Form990
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2018 , and ending 12-31-2018
BCheck if applicable:
CName of organization
SSM Health Care of Wisconsin Inc
 
 
Doing business as
See Schedule O
 
Number and street (or P.O. box if mail is not delivered to street address)
10101 Woodfield Lane
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
St Louis, MO63132
D Employer identification number

43-0688874
E Telephone number

G Gross receipts $ 637,822,525
F Name and address of principal officer:
Laura Kaiser
10101 Woodfield Lane
St Louis,MO63132
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.ssmhealth.com
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:  
L Year of formation: 1956
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Part of an integrated network providing health care in south central Wisconsin Operating three hospitals and two skilled nursing facilities.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 12
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 5
5 Total number of individuals employed in calendar year 2018 (Part V, line 2a) ...... 5 4,182
6 Total number of volunteers (estimate if necessary) ............. 6 1,302
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 5,701,449
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 909,271 4,776,919
9 Program service revenue (Part VIII, line 2g) ......... 557,012,464 604,883,224
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,349,339 8,639,611
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 27,365,324 18,846,226
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 589,636,398 637,145,980
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 50,756 77,660
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 259,406,600 256,610,825
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,201,512    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 280,741,333 296,286,839
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 540,198,689 552,975,324
19 Revenue less expenses. Subtract line 18 from line 12....... 49,437,709 84,170,656
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 676,264,787 962,649,145
21 Total liabilities (Part X, line 26)............. 297,981,508 541,091,533
22 Net assets or fund balances. Subtract line 21 from line 20..... 378,283,279 421,557,612
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2018)
Form 990 (2018)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 476,555,256 including grants of $ 77,660 ) (Revenue $ 604,883,224 )
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 expensesMediumBullet476,555,256
Form 990 (2018)
Form 990 (2018)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III.................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I..................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III.............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
Yes
 
Form 990 (2018)
Form 990 (2018)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2018)
Form 990 (2018)
Page 5
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
4,182
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
Yes
 
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N .....
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O ................
16
 
No
Form 990 (2018)
Form 990 (2018)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
5
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
 
No
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletMary Gigot1808 West Beltline Highway   Madison,WI53713 (608) 260-3551
Form 990 (2018)
Form 990 (2018)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Christopher Howard
 
Pt Yr Chair, Pt Yr Pres-Hospital Operations of SSM Health
 1.0
.................
48.0 		X   X       0 2,492,311 144,128
(2) Steve Smoot
 
Director, COO & Pres. Hospital Operations
 1.0
.................
48.0 		X           0 420,253 195,902
(3) Joanna Bisgrove MD
 
Director, Physician at SSM Health Dean Medical Group
 1.0
.................
40.0 		X           0 175,349 49,119
(4) Jamie Deering MD
 
Director
 1.0
.................
0 		X           0 0 0
(5) Jason Isenberg MD
 
Director, Physician at SSM Health Dean Medical Group
 1.0
.................
40.0 		X           0 387,984 32,210
(6) Gregory Matzke MD
 
Director, Physician at SSM Health Dean Medical Group
 1.0
.................
40.0 		X           0 600,681 37,346
(7) Wesley Sparkman
 
Director
 1.0
.................
0 		X           0 0 0
(8) Mark Covaleski
 
Director
 1.0
.................
0 		X           0 0 0
(9) Ralph Kauten
 
Director
 1.0
.................
0 		X           0 0 0
(10) John Phelan MD
 
Director, Physician at SSM Health Dean Medical Group
 1.0
.................
41.0 		X           0 371,754 32,614
(11) Stephen Sramek MD
 
Director, Physician at SSM Health Dean Medical Group
 1.0
.................
40.0 		X           0 381,360 30,407
(12) Carter Dredge
 
Director, Chief Transformation Officer
 1.0
.................
41.0 		X           0 519,365 230,789
(13) Sr Rhea Emmer
 
Director
 1.0
.................
0 		X           0 0 0
(14) June Pickett
 
Secretary, Asst VP Governance & Archives, SSM Health
 1.0
.................
71.7 		    X       0 286,530 54,057
(15) Damond Boatwright
 
Chair, Regional President - WI
 40.0
.................
9.0 		    X       751,460 0 274,270
(16) Laura Kaiser
 
Vice Chair, President/CEO of SSM Health
 1.0
.................
48.0 		    X       0 1,891,562 841,443
(17) Rosie Putman
 
Asst Secretary, SSM Health Care of Wisconsin
 40.0
.................
0.0 		    X       0 66,629 44,885
Form 990 (2018)
Form 990 (2018)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Steven Caldwell
 
System Vice President, Finance
 40.0
.......................0 		    X       0 761,249 101,957
(19) Paula Friedman
 
Vice President, Senior VP-Strategic Development SSM Health
 1.0
.......................58.0 		    X       0 1,545,828 309,578
(20) Kris Zimmer
 
Treasurer, Chief Financial Officer at SSM Health
 1.0
.......................66.0 		    X       0 1,741,877 376,259
(21) Ed Chadwick
 
Interim System Vice President, Finance
 40.0
.......................0 		    X       0 447,210 0
(22) Laura Jelle
 
Pt Yr Hospital President-St Clare
 40.0
.......................1.5 		      X     0 311,639 4,447
(23) Jonathan Rozenfeld
 
Hospital President - SSM Health St. Mary's Hospital - Madison
 40.0
.......................1.0 		      X     513,658 0 175,504
(24) LAURA WALCZAK
 
Hospital President - SSM Health St. Clare Hospital - Baraboo
 40.0
.......................0.5 		      X     223,910 0 67,877
(25) Ben Layman
 
Hospital President-SSM Health St. Mary's Hospital - Janesville
 40.0
.......................1.0 		      X     214,403 0 89,644
(26) Mark Thompson
 
Regional Chief Medical Officer
 40.0
.......................4.0 		      X     468,527 0 165,437
(27) Virginia Malone
 
VP Patient Services - St Mary's
 40.0
.......................0 		      X     294,802 0 81,602
(28) Ginger Selle
 
Pt Yr VP Patient Care - St Clare
 40.0
.......................0 		      X     131,981 0 33,384
(29) Larry Hegland
 
Regional Chief Medical Officer
 40.0
.......................0 		      X     444,427 0 9,240
(30) Jonathan Lewis
 
VP Operations
 40.0
.......................0 		      X     212,192 0 81,998
(31) Lon McPherson
 
VP-Medical Affairs
 40.0
.......................0 		      X     360,017 0 118,622
(32) Linda Statz
 
Regional VP - Employee Experience
 40.0
.......................0 		      X     0 240,340 37,149
(33) Chris Sprowl MD
 
Regional Clinical Affairs Officer
 40.0
.......................2.0 		      X     0 584,600 283,113
(34) Margo Francisco
 
Regional VP - Strategy
 40.0
.......................0 		      X     0 255,583 98,516
(35) Tom Ter Horst
 
System VP - Human Resources
 40.0
.......................0 		      X     0 323,329 142,412
(36) Jennifer Orkfritz
 
Physician
 40.0
.......................0 		        X   258,537 0 15,066
(37) Kansas Dubray
 
Physician
 40.0
.......................0 		        X   305,304 0 31,698
(38) Debra Nyquist
 
Physician
 40.0
.......................0 		        X   288,657 0 22,473
(39) Eric Marty
 
Medical Staff Director
 40.0
.......................0 		        X   248,440 0 16,943
(40) David Jarvis
 
Physician
 40.0
.......................0 		        X   261,722 0 39,221
(41) Kerry Swanson
 
Former Key Employee
 0.0
.......................44.0 		          X 0 495,144 214,793
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 4,978,037 14,300,577 4,484,104
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet195
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
BOARD OF REGENTS OF THE UNIV OF WI

1100 DELAPLAINE CT
MADISON,WI53715 		PHYSICIAN SERVICES 6,894,094
J H Findorff & Son Inc

300 S Bedford St
Madison,WI53703 		Construction services 4,035,813
UW Hospital & Clinics

Drawer 853
Milwaukee,WI53278 		Medical and ambulance services 2,242,218
AMN Healthcare Inc

12400 High Bluff Drive
San Diego,CA92130 		Staffing services 2,090,565
University of Wisconsin

1685 Highland Avenue
Room 3165
Madison,WI53705 		Medical and physician services 2,073,689
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet49
Form 990 (2018)
Form 990 (2018)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 4,509,155
e Government grants (contributions)1e 225,000
f All other contributions, gifts, grants, and similar amounts not included above1f 42,764
g Noncash contributions included in lines 1a - 1f:$  
h Total. Add lines 1a-1f.......MediumBullet 4,776,919
Program Service RevenueAmt Business Code
2a NET PATIENT SERVICE REVENUE 621110 604,883,224 604,883,224    
b
c
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f ....MediumBullet 604,883,224
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 5,935,817     5,935,817
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   1,866,045
b Less: rental expenses   658,031
c Rental income or (loss) 0 1,208,014
d Net rental income or (loss)......MediumBullet 1,208,014     1,208,014
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 139,840 2,563,954
b Less: cost or other basis and sales expenses    
c Gain or (loss) 139,840 2,563,954
d Net gain or (loss).....MediumBullet 2,703,794     2,703,794
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
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..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a 36,516
b Less: cost of goods sold ..b 18,514
c Net income or (loss) from sales of inventory..MediumBullet 18,002     18,002
Business Code Miscellaneous Revenue
11a LABORATORY 621500 5,681,631   5,681,631  
b IT ADMIN & SUPPORT SERVICES 561000 5,178,099     5,178,099
c CAFETERIA 722210 2,274,027     2,274,027
d All other revenue .... 4,486,453 0 19,818 4,466,635
e Total. Add lines 11a–11d ...... MediumBullet 17,620,210
12 Total revenue. See Instructions......MediumBullet 637,145,980 604,883,224 5,701,449 21,784,388
Form 990 (2018)
Form 990 (2018)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
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 domestic organizations and domestic governments. See Part IV, line 21 59,260 59,260
2 Grants and other assistance to domestic individuals. See Part IV, line 22 18,400 18,400
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 4,712,956 4,256,666 444,019 12,271
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 190,033,766 171,635,456 17,903,533 494,777
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 15,721,337 14,473,463 1,241,672 6,202
9 Other employee benefits ....... 32,338,970 29,208,040 3,046,731 84,199
10 Payroll taxes ........... 13,803,796 12,517,896 1,258,615 27,285
11 Fees for services (non-employees):        
a Management ...... 565,755   565,755  
b Legal ......... 411,733   411,733  
c Accounting ........... 404,890   404,890  
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) 60,189,223 34,990,262 24,694,865 504,096
12 Advertising and promotion .... 77,528   52,889 24,639
13 Office expenses ....... 26,506,760 23,921,645 2,549,903 35,212
14 Information technology ...... 25,524,208 25,512,911 11,297  
15 Royalties ..        
16 Occupancy ........... 10,309,959 9,924,802 375,564 9,593
17 Travel ............ 714,082 339,095 372,076 2,911
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 495,826 294,482 201,017 327
20 Interest ........... 8,645,733 8,645,733    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 29,753,168 29,753,168    
23 Insurance ... 728,095 728,095    
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 95,372,183 95,372,183    
b MEDICAID PROVIDER TAX 14,336,393 14,336,393    
c LICENSES AND TAXES 567,061 567,061    
d MANAGEMENT FEES - AFFILIATES 21,683,997   21,683,997  
e All other expenses 245 245 0 0
25 Total functional expenses. Add lines 1 through 24e 552,975,324 476,555,256 75,218,556 1,201,512
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2018)
Form 990 (2018)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1 483,874
2 Savings and temporary cash investments ......... 24,310,709 2 32,521,404
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 56,710,341 4 57,445,552
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
0 5 0
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 0
7 Notes and loans receivable, net ....   7  
8 Inventories for sale or use ........ 7,514,931 8 7,301,683
9 Prepaid expenses and deferred charges ...... 2,360,341 9 2,590,394
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 683,832,025
b Less: accumulated depreciation 10b 427,800,440 266,693,429 10c 256,031,585
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 305,203,353 12 317,833,904
13 Investments—program-related. See Part IV, line 11 .. 0 13 23,314,180
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 13,471,683 15 265,126,569
16 Total assets. Add lines 1 through 15 (must equal line 34)... 676,264,787 16 962,649,145
Liabilities 17 Accounts payable and accrued expenses ..... 60,080,280 17 55,512,467
18 Grants payable ...   18  
19 Deferred revenue ......... 165 19 929
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 0
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 237,901,063 25 485,578,137
26 Total liabilities. Add lines 17 through 25.. 297,981,508 26 541,091,533
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 365,836,761 27 410,609,737
28 Temporarily restricted net assets ........... 6,207,446 28  
29 Permanently restricted net assets 6,239,072 29 10,947,875
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 378,283,279 33 421,557,612
34 Total liabilities and net assets/fund balances ........ 676,264,787 34 962,649,145
Form 990 (2018)
Form 990 (2018)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
637,145,980
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
552,975,324
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
84,170,656
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
378,283,279
5
Net unrealized gains (losses) on investments ...............
5
-19,228,505
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-21,667,818
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
421,557,612
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2018)
Form 990 (2018)
Additional Data


