886,013,239
21	Total liabilities (Part X, line 26).............	326,473,150	330,740,971
22	Net assets or fund balances. Subtract line 21 from line 20.....	534,597,920	555,272,268

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 466,934,395 including grants of $ 420,854 ) (Revenue $ 550,856,907 )
	PLEASE SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses466,934,395

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,659,676	7,272,999	981,693

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c		8,452
d	Related organizations...1d		1,149,863
e	Government grants (contributions)1e		157,616

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$		17,319
h	Total. Add lines 1a-1f.......			1,315,931
			Business Code
2a	NET PATIENT REVENUE		621110	547,703,562	547,703,562
b	OTHER OPERATING REVENUE		621110	4,914,609	4,914,609
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			552,618,171
3	Investment income (including dividends, interest, and other similar amounts).......			5,845,818			5,845,818
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	1,879,026
b	Less: rental expenses	402,662
c	Rental income or (loss)	1,476,364
d	Net rental income or (loss).......			1,476,364			1,476,364
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	11,511,710	155,298
b	Less: cost or other basis and sales expenses	0	0
c	Gain or (loss)	11,511,710	155,298
d	Net gain or (loss)..........			11,667,008			11,667,008
8a	Gross income from fundraising events (not including $ 8,452 of contributions reported on line 1c). See Part IV, line 18 ..
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		36,796
b	Less: cost of goods sold ..b		16,741
c	Net income or (loss) from sales of inventory..			20,055			20,055
Miscellaneous Revenue			Business Code
11a	IT, ADMIN & SUPPORT SV		561000	7,947,412		7,947,412
b	LABORATORY		621500	7,398,025		7,398,025
c	JOINT VENTURE REVENUE		900099	-2,104,388	-2,104,388
d	All other revenue ....			2,093,592	343,124	1,750,468
e	Total. Add lines 11a–11d ......			15,334,641
12	Total revenue. See Instructions......			588,277,988	550,856,907	17,095,905	19,009,245


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............				1
2	Savings and temporary cash investments .........			31,782,182	2	94,865,471
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			59,556,492	4	53,020,637
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			6,662,985	8	6,479,282
9	Prepaid expenses and deferred charges ..........			1,726,710	9	2,111,121
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	625,784,157
b	Less: accumulated depreciation .....	10b	311,466,345	331,415,657	10c	314,317,812
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....			403,810,854	12	398,128,289
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			26,116,190	15	17,090,627
16	Total assets. Add lines 1 through 15 (must equal line 34)......			861,071,070	16	886,013,239
17	Accounts payable and accrued expenses .........			50,940,428	17	50,619,479
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			275,532,722	25	280,121,492
26	Total liabilities. Add lines 17 through 25.........			326,473,150	26	330,740,971
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			528,265,022	27	547,470,127
28	Temporarily restricted net assets ...........			3,607,246	28	3,235,312
29	Permanently restricted net assets ...........			2,725,652	29	4,566,829
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			534,597,920	33	555,272,268
34	Total liabilities and net assets/fund balances ........			861,071,070	34	886,013,239