Software ID: 18007697
Software Version: 2018v3.1
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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 12, check only one box.)
1
2
3
4
5
6
7
8
9

10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (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 VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (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) right arrow (a) 2014 (b) 2015 (c) 2016 (d) 2017 (e) 2018 (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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2018

Schedule A (Form 990 or 990-EZ) 2018
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2018 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2018 		(iii)
Distributable
Amount for 2018
1 Distributable amount for 2018 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2018:
a From 2013.......  
b From 2014.......  
c From 2015.......  
d From 2016.......  
e From 2017.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2018 distributable amount  
i Carryover from 2013 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2018 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2018 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2018, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2018. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2019. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2014......  
b Excess from 2015.....  
c Excess from 2016.....  
d Excess from 2017.....  
e Excess from 2018.....  
Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2018


Additional Data


Software ID: 18007697
Software Version: 2018v3.1
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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






Form 990-PF




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
Special Rules
......... Arrow Bullet $  
Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2
Name of organization
SSM Health Care of Wisconsin Inc
  		Employer identification number
43-0688874
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Page 3
Name of organization
SSM Health Care of Wisconsin Inc
  		Employer identification number

43-0688874
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) (2018)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)
Page 4
Name of organization
SSM Health Care of Wisconsin Inc
  		Employer identification number

43-0688874
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2018)

Additional Data


Software ID: 18007697
Software Version: 2018v3.1
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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2018

Schedule C (Form 990 or 990-EZ) 2018
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ...................................................................................................................

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2015 (b) 2016 (c) 2017 (d) 2018 (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) 2018


Schedule C (Form 990 or 990-EZ) 2018
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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
36,773
j
Total. Add lines 1c through 1i ....................................................................................................
36,773
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL AND STATE HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WERE ALLOCATED TO LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2018


Additional Data


Software ID: 18007697
Software Version: 2018v3.1

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on 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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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" on Form 990, Part IV, line 8.
1a
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.
b
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)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2018

Schedule D (Form 990) 2018
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 8,752,110 7,830,283 7,283,147 7,033,561 6,383,639
b Contributions ... 8,480,403 167,906 447,278 503,057 826,828
c Net investment earnings, gains, and losses -713,464 994,144 293,091 -11,394 648,223
d Grants or scholarships ... 57,826 129,422 53,069 45,000 28,500
e Other expenditures for facilities
and programs ... 		130,941 110,801 140,164 197,077 796,629
f Administrative expenses ....          
g End of year balance ...... 16,330,282 8,752,110 7,830,283 7,283,147 7,033,561
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet49.85 %
b
Permanent endowment SchDMd Bullet40.27 %
c
Temporarily restricted endowment SchDMd Bullet9.88 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
Yes
 
(ii) related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
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" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   11,489,904 11,489,904
b Buildings ....   374,840,015 214,452,471 160,387,544
c Leasehold improvements   65,209,416 38,861,610 26,347,806
d Equipment ....   220,977,050 172,529,373 48,447,677
e Other .....   11,315,640 1,956,986 9,358,654
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 256,031,585
Schedule D (Form 990) 2018

Schedule D (Form 990) 2018
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered "Yes" on 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		 246,716,519 F

(B) BENEFICIAL INTEREST IN FOUNDATION		    

(C) INVESTMENTS IN OTHER AFFILIATES		 71,117,385 F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 317,833,904
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Other Receivables 6,139,754
(2) Due from affiliates 258,298,214
(3) Other non-current assets 688,601
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 265,126,569
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
PENSION FUNDING LIABILITY -5,906,698
DUE TO AFFILIATES 12,424,891
ASSET RETIREMENT LIABILITY 810,167
THIRD PARTY PAYOR 10,491,544
RABBI TRUST LIABILITY 375,258
ALLOCATED TAX-EXEMPT DEBT - SSM HEALTH CARE 461,630,158
DEFERRED COMPENSATION 64,811
DEFINED CONTRIBUTION LIABILITY 3,547,853
Third-party patient loans 2,140,153
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 485,578,137
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) 2018

Schedule D (Form 990) 2018
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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
Schedule D, Part V, Line 4 Intended uses of endowment funds Endowment funds will be used for the specific purpose identified when the endowment was established. Activities supported by the endowment funds include scholarships, continuing education, and specific department patients.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote SSM HEALTH CARE OF WISCONSIN'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH 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 2018 OR 2017.
Schedule D (Form 990) 2018


Additional Data


Software ID: 18007697
Software Version: 2018v3.1




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
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
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
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? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . . 		    7,048,500   7,048,500 1.27 %
b Medicaid (from Worksheet 3, column a) . . . . .     90,090,633 60,544,979 29,545,654 5.34 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     2,846,171 1,757,671 1,088,500 0.20 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 99,985,304 62,302,650 37,682,654 6.81 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     740,397 2,135 738,262 0.13 %
f Health professions education (from Worksheet 5) . . .     11,716,241 1,956,080 9,760,161 1.77 %
g Subsidized health services (from Worksheet 6) . . . .     558,101 122,106 435,995 0.08 %
h Research (from Worksheet 7) .     35,520 0 35,520 0.01 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     798,940 100 798,840 0.14 %
j Total. Other Benefits . . 0 0 13,849,199 2,080,421 11,768,778 2.13 %
k Total. Add lines 7d and 7j . 0 0 113,834,503 64,383,071 49,451,432 8.94 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development     910   910 0 %
3 Community support     23,848   23,848 0 %
4 Environmental improvements     239,107   239,107 0.04 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building     8,322   8,322 0 %
7 Community health improvement advocacy     60,637   60,637 0.01 %
8 Workforce development     597,540   597,540 0.11 %
9 Other         0 0 %
10 Total 0 0 930,364 0 930,364 0.17 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
18,316,857
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
186,591,862
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
200,672,796
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-14,080,934
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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) 2018
Schedule H (Form 990) 2018
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?3Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 SSM Health St Mary's Hospital - Madison
700 SOUTH PARK STREET
MADISON,WI53715
https://www.ssmhealth.com/locations/st-marys-hospital-madison
71 		X X   X     X     A
2 SSM Health St Clare Hospital - Baraboo
707 FOURTEENTH STREET
BARABOO,WI53913
https://www.ssmhealth.com/locations/st-clare-hospital-baraboo
65 		X X   X     X     B
3 SSM Health St Mary's Hospital - Janesville
3900 E RACINE ST
JANESVILLE,WI53546
https://www.ssmhealth.com/locations/st-marys-hospital-janesville
318 		X X   X     X     C
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 4
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)
A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.ssmhealth.com/about/community-health-needs-assessments
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2018
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
http://www.ssmhealth.com/for-patients/financial-assistance
b
http://www.ssmhealth.com/for-patients/financial-assistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
A
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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
b
c
d
e
f
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
A
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 4
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)
B
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		2
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.ssmhealth.com/about/community-health-needs-assessments
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2018
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
B
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
http://www.ssmhealth.com/for-patients/financial-assistance
b
http://www.ssmhealth.com/for-patients/financial-assistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
B
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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
b
c
d
e
f
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
B
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 4
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)
C
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		3
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): http://www.ssmhealth.com/about/community-health-needs-assessments
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2018
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
C
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
http://www.ssmhealth.com/for-patients/financial-assistance
b
http://www.ssmhealth.com/for-patients/financial-assistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
C
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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
b
c
d
e
f
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
C
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 3E THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.
Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - SSM Health St. Mary's Hospital - Madison. THE HOSPITAL, THROUGH THE HEALTHY DANE COLLABORATIVE, ASSESSED INPUT FROM THE COMMUNITY AND DATA RELATED TO HEALTH FACTORS PRESENTED BY THE COUNTY HEALTH RANKINGS TO UNDERSTAND WHAT IMPACTS THE HEALTH OF THE COMMUNITY. PARTICULAR ATTENTION WAS GIVEN TO SOCIAL, ECONOMIC, AND ENVIRONMENTAL DISADVANTAGED POPULATIONS. THE HOSPITAL UTILIZED FOCUS GROUPS AND ENGAGEMENT SESSIONS WITH A DIVERSE VARIETY OF STAKEHOLDERS AND THE PUBLIC AND ANALYZED HOW VARIOUS NEEDS AND FACTORS ARE TRENDING. ADDITIONAL INFORMATION ON HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY CAN BE FOUND ON PAGES 12 THROUGH 15 OF THE CHNA.
Schedule H, Part V, Section B, Line 6a Facility A, 1 Facility A, 1 - SSM Health St. Mary's Hospital - Madison. THE 2019-2021 CHNA WAS COLLABORATIVELY COMPLETED IN 2018 WITH THE FOLLOWING OTHER HOSPITALS THROUGH THE HEALTHY DANE COLLABORATIVE: STOUGHTON HOSPITAL, UNITYPOINT HEALTH-MERITER, AND UW HEALTH.
Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - SSM Health St. Mary's Hospital - Madison. THE 2019-2021 CHNA WAS COLLABORATIVELY COMPLETED IN 2018 WITH THE FOLLOWING OTHER COMMUNITY PARTNERS THROUGH THE HEALTHY DANE COLLABORATIVE: GROUP HEALTH COOPERATIVE AND PUBLIC HEALTH MADISON DANE COUNTY.
Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - SSM Health St. Mary's - Madison. The hospital identified various health needs in the 2018 CHNA, which was done in conjunction with the Healthy Dane Collaborative. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Maternal/child health - Mental Health/Behavioral Health - Chronic conditions (heart & diabetes) Maternal/child health In Dane County, maternal and child health has continually been identified as a top health priority. Mother and baby wellbeing plays a large role in the health of the next generation. There are also significant disparities within the county between races and ethnicities. Data regarding the maternal and child health in Wisconsin shows the following: - In Dane County, the infant mortality rate is 13.0 deaths per 1,000 live births and 14.7 deaths per 1,000 live births for babies born to Black mothers and mothers of two or more races respectively. For white mothers, the rate is 4.3 deaths per 1,000 live births - The preterm birth rate rose to 9.6%, increasing for the third year in a row - Throughout the state, the preterm birth rate among Black women is 54% higher than the rate among all other women The hospital has the following action plan in place to improve maternal and child health: - Continue partnership with the Health Council on disparities in low birth weight-focusing specifically on racial inequities - Enhance collaboration with the Wisconsin Women's Health Foundation to increase awareness and educational opportunities around prenatal and preconception care, focusing on smoking cessation - Work with the Health Dane Collaborative partners on opportunities to collaborate on evidence-based community programs/efforts to increase access to culturally competent preconception, prenatal and post-partum care with local community partners - Elevate efforts with Safe Communities-Pregnancy to Recovery program - Pursuit of Baby-Friendly Designation at St. Mary's Madison - Support prenatal care services at Access Community Health Centers - Expand Group Prenatal Care within Dean Medical Group locations - focus on cohorts with increased diversity - Continued growth of post-partum support and education in the hospital and medical group Mental Health Mental health is also a top concern in Dane County. There is a disconnect between the perception of the problem and the true reality of the impact of mental health. Mental health is important at every stage of life, from childhood and adolescence through adulthood. Without treatment the consequences of mental illness for the individual and society are staggering: disability, unemployment, substance abuse, homelessness, incarceration, and suicide. The following data demonstrates the severity of mental health concern in the area: - Among suicides with known circumstances, 51% of decedents had a current mental health problem and 43% were currently receiving mental health treatment - Approximately $92 million spent annually on inpatient hospitalizations due to self-inflicted injury - Approximately 1 in 8 adults screened positive for major depression within Dane County, while 1 in 5 adults screened positive for moderate of severe anxiety The hospital has implemented the following steps to address mental health in the community: - Increase Telehealth opportunities with our medical group partners to allow for more timely access to care - Partner with Safe Communities Coalition on the Recovery Coach program at St. Mary's ED as well as the Pregnancy to Recovery program within OB - Work with Healthy Dane partners on opportunities to collaborate to create, enhance, or sustain evidence-based community programs/efforts to reduce the incidence of suicide in Dane County - Collaborate with Zero-Suicide Initiative partners to sustain community efforts across Dane County - Explore expansion of the Community Paramedic program to include Mental Health - System change in approach to measuring Mental Health needs using Columbia Tool - Continued efforts in county-wide initiative on patient safety plans following discharge - Explore options for more follow-up and controlling day-to-day needs as well as transportation concerns for patients Chronic conditions (heart & diabetes) Chronic conditions account for the greatest number of poor health outcomes and increasing health care costs in Wisconsin. Currently, the state spends an estimated $3.9 billion and $4.1 billion in health care and lost productivity costs annually on diabetes and heart disease alone. For many individuals suffering from chronic conditions, associated risk factors can be addressed and treated. By focusing on risk factors for chronic conditions, complications and comorbidities can be prevented. Statistics on chronic conditions in Wisconsin show: - 7 out of 10 leading causes of death in Wisconsin are due to chronic conditions accounting for two out of every three deaths annually - More than 1,300 Wisconsin residents die from diabetes and many more suffer disabling complications such as heart disease, kidney disease, blindness, and amputations. This burden is higher among minority populations - Heart disease is the second leading cause of death overall, and the leading cause for those over the age of 65.2 The hospital's action plan on chronic disease involves: - Increase support of Rebalanced Life Wellness Association-Men's Health Center and Wellness Center - Engage with the Foundation for Black Women's Wellness -working specifically on Black Women's Heart Health - Support Edgewood students at Triangle (Diabetic Clinic) and support at RLW - Pulse Point partner-educate the community on importance of early intervention of CPR - Further explore Healthy Dane Funders /AHA-food deserts - Explore expansion of Community Paramedic Program - Continue supporting Double Dollars Program-access to local / fresh produce for underserved populations - On-going partnership with REAP-kids education and nutrition support in the schools - Explore Primary Care Provider education options (vs. coming to ED) The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs and address additional community needs within its efforts. The following community needs were identified but have not been prioritized due to the hospital's limited resources at this time: - Substance abuse, tobacco, drug and alcohol use - Obesity, diet, and exercise - Sexually-transmitted diseases - Access to and quality of care - Community safety - Pollution and housing
Schedule H, Part V, Section B, Line 3E THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.
Schedule H, Part V, Section B, Line 5 Facility B, 1 Facility B, 1 - SSM Health St. Clare Hospital - Baraboo. THE HOSPITAL UTILIZED A COMMUNITY PERCEPTION SURVEY TO GATHER PRIMARY DATA ON AREA HEALTH NEEDS. IT ALSO CONDUCTED NUMEROUS FOCUS GROUPS WITH KEY STAKEHOLDERS IN SAUK COUNTY COMMUNITIES. THE SURVEY WAS PROVIDED TO DIVERSE GROUPS WITH ACCESS TO TRANSLATORS WHEN NEEDED AND WAS AVAILABLE ONLINE AND IN WRITTEN FORMAT. ADDITIONALLY, THE HOSPITAL RESEARCHED AND REVIEWED DATA FROM COUNTY HEALTH RANKINGS AND STATE AND NATIONAL HEALTH ASSOCIATIONS. ADDITIONAL DETAIL ON HOW THE HOSPITAL TOOK INTO ACCOUNT PERSONS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY CAN BE FOUND ON PAGES 12 THROUGH 14 OF THE CHNA.
Schedule H, Part V, Section B, Line 6a Facility B, 1 Facility B, 1 - SSM Health St. Clare Hospital - Baraboo. THE HOSPITAL, THROUGH THE SAUK COUNTY HEALTH & WELLNESS COALITION, CONDUCTED ITS MOST RECENT CHNA IN COLLABORATION WITH THE FOLLOWING HOSPITALS: REEDSBURG AREA MEDICAL CENTER AND SAUK PRAIRIE HEALTH CARE.
Schedule H, Part V, Section B, Line 6b Facility B, 1 Facility B, 1 - SSM Health St. Clare Hospital - Baraboo. THE HOSPITAL, THROUGH THE SAUK COUNTY HEALTH & WELLNESS COALITION, CONDUCTED ITS MOST RECENT CHNA IN COLLABORATION WITH THE SAUK COUNTY HEALTH DEPARTMENT.
Schedule H, Part V, Section B, Line 11 Facility B, 1 Facility B, 1 - SSM Health St. Clare Hospital - Baraboo. The hospital identified various health needs in the 2018 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Mental Health - Obesity - Chronic Disease Mental Health The main concern with mental health in the community is limited access and the lack of mental health facilities. In the past, local law enforcement officials stated they often have had to drive mental health patients hours away for treatment. The 2018 Wisconsin County Health Rankings show that respondents had an average of 3.4 mentally unhealthy days per month in Sauk County. Statistics from the 2018 Sauk County Health & Wellness Coalition Survey show: - 25.3% of respondents reported being treated for, or told by a doctor, that they have a mental health condition - 27.4% of respondents reported feeling sad, blue or depressed at least sometimes in the past month - Nearly 1 in 12 (8.8%) of respondents report they did not receive the mental health care they thought they needed in the last 12 months. Cost and lack of insurance coverage were cited by 2 of 5 (43.6%) of those respondents who did not receive care. One in four (25.5%) respondents said they were unable to get an appointment The hospital has outlined the following action plan to improve community mental health: - Collaborate with Journey Mental Health and Sauk County Health & Wellness Coalition to provide mental health first aid training two times per year in our service area - Enhance county-wide collaborations to increase awareness, education, treatment and pre-event intervention with organizations including Rural Safety Days, Sauk County Partnership for Prevention and Recovery, Region 11 Critical Incident and Stress Management group - Collaborate with hospital foundation on twice-yearly Healthy Community Partnership grants directed to organizations collaborating on health initiatives impacting mental health including Zoo camp, Boys and Girls Clubs programming, community mental health forums and school district mindfulness programming - Collaborate with SSM Health Regional team on Time For Kids Ambassador programming - Collaborate with service area health care providers to collate and share mental health resources for the agricultural community - Expand clinical and hospital-based mental health tools including implementation of Columbia Suicide Screening for high risk patients, addition of licensed clinical social worker, outpatient AODA clinical counselor and ED referral process for suboxone - Conduct an annual Grief Share 15-week mental health support group for individuals who have experienced a life-changing loss - Create community awareness of mental health by participating in St. Clare Hospital radio programs Obesity Obesity continues to be a growing issue in the Sauk and Columbia County communities. Lack of physical activity is one of the main contributors to obesity. Given the wide variety of venues to be physically active, there may be a lack of interest in utilizing the area's resources that encourage exercise and motion. Statistics from the 2018 Sauk County Health & Wellness Coalition survey show: - Only 31% of respondents reported a healthy BMI - 33% of respondents reported an overweight BMI - 35% of respondents reported an obese BMI - Only 20.5% of respondents reported being physically active for five days or more - 34.9% of respondents reported being physically active for one day or less - 23% of Sauk County respondents reported having no leisure-time physical activity The hospital has organized the following activities to improve community obesity measures: - Collaborate with hospital foundation on twice-yearly Healthy Community Partnership grants directed to organizations collaborating on health initiatives impacting obesity including fresh food boxes from local food pantries, Boys and Girls Clubs healthy eating programs for members and senior citizens, community-based nutritional meals, fitness programs - Collaborate with hospital foundation on childhood fitness in local school districts titled "Fun & Fit" program for all 3rd grade fitness classes in the Baraboo and Wisconsin Dells school districts - Partner to enhance farm-to-table options through food courses and cooking classes at local schools and community "tables" - Support partnerships with municipal and health coalition leaders to address population-dense areas of high-risk individuals to promote healthy food access / eating options including community meals and Farmer's Markets funding - Collaborate with county resources to build on Sauk County's Healthy Communities designation - Support local activities which promote fitness - Partner with Outlets at the Dells to implement a county-wide Saturday morning fitness program for children incorporating movement, healthy food options and fun - Honor requests from community organizations for speakers at healthy lifestyle presentations - Promote healthy living through community-based, schools and business-specific health fairs and events - Create community awareness of how to live healthy and well in Sauk County through St. Clare Hospital's radio programming Chronic disease Chronic disease burden is more highly concentrated among high-risk populations. The poor are more vulnerable to chronic diseases because of material deprivation and psychological stress, higher levels of risky behavior, unhealthy living conditions and limited access to good-quality healthcare. Statistics from the 2018 Sauk County Health & Wellness Coalition Survey and the County Health Rankings show: - 67.4% of respondents reported receiving a routine checkup in the last year - 58.3% of respondents received cholesterol testing in the last year - 52.5% of respondents reported having an eye exam in the last year - 19.8% of respondents reported being treated for/told by a doctor in the last 3 years that they have high blood pressure - 20.3% of respondents reported that they have been told by a physician that they have high cholesterol, most of whom say it is under control - 4.7% of respondents reported being treated for/told by a doctor in the last 3 years that they have heart disease - 6.1% of respondents reported having been treated or diagnosed by a physician for diabetes - 3.1% of respondents reported being treated for/told by a doctor in the last 3 years that they have cancer - 15% of Sauk County adults are currently smokers. This indicator is relevant because tobacco use is linked to leading causes of death such as cancer and cardiovascular disease The hospital was involved in the following initiatives to improve chronic disease in the community served: - Provide expanded hospital-based palliative intensive education care to outpatients for management of heart failure, COPD and diabetes - Work collaboratively with hospital foundation to expand access to services in Baraboo and Wisconsin Dells to improve follow up care - Collaborate with hospital foundation on twice-yearly Healthy Community Partnership grants directed to organizations collaborating on health initiatives impacting chronic disease and diabetes including fresh food boxes from local food pantries, Boys and Girls Clubs nutritional dietary programming for members and senior citizens, community-based nutritional meals - Enhance partnerships with key city, village, township and health coalition leaders to address population-dense areas of high-risk individuals to promote healthy food access / eating options including community meals and Farmer's Markets funding - Participate in area health fairs and educational seminars to provide education and strategies surrounding obesity, stress, COPD, vaping and the progression of chronic disease - Create community awareness of chronic disease options and proactive programming through St. Clare Hospital's radio show - Improving chronic disease management through personalized telephone follow up programming to heart failure patients after discharge from St. Clare Hospital - Host monthly diabetes and chronic disease support groups at St. Clare Hospital for population/s and communities served The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs and address additional community needs within its efforts. The following community needs were identified but have not been prioritized due to the hospital's limited resources at this time: - Alcohol abuse - Unintentional injury and traffic accidents - Lack of dental care - Cancer
Schedule H, Part V, Section B, Line 3E THE HOSPITAL FACILITY ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAS PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.
Schedule H, Part V, Section B, Line 5 Facility C, 1 Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. THE HOSPITAL, IN COLLABORATION WITH THE ROCK COUNTY PUBLIC HEALTH DEPARTMENT AND HEALTY EQUITY ALLIANCE OF ROCK COUNTY, CREATED A COUNTY HEALTH ASSESSMENT WHICH GATHERED COMMUNITY PERSPECTIVES AND DATA THROUGH A SURVEY, ONE-ON-ONE INTERVIEWS, AND FOCUS GROUPS. ADDITIONALLY, STATISTICAL DATA WAS OBTAINED AND REVIEWED FROM THE HEALTHY COMMUNITIES INSTITUTE. MORE INFORMATION ON THE HOW THE HOSPITAL TOOK INTO ACCOUNT PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY CAN BE FOUND ON PAGES 11 AND 12 OF THE CHNA.
Schedule H, Part V, Section B, Line 6a Facility C, 1 Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. THE HOSPITAL WORKED CLOSELY WITH THE HEALTH EQUITY ALLIANCE OF ROCK COUNTY, AS WELL AS THE FOLLOWING HOSPITAL FACILITIES: BELOIT HEALTH SYSTEM, CHILDREN'S HOSPITAL - EXCHANGE FAMILY RESOURCE CENTER, COMMUNITY HEALTH SYSTEMS, INC., EDGERTON HOSPITAL, AND MERCY HEALTH.
Schedule H, Part V, Section B, Line 6b Facility C, 1 Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. THE HOSPITAL WORKED CLOSELY WITH THE HEALTH EQUITY ALLIANCE OF ROCK COUNTY, AS WELL AS NUMEROUS OTHER ORGANIZATIONS. A FULL LIST OF THE COLLABORATORS CAN BE FOUND ON PAGE 25 OF THE CHNA.
Schedule H, Part V, Section B, Line 11 Facility C, 1 Facility C, 1 - SSM Health St. Mary's Hospital - Janesville. The hospital identified various health needs in the 2018 CHNA. In order to make meaningful impact, and to use its finances most effectively and efficiency, the hospital will place primary focus on the following key priorities: - Obesity - Substance abuse - Tobacco use Obesity Obesity continues to be a primary community health concern in Rock County. Lifestyle complications that lead to increased risk of obesity include physical inactivity combined with unhealthy diet and eating habits. In some cases, minorities and those living under financial distress are often segments of the population most affected by factors contributing to obesity. Additional facts and figures that relate to obesity show: - Obesity was identified as a community health issue by the Rock County Public Health Department - Obesity was identified as a community health issue by community stakeholders - Adults who are Obese represent 32.1 percent of adults in Rock County, more than 10 percent higher than the overall Wisconsin percentage of 28.5 percent - Families Living Below Poverty Level represent 11.2 percent of households in Rock County, more than 30 percent higher than the overall Wisconsin rate of 8.5 percent - The Child Food Insecurity Rate in Rock County was 18.9 percent, nearly 20 percent higher than the overall Wisconsin rate of 16.0 percent - Adults who are Sedentary are 20.2 percent of adults in Rock County, the same as the overall Wisconsin percentage of 20.2 percent The hospital is involved in the following initiatives to improve obesity measures in the community served: - Explore opportunities to collaborate with Rock County public schools on nutrition education - Work with faith community and other community groups on nutrition education and physical fitness - Continue sponsorship of the Janesville Farmer's Market - Partner with hospital cafeteria to ensure healthy offerings are consistently provided at a reasonable cost - Explore options to bring healthy food and opportunities for physical activity into underserved communities - Support organizations which provide healthy food to impoverished members of the community, including Meals on Wheels, ECHO, and food pantries - Partner with community organizations, such as the VeloClub, on providing access to physical fitness programming to underserved youth Substance Abuse Multiple factors contribute to substance abuse, including mental health needs, poor economic conditions, high poverty rates, lower educational attainment levels, higher percentages of individuals living alone, and easy access to alcohol and other substances. Additional facts and figures that relate to substance abuse are below. - Drug, alcohol, and substance abuse were identified as a community health issue by community stakeholders - A lack of substance abuse treatment was identified as a community health issue by community stakeholders - The Death Rate due to Drug Poisoning in Rock County is 21.7 deaths per 100,000 population, more than one-third higher than the Wisconsin rate of 16.2. This measure assesses the age-adjusted death rate per 100,000 population due to drug overdose - Alcohol-Impaired Driving Deaths are 43.4 percent of motor-vehicle crash deaths in Rock County, more than one-fifth higher than the overall Wisconsin percentage of 35.7 percent - Depression within the Medicare Population of Rock County is 19.1 percent, more than one tenth higher than the Wisconsin rate of 17.0 percent - Life Expectancy is lower in Rock County for both males (76.9 years) and females, compared to the overall Wisconsin life expectancy for males (77.7 years) and females (81.9 years) The hospital is implementing the following measures to reduce substance abuse: - Offer education or partner with other organizations regarding the root causes, prevention and/or treatment for opioid abuse - Research establishing an on-site pharmaceuticals disposal site and/or home medication lock boxes - Create community awareness regarding opioid and other drug issues through community activities - Provide community support services for diagnosed patients, and provide immediate support from community organizations for Emergency Department patients wanting assistance with substance abuse - Support organizations which provide substance abuse services, including Rock County One to One - Partner with regional mental health providers on offering patient placement - With partnerships with other organizations, explore establishing additional mental health services and placement opportunities in Rock County - Partner with physicians to increase alternatives to opioid (ALT) medication prescriptions Tobacco Use Tobacco use is a growing concern in the hospital's service area. Tobacco use is responsible for multitudes of avoidable illness and death nationwide, brings about premature death and complications from second-hand smoke. Statistics on tobacco use show: - Cancer, which can be caused by tobacco use, was identified as a community health issue by community stakeholders - Mothers who Smoked During Pregnancy are 15.2 percent of births in Rock County, one-third higher than the overall Wisconsin percentage of 11.4 percent - Adults who Smoke represent 22.4 percent of adults in Rock County, more than one-quarter higher than the overall Wisconsin percentage of 17.9 percent - The Age-Adjusted Death Rate due to Lung Cancer in Rock County is 54.4 deaths per 100,000 population, nearly one-quarter higher than the Wisconsin rate of 44.2 - The Lung and Bronchus Cancer Incidence Rate in Rock County is 73.9 cases per 100,000 population, more than one-fifth higher than the Wisconsin rate of 60.9 - The Age-Adjusted Death Rate due to Cancer in Rock County is 186.6 deaths per 100,000 population, more than one-tenth higher than the Wisconsin rate of 168.1 The hospital will address health implications from tobacco use through the following: - Offer education or partner with other organizations regarding the root causes, prevention and/or treatment for tobacco use - Provide prevention education to school-age children through various outreach efforts - Create community awareness regarding the hazards of tobacco use through community activities - Provide smoking cessation survival kits at community events - Continue offering on-site "Freedom from Smoking" smoking cessation program - Explore offering community evidence-based programs regarding tobacco cessation during pregnancy The hospital has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs and address additional community needs within its efforts. The following community needs were identified but have not been prioritized due to the hospital's limited resources at this time: - Access Issue - Aging Issues - Alcohol Abuse - Asthma - Cancers - Dental Problems - Diabetes - Domestic Violence - Heart Disease - HIV/AIDS - Maternal and Child Health - Mental Health - Rape and Sexual Assault - STDs / STIs - Teen Pregnancy - Violence/Gun Injuries
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 9
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?10
Name and address Type of Facility (describe)
1 ST CLARE CARDIAC AND PULMONARY REHAB - WISCONSIN DELLS
1306 BROADWAY ROAD
WISCONSIN DELLS,WI53965 		REHABILITATION
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 MARY'S SLEEP CENTER
2844 INDEX ROAD
FITCHBURG,WI53713 		SLEEP CENTER
6 ST CLARE URGENT CARE
530 WISCONSIN DELLS PARKWAY
LAKE DELTON,WI53965 		URGENT CARE CENTER
7 ST CLARE CENTER
1510 JEFFERSON STREET
BARABOO,WI53913 		AODA TREATMENT
8 ST MARY'S CHILD CARE CENTER
723 S ORCHARD STREET
MADISON,WI53715 		CHILD CARE CENTER
9 ADULT DAY HEALTH CENTER
2440 ATWOOD AVENUE
MADISON,WI53704 		ADULT DAY CARE
10 ST CLARE CHILD CARE CENTER
1605 JEFFERSON STREET
BARABOO,WI53913 		CHILD CARE CENTER
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page 10
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
Schedule H, Part I, Line 3c Discounted Care Exceptions Patients whose family income exceeds 400% of the FPL may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of the hospital; however the discounted rates shall not be greater than the amounts generally billed to commercially insured [or Medicare] patients. In such cases, other factors may be considered in determining their eligibility for discounted or free services, including: * Bank accounts, investments and other assets * Employment status and earning capacity * Amount and frequency of bills for health care services * Other financial obligations and expenses * Generally, financial responsibility will be no more than 25% of gross family income. The hospital may utilize predictive analytical software or other criteria to assist in making a determination of financial assistance eligibility in situations where the patient qualifies for financial assistance but has not provided the necessary documentation to make a determination. This process is called "presumptive eligibility."
Schedule H, Part I, Line 6a Community benefit report prepared by related organization SSM Health Care Corporation, 46-6029223
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The amounts reported on Form 990, Schedule H, Part I, Line 7a, 7b, and 7c were determined using the cost to charge ratio derived from worksheet 2 in the schedule h instructions. Form 990, schedule h, part I, Lines 7e, 7f, 7g, 7h, and 7i are reported at cost as reported in the organization's financial statements. The calculation of Schedule H, Part I, Line 7, Column F utilizes 990, Part IX, Line 25, Column A, which does not include Bad Debt Expense.
Schedule H, Part II Community Building Activities SSM Health Care of Wisconsin participates in a wide array of community and civic organizations in the promotion of health care and community building activities. Specific activities reported in Part II of Schedule H include the following: - Hospital Leadership participating and supporting Economic Development groups and Environmental Resourcing organizations. - Participation and support of local Emergency Preparedness Committees in collaboration with community partners in each hospital community - Waste Removal and Recycling programs - Workforce Development opportunities for college students as well as health exploration days for high schoolers interested in a health specific career path - Ongoing collaboration with our local health partners including competitor hospitals and public health departments around CHNA priorities and health advocacy including behavioral health, maternal child health, chronic disease management, elder care and more. Our partnership with the Dane County Health Council is providing a multipronged approach to Maternal Child Health Disparities in our community.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS AT CHARGES AS RECORDED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ALLOWANCE FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology SSM Health Care of Wisconsin, Inc. did not make an estimate of the organization's bad debt attributable to patients eligible under the organization's financial assistance policy.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote SSM Health Care of Wisconsin, Inc. is part of the SSM Health consolidated audit. The footnote that references the treatment of uncollectible accounts and implicit price concessions in the December 31, 2018 consolidated audit is contained on page 23 and 24 of the attached financial statements.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance SSM Health Care of Wisconsin, Inc. has established a written credit and collection policy and procedures. The billing and collection policies and practices reflect the mission and values of SSM Health, including our special concern for people who are poor and vulnerable. SSM Health Care of Wisconsin embraces its responsibility to serve the communities in which it participates by establishing sound business practices. SSM Health Care of Wisconsin's billing and collection practices will be fairly and consistently applied. All staff and vendors are expected to treat all patients consistently and fairly regardless of their ability to pay. They respond to patients in a prompt and courteous manner regarding any questions about their bills and provide notification of the availability of financial assistance. All uninsured patients will be provided a standard discount for medically necessary inpatient and outpatient services, including services provided at off-campus outpatient sites. The hospital determined the amount of the discount based on the local managed care market, applicable statutory requirements and other relevant local circumstances. The rate must be no less than the lowest effective discount rate and no greater than the highest effective discount rate for the current managed care contracts of the hospital. Uninsured patients may also qualify for an additional discount based upon financial need under the system financial assistance policy. All accounts due from the patient will receive a statement after discharge or after final adjudication from patient's insurance. Generally the patient will receive 4 months (120 days) of in-house collection efforts (including early out vendors) and 12 months of bad debt collection efforts. The hospital will make Reasonable Efforts to determine FAP eligibility including: 1. The financial assistance summary will be included with each billing statement 2. Extraordinary Collection Activity (ECAs) may not occur until bad debt placement and only after 120 days. 3. ECAs must be suspended if a guarantor submits a FAP application during the application period. 4. Reasonable measures must be taken to reverse ECAs if the application is approved which may include refunding any payments made in excess of amounts owed as an FAP-eligible individual. 5. Bad Debt vendors will gain written approval from SSM prior to engaging in ECAs. SSM will review the accounts and verify satisfactory completion of reasonable efforts during the notification and application period. A waiver is not considered reasonable efforts. Obtaining a signed waiver that an individual does not wish to apply for FAP assistance or receive FAP application information will not meet the requirement to make "reasonable efforts" to determine whether the individual is FAP-eligible before engaging in ECAs. All outside collection agencies must comply with state and federal laws, comply with the association of credit and collection professional's code of ethics and professional responsibility and comply with SSM Health Care of Wisconsin's collection and financial assistance policies.
Schedule H, Part V, Section B, Line 16a FAP website A - SSM Health St. Mary's Hospital - Madison: Line 16a URL: http://www.ssmhealth.com/for-patients/financial-assistance; B - SSM Health St. Clare Hospital - Baraboo: Line 16a URL: http://www.ssmhealth.com/for-patients/financial-assistance; C - SSM Health St. Mary's Hospital - Janesville: Line 16a URL: http://www.ssmhealth.com/for-patients/financial-assistance;
Schedule H, Part V, Section B, Line 16b FAP Application website A - SSM Health St. Mary's Hospital - Madison: Line 16b URL: http://www.ssmhealth.com/for-patients/financial-assistance; B - SSM Health St. Clare Hospital - Baraboo: Line 16b URL: http://www.ssmhealth.com/for-patients/financial-assistance; C - SSM Health St. Mary's Hospital - Janesville: Line 16b URL: http://www.ssmhealth.com/for-patients/financial-assistance;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - SSM Health St. Mary's Hospital - Madison: Line 16c URL: http://www.ssmhealth.com/for-patients/financial-assistance; B - SSM Health St. Clare Hospital - Baraboo: Line 16c URL: http://www.ssmhealth.com/for-patients/financial-assistance; C - SSM Health St. Mary's Hospital - Janesville: Line 16c URL: http://www.ssmhealth.com/for-patients/financial-assistance;
Schedule H, Part VI, Line 2 Needs assessment SSM Health (SSMH) participates in Community Benefit according to our vision, Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically, and socially marginalized, will experience improved health in mind, body, spirit and environment. In the tradition of our founders, the Franciscan Sisters of Mary, caring for those in greatest need remains our organizational priority. Today our System Board monitors Community Benefit efforts, and views achievement of our vision as a primary responsibility. The purpose of SSMH's Community Benefit program is to assess and address community health needs. Making our communities healthier in measurable ways is always our goal. To fulfill this commitment, SSMH's Community Benefit is divided into two parts: 1) Community Health Needs Assessment (CHNA), and 2) Community Benefit Inventory for Social Accountability (CBISA). The CHNA is an assessment and prioritization of community health needs and the adoption and implementation of strategies to address those needs. A CHNA is conducted every three years by each hospital according to the following steps: * Assess and prioritize community health needs: Gather CHNA data from secondary sources; obtain input from stakeholders representing the broad interests of the community through interviews and focus groups; use data to select top health priorities; and complete written CHNA. * Develop, adopt, and implement strategies to address top-health priorities: Establish strategies to address priorities; complete Strategic Implementation Plan; obtain Regional/Divisional Board approval; and integrate strategies into operational plan. * Make CHNA widely available to the public: Publish CHNA and summary document on hospital's website. * Monitor, track, and report progress on top health priorities: Collect data and evaluate progress; report to Regional/Divisional Board every six months and System Board every year; share findings with community stakeholders; and send results to finance for submission to the Internal Revenue Service (IRS). System Office staff and leaders oversee and monitor SSMH's Community Benefit Program, and ensure reporting is in compliance with IRS regulations. In collaboration with community stakeholders and partner organizations, SSM Health Care Corporation also identifies needs based on assessments and research, and SSMH facilities also involve case managers and care team staff to pinpoint critical health issues in the community. All hospital CHNAs are completed, approved, and integrated into the organization's strategic plan. We continue to monitor and assess the progress of our local efforts in the spirit of caring for others and improving community health.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Each entity providing medical service 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 communication 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 are easy to understand by the general public, culturally appropriate and available in those languages that are prevalent in the community. They 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 * Who to contact to get additional information or financial counseling. The following types of notices to the public are 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 is also provided to public agencies.
Schedule H, Part VI, Line 4 Community information SSM Health St. Mary's Hospital - Madison St Mary's Hospital serves Dane County in south-central Wisconsin, which is home to Wisconsin's state capitol, Madison, and Wisconsin's flagship public university, the University of Wisconsin-Madison. Dane County is the second most densely populated county in Wisconsin and Madison is the second largest city in the state. The population of Dane County grew 5.5% between 2012 and 2016 bringing the population to 531,273. Dane County's Diversity is concentrated in the City of Madison, but the County as a minority population around 15%. Life expectancy in Dane County is higher than the national average for both men and women; however, the gap in life expectancy between Black and White populations has grown. The percent of the population that has at least a bachelor's degree is much higher in Dane County than in Wisconsin and the US. However, Dane County's current 87.1% high school graduation rate is one of the lowest among Wisconsin counties. The median household income for Dane County is $64,773, higher than state and national values. Despite the high median household income and second lowest unemployment rate in the state (2.8%), Dane County is faced with a disparity of minorities living in poverty. Additional detailed information on the St Mary's Hospital service area can be found throughout the CHNA. SSM Health St. Clare Hospital - Baraboo St. Clare Hospital serves the primarily serves Sauk County in Wisconsin. There are 16 zip codes in this county, which make up 85% of the hospital's total patients. The hospital, in Baraboo, Wisconsin, has urgent care clinics in Lake Delton and Wisconsin Dells. In 2017, Sauk County had an estimated population of 73,275 persons. The community has a high proportion of residents aged 55 and older at about 35%. Sauk County has seen increasing diversity in the past three years, with nearly 12% of the population a minority. While Sauk County has a lower poverty rate than the state and national averages at 10%, only 20.5% of residents hold at least a Bachelor's degree. Additional detailed information on the St Clare Hospital service area can be found on page 19 through 21 of the CHNA. SSM Health St. Mary's Hospital - Janesville St Mary's Janesville defines its community as Rock County, Wisconsin. There are 22 zip codes that are contained within or overlay the county. The hospital is located in Janesville, Wisconsin. In 2016, Rock County had an estimated population of 161,620 persons. Rock County is seeing increasing race and ethnic diversity, with nearly 17% of the population a minority. The county has a poverty rate for families of 11.2%, which while lower than previously reported, is still higher than the state and national averages. Life expectancy rates are near national averages. Additional detailed information on the St Mary's Janesville Hospital service area can be found on page 13 through 20 of the CHNA.
Schedule H, Part VI, Line 5 Promotion of community health SSM Health Care of Wisconsin participates in a wide array of community programs throughout the area to further its exempt purpose of promoting the health of the community. The community initiatives build on the strengths of our communities and systems to improve the quality of life and to create a sense of hope. Community Benefit initiatives build community capacity and individual empowerment through community organizing, leadership development, partnerships, and coalition building. Our Community Health programs provide compassionate and competent care while they promote health improvement by reaching directly into the community to ensure that low-income and under-served persons can access health care services. Focusing on a broad definition of health, SSM Health Care of Wisconsin's hospitals, clinics and programs provide medical and mental health services, health education, health management, prevention, referrals, insurance enrollment and in-home primary care services and support, while fostering collaboration and incorporating Community Benefit strategies. SSM Health Care of Wisconsin promotes grassroots advocacy and engages persons of influence to affect social and public policy change in order to promote community health. SSM Health Care of Wisconsin also furthers its exempt purpose with the following activities: * Operates an emergency room that is open to all persons regardless of ability to pay, * Has an open medical staff with privileges available to all qualified physicians in the area, * Engages in the training and education of health care professionals, * Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs * All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system.
Schedule H, Part VI, Line 6 Affiliated health care system SSM HEALTH CARE OF WISCONSIN (SSMHC/WI) IS A COMPREHENSIVE NOT-FOR- PROFIT CATHOLIC HEALTH CARE ORGANIZATION PROVIDING HEALTH CARE SERVICES TO AN 18- COUNTY AREA IN SOUTH- CENTRAL WISCONSIN. SSMHC/WI, WITH HEADQUARTERS IN MADISON, WI, IS SPONSORED BY SSM HEALTH MINISTRIES AND IS OWNED AND OPERATED BY SSM HEALTH (SSMH) BASED IN ST. LOUIS, MISSOURI. SSMHC/WI PROVIDES HEALTH CARE SERVICES AT THREE WHOLLY-OWNED ACUTE CARE HOSPITALS, SSM HEALTH ST. MARY'S HOSPITAL - MADISON, SSM HEALTH ST. CLARE HOSPITAL - BARABOO AND SSM HEALTH ST. MARY'S HOSPITAL - JANESVILLE, AS WELL AS AT TWO NURSING HOMES - SSM HEALTH ST. MARY'S CARE CENTER IN MADISON AND SSM HEALTH ST. CLARE MEADOWS CARE CENTER IN BARABOO.
Schedule H, Part VI, Line 7 State filing of community benefit report WI
Schedule H (Form 990) 2018
Additional Data


Software ID: 18007697
Software Version: 2018v3.1

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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," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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
1
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? ........................
2
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) Blackhawk Technical College Foundation
6004 S County Rd G
PO Box 5009
Janesville,WI53547 		39-1391659 501(c)(3) 10,000       Support for nursing scholarship fund
(2) Greater Sauk County Community Foundation
PO Box 544
Baraboo,WI53913 		39-1919240 501(c)(3) 10,000       Support of community improvement initiatives
(3) St Clare Health Care Foundation Inc
10101 Woodfield Lane
St Louis,MO63132 		43-1940683 501(c)(3) 22,353       Support Foundation in providing equipment for SSM Health St. Clare Hospital - Baraboo
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2018

Schedule I (Form 990) 2018
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) Scholarships 28 18,400      
(1)
(2)
(3)
(4)
(5)
(6)
(7)
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
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. THE PROCEDURES USED TO MONITOR THE USE OF GRANT FUNDS 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) 2018



Additional Data


Software ID: 18007697
Software Version: 2018v3.1


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" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
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
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
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 .........
1b
Yes
 
2
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? ..
2
Yes
 
3
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.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on 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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
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 on 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 in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Christopher Howard
 
Pt Yr Chair, Pt Yr Pres-Hospital Operations of SSM Health 		(i)

(ii)		 0
-------------
556,972 		0
-------------
600,000 		0
-------------
1,335,339 		0
-------------
123,963 		0
-------------
20,165 		0
-------------
2,636,440 		0
-------------
1,285,002
2Steve Smoot
 
Director, COO & Pres. Hospital Operations 		(i)

(ii)		 0
-------------
358,627 		0
-------------
0 		0
-------------
61,626 		0
-------------
189,508 		0
-------------
6,394 		0
-------------
616,154 		0
-------------
0
3Joanna Bisgrove MD
 
Director, Physician at SSM Health Dean Medical Group 		(i)

(ii)		 0
-------------
173,984 		0
-------------
0 		0
-------------
1,365 		0
-------------
20,190 		0
-------------
28,929 		0
-------------
224,468 		0
-------------
0
4Jason Isenberg MD
 
Director, Physician at SSM Health Dean Medical Group 		(i)

(ii)		 0
-------------
386,549 		0
-------------
0 		0
-------------
1,435 		0
-------------
2,856 		0
-------------
29,354 		0
-------------
420,194 		0
-------------
0
5Gregory Matzke MD
 
Director, Physician at SSM Health Dean Medical Group 		(i)

(ii)		 0
-------------
599,666 		0
-------------
0 		0
-------------
1,015 		0
-------------
9,510 		0
-------------
27,836 		0
-------------
638,027 		0
-------------
0
6John Phelan MD
 
Director, Physician at SSM Health Dean Medical Group 		(i)

(ii)		 0
-------------
366,035 		0
-------------
0 		0
-------------
5,719 		0
-------------
3,966 		0
-------------
28,648 		0
-------------
404,368 		0
-------------
0
7Stephen Sramek MD
 
Director, Physician at SSM Health Dean Medical Group 		(i)

(ii)		 0
-------------
374,588 		0
-------------
0 		0
-------------
6,772 		0
-------------
4,125 		0
-------------
26,282 		0
-------------
411,767 		0
-------------
0
8Carter Dredge
 
Director, Chief Transformation Officer 		(i)

(ii)		 0
-------------
495,016 		0
-------------
0 		0
-------------
24,349 		0
-------------
212,975 		0
-------------
17,814 		0
-------------
750,154 		0
-------------
0
9June Pickett
 
Secretary, Asst VP Governance & Archives, SSM Health 		(i)

(ii)		 0
-------------
229,703 		0
-------------
0 		0
-------------
56,827 		0
-------------
39,862 		0
-------------
14,195 		0
-------------
340,587 		0
-------------
23,155
10Damond Boatwright
 
Chair, Regional President - WI 		(i)

(ii)		 620,000
-------------
0 		0
-------------
0 		131,460
-------------
0 		274,270
-------------
0 		0
-------------
0 		1,025,730
-------------
0 		89,103
-------------
0
11Laura Kaiser
 
Vice Chair, President/CEO of SSM Health 		(i)

(ii)		 0
-------------
1,469,008 		0
-------------
400,000 		0
-------------
22,554 		0
-------------
834,575 		0
-------------
6,868 		0
-------------
2,733,005 		0
-------------
0
12Steven Caldwell
 
System Vice President, Finance 		(i)

(ii)		 0
-------------
571,079 		0
-------------
0 		0
-------------
190,170 		0
-------------
83,368 		0
-------------
18,589 		0
-------------
863,206 		0
-------------
148,744
13Paula Friedman
 
Vice President, Senior VP-Strategic Development SSM Health 		(i)

(ii)		 0
-------------
724,285 		0
-------------
450,000 		0
-------------
371,543 		0
-------------
299,866 		0
-------------
9,712 		0
-------------
1,855,406 		0
-------------
550,740
14Kris Zimmer
 
Treasurer, Chief Financial Officer at SSM Health 		(i)

(ii)		 0
-------------
870,069 		0
-------------
600,000 		0
-------------
271,808 		0
-------------
356,499 		0
-------------
19,760 		0
-------------
2,118,136 		0
-------------
705,454
15Ed Chadwick
 
Interim System Vice President, Finance 		(i)

(ii)		 0
-------------
447,210 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
0 		0
-------------
447,210 		0
-------------
0
16Kerry Swanson
 
Former Key Employee 		(i)

(ii)		 0
-------------
445,866 		0
-------------
0 		0
-------------
49,278 		0
-------------
182,331 		0
-------------
32,462 		0
-------------
709,936 		0
-------------
24,157
17Laura Jelle
 
Pt Yr Hospital President-St Clare 		(i)

(ii)		 0
-------------
112,669 		0
-------------
0 		0
-------------
198,970 		0
-------------
1,731 		0
-------------
2,716 		0
-------------
316,086 		0
-------------
52,821
18Jonathan Rozenfeld
 
Hospital President - SSM Health St. Mary's Hospital - Madison 		(i)

(ii)		 489,518
-------------
0 		0
-------------
0 		24,140
-------------
0 		150,554
-------------
0 		24,950
-------------
0 		689,162
-------------
0 		0
-------------
0
19LAURA WALCZAK
 
Hospital President - SSM Health St. Clare Hospital - Baraboo 		(i)

(ii)		 195,144
-------------
0 		10,084
-------------
0 		18,682
-------------
0 		56,922
-------------
0 		10,955
-------------
0 		291,787
-------------
0 		8,702
-------------
0
20Ben Layman
 
Hospital President-SSM Health St. Mary's Hospital - Janesville 		(i)

(ii)		 196,010
-------------
0 		0
-------------
0 		18,393
-------------
0 		62,525
-------------
0 		27,119
-------------
0 		304,047
-------------
0 		0
-------------
0
21Mark Thompson
 
Regional Chief Medical Officer 		(i)

(ii)		 464,762
-------------
0 		0
-------------
0 		3,766
-------------
0 		137,069
-------------
0 		28,368
-------------
0 		633,964
-------------
0 		0
-------------
0
22Virginia Malone
 
VP Patient Services - St Mary's 		(i)

(ii)		 267,537
-------------
0 		0
-------------
0 		27,265
-------------
0 		64,034
-------------
0 		17,569
-------------
0 		376,404
-------------
0 		10,869
-------------
0
23Ginger Selle
 
Pt Yr VP Patient Care - St Clare 		(i)

(ii)		 90,588
-------------
0 		0
-------------
0 		41,393
-------------
0 		17,024
-------------
0 		16,360
-------------
0 		165,365
-------------
0 		31,352
-------------
0
24Larry Hegland
 
Regional Chief Medical Officer 		(i)

(ii)		 15,541
-------------
0 		0
-------------
0 		428,887
-------------
0 		1,159
-------------
0 		8,081
-------------
0 		453,667
-------------
0 		114,399
-------------
0
25Jonathan Lewis
 
VP Operations 		(i)

(ii)		 200,283
-------------
0 		0
-------------
0 		11,909
-------------
0 		53,890
-------------
0 		28,108
-------------
0 		294,190
-------------
0 		10,052
-------------
0
26Lon McPherson
 
VP-Medical Affairs 		(i)

(ii)		 359,977
-------------
0 		0
-------------
0 		40
-------------
0 		93,947
-------------
0 		24,675
-------------
0 		478,638
-------------
0 		0
-------------
0
27Linda Statz
 
Regional VP - Employee Experience 		(i)

(ii)		 0
-------------
211,499 		0
-------------
0 		0
-------------
28,841 		0
-------------
11,867 		0
-------------
25,282 		0
-------------
277,489 		0
-------------
24,679
28Chris Sprowl MD
 
Regional Clinical Affairs Officer 		(i)

(ii)		 0
-------------
566,049 		0
-------------
0 		0
-------------
18,551 		0
-------------
256,033 		0
-------------
27,080 		0
-------------
867,713 		0
-------------
0
29Margo Francisco
 
Regional VP - Strategy 		(i)

(ii)		 0
-------------
249,263 		0
-------------
0 		0
-------------
6,320 		0
-------------
71,545 		0
-------------
26,971 		0
-------------
354,099 		0
-------------
0
30Tom Ter Horst
 
System VP - Human Resources 		(i)

(ii)		 0
-------------
319,665 		0
-------------
0 		0
-------------
3,664 		0
-------------
112,825 		0
-------------
29,587 		0
-------------
465,741 		0
-------------
0
31Jennifer Orkfritz
 
Physician 		(i)

(ii)		 256,762
-------------
0 		0
-------------
0 		1,774
-------------
0 		14,490
-------------
0 		577
-------------
0 		273,603
-------------
0 		0
-------------
0
32Kansas Dubray
 
Physician 		(i)

(ii)		 302,259
-------------
0 		0
-------------
0 		3,045
-------------
0 		22,280
-------------
0 		9,418
-------------
0 		337,002
-------------
0 		0
-------------
0
33Debra Nyquist
 
Physician 		(i)

(ii)		 263,271
-------------
0 		18,750
-------------
0 		6,636
-------------
0 		3,886
-------------
0 		18,587
-------------
0 		311,131
-------------
0 		0
-------------
0
34Eric Marty
 
Medical Staff Director 		(i)

(ii)		 247,088
-------------
0 		0
-------------
0 		1,352
-------------
0 		8,573
-------------
0 		8,370
-------------
0 		265,383
-------------
0 		0
-------------
0
35David Jarvis
 
Physician 		(i)

(ii)		 260,456
-------------
0 		0
-------------
0 		1,267
-------------
0 		14,501
-------------
0 		24,720
-------------
0 		300,944
-------------
0 		0
-------------
0
Schedule J (Form 990) 2018

Schedule J (Form 990) 2018
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
Schedule J, Part I, Line 1a Tax indemnification and gross-up payments The following individuals listed on Part VII Section A received a tax indemnification/gross up payment in 2018. These payments were included in their taxable compensation. Kansas Dubray
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The organization's top management official, regional president, is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Schedule J, Part I, Line 4a Severance or change-of-control payment SSM Health has adopted a severance policy to provide a financial transition in the event of involuntary termination without cause for executive level positions. The amount of the compensation is based on the position held and length of service with SSMH. The following individuals listed in Part VII of the Form 990 received payments under the plan in the current year. Steven Caldwell $101,436 Larry Hegland $259,965 Christopher Howard $352,692 Laura Jelle $111,850
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Pension Restoration Plan: SSM Health (SSMH) provides this supplemental defined benefit nonqualified retirement plan to any employee who is a participant in the SSMH qualified defined benefit plan who earns over the Internal Revenue Service compensation limit. The plan "restores" the benefits to these employees that would have been provided under the SSMH qualified plan if the regulations did not impose compensation limits. An individual can take a distribution from the plan at (1) age 65 or older if the individual is still employed by SSMH or (2) age 55 or older if the individual is no longer employed by SSMH. The following individuals listed on Part VII of Form 990 received distributions from the plan in 2018: Laura Jelle $335,778 Capital Accumulation Plan: SSMH provides this supplemental nonqualified retirement plan to executive level employees. The organization contributed a percentage of the employee's base salary into their choice of a select list of investments. The deposits and earnings of the plan are owned by SSMH and are tax-deferred until a distribution is made to the employee. In addition, the plan has special safeguards in place to protect the funds from contingencies, other than insolvency. For contributions made to the plan in 2014 or after, the distribution will occur after the completion of four plan years for all executives that are still actively employed on the distribution date. Any active participant 65 years or older will receive the contribution in the current year. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2018. THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Christopher Howard $110,040 Steve Smoot $90,000 Carter Dredge $60,000 Damond Boatwright $74,400 Laura Kaiser $264,600 Paula Friedman $87,389 Kris Zimmer $105,240 Ben Layman $16,400 Jonathan Rozenfeld $39,710 Ginger Selle $6,346 Laura Walczak $7,491 Linda Statz $8,605 Mark Thompson, MD $38,000 Chris Sprowl, MD $69,000 Jonathan Lewis $8,410 Margo Francisco $20,648 Tom Ter Horst $26,490 Lon McPherson $14,661 Kerry Swanson $54,776 The following individuals listed on Part VII of the Form 990 received distributions from this plan in 2018. All distributions received from the plan in the current year were included in the individual's taxable compensation. Damond Boatwright $89,103 Steven Caldwell $190,941 Paula Friedman $100,740 Larry Hegland $114,399 Christopher Howard $685,002 Laura Jelle $52,821 Jonathan Lewis $10,052 Virginia Malone $21,721 June Pickett $41,882 Ginger Selle $31,352 Linda Statz $24,679 Kerry Swanson $24,157 Laura Walczak $8,702 Kris Zimmer $105,454 During 2018, the following individuals participated in a nonqualified retirement plan from the organization or a related organization. The amounts reported below represent the change in accrued benefit for each individual and also include amounts accrued under the pension restoration plan. The amounts below are in addition to those reported in Part II, Column C: Damond Boatwright ($2,203) Kansas Dubray $5,821 Paula Friedman $252,107 Larry Hegland ($1,949) Christopher Howard $399,961 David Jarvis ($2,735) Jonathan Lewis ($1,022) Virginia Malone ($96) Eric Marty $269 Jennifer Orkfritz ($2,763) June Pickett ($101,871) Jonathan Rozenfeld $12,544 Linda Statz $28,929 Kerry Swanson $8,476 Laura Walczak ($944) Kris Zimmer $137,310
Schedule J (Form 990) 2018
Additional Data


Software ID: 18007697
Software Version: 2018v3.1
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
SSM Health Care of Wisconsin Inc
 
Employer identification number

43-0688874
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2018
Schedule L (Form 990 or 990-EZ) 2018
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Integrated Healthcare Financial Strategies LLC
  		ED CHADWICK - OFFICER 447,210 Contract services   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2018


Additional Data


Software ID: 18007697
Software Version: 2018v3.1




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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
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 III, Line 4a Description of Program Service Briefly describe the corporation's mission: Since it was founded in 1872 by Catholic sisters, SSM Health (SSMH) has existed to meet the health needs of the communities it serves. SSMH is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through one of the largest integrated delivery systems in the nation. With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSMH includes 23 acute care hospitals, one children's hospital, more than 300 physician offices and other outpatient and virtual care services, 10 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company, and an Accountable Care Organization. The health system employs more than 40,000 people and is affiliated with more than 9,900 physicians making it one of the largest employers in every community it serves. In the tradition of its founding sisters, SSMH strives to fulfill its mission by providing exceptional health care to everyone who comes to its hospitals, regardless of their ability to pay. About SSM Health Care of Wisconsin: SSM Health Care of Wisconsin provides health care services at three wholly-owned acute care hospitals, SSM Health St. Mary's Hospital - Madison, SSM Health St. Clare Hospital - Baraboo and SSM Health St. Mary's Hospital - Janesville, as well as at two nursing homes - SSM Health St. Mary's Care Center in Madison and SSM Health St. Clare Meadows Care Center in Baraboo. SSM Health Care of Wisconsin, including its three wholly owned hospitals and two nursing homes, earned Wisconsin's highest recognition of quality business practices in 2013: the Excellence Level of the Wisconsin Forward Award. The honor remains in effect for five years. SSM Health Care of Wisconsin, in partnership with SSM Health Dean Medical Group, also earned recognition as a finalist for OrthoServiceLine.com's Ortho Transformation Award. The award highlighted the Steady Strides Joint Replacement Program which is available at all three acute care hospitals. SSM Health St. Mary's Hospital - Madison is a 440-bed tertiary referral hospital offering inpatient and outpatient treatment and diagnostic services in primary care and nearly all specialties. The campus includes an outpatient surgery center and an employee child care center. St. Mary's also operates an off-site Adult Day Health Center, is owner of a home health care organization, and is affiliated with the SSM Health St. Mary's Care Center (a skilled nursing facility) on Madison's southwest side. St. Mary's Hospital in partnership with SSM Health Dean Medical Group has chosen to participate in a Medicare Accountable Care Organization Program. St. Mary's Hospital offers a full range of inpatient and outpatient treatment and diagnostic services in primary care and nearly all specialties. St. Mary's was also redesignated as a Magnet hospital in 2017 and has previously attained elite status as well. Magnet hospitals are considered "the gold standard" of nursing. Their emphasis on quality, innovation and collaboration tends to lead to better outcomes, high patient satisfaction and a more stable workforce. In 2018, St. Mary's Hospital was recognized by the Women's Choice Award for high standards in obstetrics and also by the Watson Health 100 Top Hospitals. SSM Health St. Clare Hospital - Baraboo offers acute care services as well as a wide range of other services including chemical dependency treatment and hemodialysis. St. Clare also offers cardiac rehabilitation, orthopedics, women's services, and older adult services and senior living. SSM Health St. Clare Meadows Care Center, an affiliate of St. Clare Hospital, provides a variety of healthcare and living options for the elderly of the greater Baraboo and Sauk County area. The 100-bed Medicare and Medicaid skilled nursing facility provides 24-hour nursing care for temporary rehabilitation care or permanent care basis in an atmosphere that celebrates the needs of the individual. SSM Health St. Mary's Hospital - Janesville operates a 50-bed hospital and an adjacent physicians' office complex. The hospital serves its community through emergency services, inpatient and outpatient services, a sleep lab, radiology, cardiology rehabilitation, and palliative care consulting. Built in 2012, the medical campus provides all private rooms, electronic health records, and a state-of-the-art emergency department. SSM Health Care of Wisconsin also furthers its exempt purpose with the following activities: - Operates an emergency room that is open to all persons regardless of ability to pay - Has an open medical staff with privileges available to all qualified physicians in the area - Has a governing body in which independent persons representative of the community comprise a majority - Engages in the training and education of health care professionals - Participates in Medicaid, Medicare, Champus, Tricare, and/or other government-sponsored health care programs - All surplus funds generated by SSMH entities are reinvested in improving our patient care delivery system. Quantifiable Uncompensated Care: The following is a list of the types of programs and services that could be included as uncompensated care: Traditional Charity Care $ 7,048,500 Unpaid Cost of Medicaid $ 29,545,654 Unpaid Cost of Medicare $ 14,080,934 Unpaid Cost of Other Government Programs $ 1,088,500 Total Quantifiable Uncompensated Care $ 51,763,588
Form 990, Part V, Line 1a Common Paymaster ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223.
Form 990, Part VI, Line 15a Process for determining compensation The organization's top management official, regional president, is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 15b Process for determining compensation The organization's top management official, regional president, is compensated by a related organization that utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.
Form 990, Part VI, Line 4 Significant changes to organizational documents The bylaws of the filing organization were amended during the year for the following items: A. Removal of clause that Class B Directors must include a physician. B. New reference that the "President" refers to the Regional President-Operations. C. Additional responsibilities of the Board to conduct an annual self-evaluation and annually obtain Conflict of Interest forms. D. Adjustment to the number of Class A Directors and Class B Directors. E. Updating references to Joint Nominating Committee with the Regional Governance and Engagement Committee. F. The President is now the Chairperson where he was previously the Vice-Chairperson. Additionally, the member will appoint the Vice-Chairperson where previously the member appointed the Chairperson.
Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE 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.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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 ARTICLES 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 INTEREST IN THE PROPERTY OF THE CORPORATION P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO 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, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS, AND OBJECTIVES OF THE MEMBER AS DETERMINED BY THE MEMBER Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN 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, Line 8b Documentation of meetings held by committees of governing body The organization does not have any committees with authority to act on behalf of the governing body.
Form 990, Part VI, Line 11b Review of form 990 by governing body The Form 990 is prepared by the Tax Department of the parent organization, SSM Health Care Corporation (SSM). The Form 990 is reviewed by certain members of Senior Management. Any questions are addressed to the Tax Director of SSM prior to filing the Form 990 with the Internal Revenue Service. A copy of the Form 990 is provided to the Board of Directors at the next regularly scheduled board meeting.
Form 990, Part VI, Line 12c Conflict of interest policy 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 ONLINE. 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, Line 19 Required documents available to the public THE YEAR-END AUDITED CONSOLIDATED FINANCE STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'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 VII, Section A Compensation of Former Officers Compensation of select former officers reported on Form 990, Schedule A, represents amounts paid from a related organization for continued service to that related organization.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue ALL OTHER REVENUE - Total Revenue: 4486453, Related or Exempt Function Revenue: , Unrelated Business Revenue: 19818, Revenue Excluded from Tax Under Sections 512, 513, or 514: 4466635;
Form 990, Part IX, Line 11g Other Fees Medical and other professional services - Total Expense: 60189223, Program Service Expense: 34990262, Management and General Expenses: 24694865, Fundraising Expenses: 504096;
Form 990, Part X, Line 29 Adoption of ASC 958-205 Effective for the 2018 calendar year, the organization has adopted ASC 958-205, which modifies how Not-for-Profit Entities present their net asset balances for Financial Statement reporting. The organization will report ending balances on Part X, Balance Sheet, in accordance with ASC 958-205 and include all amounts previous reported as temporarily restricted net assets and permanently restricted net assets on line 29.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in beneficial interest in foundations - -5521890; Transfers to affiliates - -16145928;
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 ST. CLARE MEADOWS CARE CENTER ST. CLARE URGENT CARE AT LAKE DELTON ST. CLARE URGENT CARE AT WISCONSIN DELLS ST. MARY'S CARE CENTER ST. MARY'S HOSPITAL MEDICAL CENTER ST. MARY'S JANESVILLE HOSPITAL SSM HEALTH ST. CLARE MEADOWS CARE CENTER SSM HEALTH ST. MARY'S CARE CENTER SSM HEALTH ST. MARY'S HOSPITAL - MADISON SSM HEALTH ST. CLARE HOSPITAL - BARABOO SSM HEALTH ST. MARY'S HOSPITAL - JANESVILLE
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


Additional Data


Software ID: 18007697
Software Version: 2018v3.1
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2018
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?
Yes No
(1)SSM Health Care Corporation
10101 Woodfield Lane

St Louis,MO63132
46-6029223 		Health Care MO 501(c)(3) Type I SSM Health Ministries
 
 
No
(2)SSMHC Liability Trust I
10101 Woodfield Lane

St Louis,MO63132
43-6331003 		Insurance MO 501(c)(3) Type 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) 10 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) Type 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) 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) 7 SSM Cardinal Glennon Children's Hospital
 
 
No
(8)SSM Health Foundation - St Louis
10101 Woodfield Lane

St Louis,MO63132
43-1552945 		Fundraising MO 501(c)(3) 7 SSM Health Care St Louis
 
 
No
(9)SSM Health Care of Oklahoma Inc
10101 Woodfield Lane

St Louis,MO63132
73-0657693 		Health Care OK 501(c)(3) 3 SSM Health Care Corporation
 
 
No
(10)The St Anthony Hospital Foundation Inc
10101 Woodfield Lane

St Louis,MO63132
73-6104300 		Fundraising OK 501(c)(3) 7 SSM Health Care of Oklahoma
 
 
No
(11)Dells Medical Building Inc
10101 Woodfield Lane

St Louis,MO63132
39-1613292 		MOB WI 501(c)(2)   SSM Health Care of Wisconsin
 
Yes
 
(12)St Mary's Foundation Inc
10101 Woodfield Lane

St Louis,MO63132
43-1940686 		Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin
 
Yes
 
(13)St Clare Health Care Foundation Inc
10101 Woodfield Lane

St Louis,MO63132
43-1940683 		Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin
 
Yes
 
(14)Home Health United Inc
2802 Walton Commons Lane

Madison,WI53718
39-1539827 		Health Care WI 501(c)(3) 10 SSM Health Care of Wisconsin
 
Yes
 
(15)Home Care United Inc
2802 Walton Commons Lane

Madison,WI53718
39-1776340 		Health Care WI 501(c)(3) 10 SSM Health Care of Wisconsin
 
Yes
 
(16)HHU Xtra Care Inc
2802 Walton Commons Lane

Madison,WI53718
39-1705111 		Health Care WI 501(c)(3) 10 SSM Health Care of Wisconsin
 
Yes
 
(17)SSM Health at Home Foundation of Wisconsin Inc
2802 Walton Commons Lane

Madison,WI53718
39-1839309 		Fundraising WI 501(c)(3) Type I Home Health United Inc
 
 
No
(18)SSM Regional Health Services
10101 Woodfield Lane

St Louis,MO63132
44-0579850 		Health Care MO 501(c)(3) 3 SSM Health Care Corporation
 
 
No
(19)St Mary's Health Center Jefferson City Missouri Foundation
10101 Woodfield Lane

St Louis,MO63132
43-1575307 		Fundraising MO 501(c)(3) Type I SSM Regional Health Services
 
 
No
(20)Good Samaritan Regional Health Center
10101 Woodfield Lane

St Louis,MO63132
43-0653587 		Health Care IL 501(c)(3) 3 SSM Regional Health Services
 
 
No
(21)St Mary's Hospital Centralia Illinois
10101 Woodfield Lane

St Louis,MO63132
37-0662580 		Health Care IL 501(c)(3) 3 SSM Regional Health Services
 
 
No
(22)St Mary's - Good Samaritan Inc
10101 Woodfield Lane

St Louis,MO63132
36-4170833 		Health Care IL 501(c)(3) Type I SSM Regional Health Services
 
 
No
(23)Good Samaritan Regional Health Center Foundation
10101 Woodfield Lane

St Louis,MO63132
26-2884795 		Fundraising IL 501(c)(3) 7 St Mary's-Good Samaritan Inc
 
 
No
(24)St Mary's Hospital Foundation
10101 Woodfield Lane

St Louis,MO63132
36-4636691 		Fundraising IL 501(c)(3) 7 St Mary's-Good Samaritan Inc
 
 
No
(25)St Mary's Hospital Auxiliary
400 N Pleasant

Centralia,IL62801
23-7126345 		Fundraising IL 501(c)(3) 10 St Mary's Hospital Foundation
 
 
No
(26)SSM Health Businesses
10101 Woodfield Lane

St Louis,MO63132
43-1333488 		Health Care MO 501(c)(3) 10 SSM Health Care Corporation
 
 
No
(27)SSM Health Care St Louis
10101 Woodfield Lane

St Louis,MO63132
43-1343281 		Health Care MO 501(c)(3) 3 SSM Health Care Corporation
 
 
No
(28)Centralia Medical Services Bldg Assoc
10101 Woodfield Lane

St Louis,MO63132
23-7408025 		MOB IL 501(c)(3) Type I SSM Regional Health Services
 
 
No
(29)St Mary's Janesville Foundation Inc
10101 Woodfield Lane

St Louis,MO63132
27-3439133 		Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin
 
Yes
 
(30)SSM Health Ministries
3221 McKelvey Road Suite 107

Bridgeton,MO63044
43-1012492 		Religious Organization MO 501(c)(3) 1 NA
 
 
No
(31)Lee Dewey Corporation
10101 Woodfield Lane

St Louis,MO63132
73-1279603 		MOB OK 501(c)(3) Type I SSM Health Care of Oklahoma
 
 
No
(32)SSM Hospice & Home Care Foundation
10101 Woodfield Lane

St Louis,MO63132
30-0012246 		Fundraising MO 501(c)(3) 7 SSM Health Businesses
 
 
No
(33)St Mary's Hospital Auxiliary
100 St Marys Medical Plaza

Jefferson City,MO65101
43-6049878 		Fundraising MO 501(c)(3) Type II NA
 
 
No
(34)Good Samaritan Hospital Auxiliary
1 Good Samaritan Way

Mount Vernon,IL62864
23-7049599 		Fundraising IL 501(c)(3) Type III-FI NA
 
 
No
(35)St Anthony Shawnee Hospital Inc
1000 N Lee Ave

Oklahoma City,OK73102
45-5055149 		Health Care OK 501(c)(3) 3 SSM Health Care of Oklahoma
 
 
No
(36)SSM Audrain Health Care Inc
10101 Woodfield Lane

St Louis,MO63132
43-1550298 		Health Care MO 501(c)(3) 3 SSM Regional Health Services
 
 
No
(37)Audrain Medical Center Foundation Inc
620 E Monroe St

Mexico,MO65265
43-1265060 		Fundraising MO 501(c)(3) Type I NA
 
 
No
(38)SSM-SLUH Inc
10101 Woodfield Lane

St Louis,MO63132
47-4196634 		Health Care MO 501(c)(3) 3 SSM Health Care St Louis
 
 
No
(39)SSM Health Plan
1277 Deming Way

Madison,WI53717
83-1979548 		Insurance MO 501(c)(4)   SSM Health Businesses
 
 
No
(40)Agnesian Healthcare Inc
430 E Division St

Fond du Lac,WI54935
39-0807236 		Health Care WI 501(c)(3) 3 SSM Health Care of Wisconsin
 
Yes
 
(41)Ripon Medical Center Inc
845 Parkside Street

Ripon,WI54971
39-1101287 		Health Care WI 501(c)(3) 3 Agnesian Healthcare Inc
 
 
No
(42)Waupun Memorial Hospital Inc
620 West Brown Street

Waupun,WI53963
39-0806265 		Health Care WI 501(c)(3) 3 Agnesian Healthcare Inc
 
 
No
(43)St Francis Home of Fond du Lac Wisconsin Inc
33 Everett Street

Fond du Lac,WI54935
39-1029998 		Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc
 
 
No
(44)Sister Servants of Christ the King Villa Loretto
N8114 County WW

Mount Calvary,WI53057
39-1022770 		Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc
 
 
No
(45)Villa Rosa Inc
N8120 County WW

Mount Calvary,WI53057
42-1670962 		Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc
 
 
No
(46)The Christian Home and Rehabilitation Center Incorporated
331 Bly Street

Waupun,WI53963
39-0884514 		Health Care WI 501(c)(3) 10 Agnesian Healthcare Inc
 
 
No
(47)The Monroe Clinic Inc
515 22nd Avenue

Monroe,WI53566
39-0808509 		Health Care WI 501(c)(3) 3 SSM Health Care of Wisconsin
 
Yes
 
(48)Monroe Clinic and Hospital Foundation Inc
515 22nd Avenue

Monroe,WI53566
20-5769038 		Fundraising WI 501(c)(3) 7 SSM Health Care of Wisconsin
 
Yes
 
(49)Agnesian Healthcare Foundation Inc
430 E Division St

Fond du Lac,WI54935
39-1684956 		Fundraising WI 501(c)(3) Type I SSM Health Care of Wisconsin
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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
Yes No Yes No
(1) SSM St Joseph Endoscopy Center LLC

10101 Woodfield Lane
St Louis,MO63132
27-0046559 		Surgery Services MO NA
  		N/A 0 0     0     0 %
(2) St Clare Imaging Services LLC

707 14th Street Suite A
Baraboo,WI53913
20-0122365 		Diag. Services WI NA
  		N/A 0 0     0     0 %
(3) Mt Vernon Radiation Therapy Center LLC

10101 Woodfield Lane
St Louis,MO63132
20-1382620 		Radiation Therapy IL NA
  		N/A 0 0     0     0 %
(4) Sleep & Neurology Center of Southern Illinois LLC

10101 Woodfield Lane
St Louis,MO63132
20-8468195 		Diag. Services IL NA
  		N/A 0 0     0     0 %
(5) CHOWSMGSI Office Building LLC

10101 Woodfield Lane
St Louis,MO63132
37-1383861 		MOB IL NA
  		N/A 0 0     0     0 %
(6) Oza Cancer Center LLC

10101 Woodfield Lane
St Louis,MO63132
20-1382727 		MOB IL NA
  		N/A 0 0     0     0 %
(7) Shawnee Real Estate Holdings LLC

1000 N Lee Ave
Oklahoma City,OK73102
45-5458304 		MOB OK NA
  		N/A 0 0     0     0 %
(8) Dean Clinic & St Mary's Hospital Accountable Care Organization LLC

1808 West Beltline Highway
Madison,WI53713
45-2995500 		Accountable Care Organization WI NA
  		N/A 0 0     0     0 %
(9) Wisconsin Integrated Information Technology and Telemedicine Systems LLC

1808 West Beltline Highway
Madison,WI53713
39-2016715 		Information Technology Services WI NA
  		N/A 0 0     0     0 %
(10) Dean Health Holdings LLC

1277 Deming Way
Madison,WI53717
26-1594709 		Support Services WI NA
  		N/A 857,272 1,555,573   No 0   No 47.37 %
(11) Wingra Building Group

1808 West Beltline Highway
Madison,WI53713
39-0237060 		MOB WI NA
  		N/A 0 0     0     0 %
(12) Janesville Riverview Clinic Building Partnership

1808 West Beltline Highway
Madison,WI53713
39-6220698 		MOB WI NA
  		N/A 0 0     0     0 %
(13) 1110 N Classen Blvd LLC

1110 N Classen Boulevard
Oklahoma City,OK73106
73-1158158 		MOB OK NA
  		N/A 0 0     0     0 %
(14) SSM St Clare Surgical Center LLC

10101 Woodfield Lane
St Louis,MO63132
26-1439695 		Surgery Services MO NA
  		N/A 0 0     0     0 %
(15) Windmill LLP

50 Village View Lane
Chesterfield,MO63017
43-1804651 		Investments MO NA
  		N/A 0 0     0     0 %
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
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) SSM Managed Care Organization LLC

10101 Woodfield Lane
St Louis,MO63132
43-1708511 		Health Promotion MO NA
  		C Corporation 0 0 0 %   No
(2) FPP INC & Subs

10101 Woodfield Lane
St Louis,MO63132
43-1465174 		Health Care MO NA
  		C Corporation 0 0 0 %   No
(3) Diversified Health Services Corp

10101 Woodfield Lane
St Louis,MO63132
43-1369305 		Medical Equipment MO NA
  		C Corporation 0 0 0 %   No
(4) SSM Cardiovascular and Thoracic Services Inc

10101 Woodfield Lane
St Louis,MO63132
26-0286559 		Health Care MO NA
  		C Corporation 0 0 0 %   No
(5) SSM Properties Inc

10101 Woodfield Lane
St Louis,MO63132
43-1462486 		Property Services MO NA
  		C Corporation 0 0 0 %   No
(6) SSM DePaul Medical Group Inc

10101 Woodfield Lane
St Louis,MO63132
43-1715106 		Health Care MO NA
  		C Corporation 0 0 0 %   No
(7) SSM St Charles Clinic Medical Group Inc

10101 Woodfield Lane
St Louis,MO63132
43-0626408 		Physician Offices MO NA
  		C Corporation 0 0 0 %   No
(8) HealthFirst Physician Management Services

10101 Woodfield Lane
St Louis,MO63132
73-1534336 		Medical Services OK NA
  		C Corporation 0 0 0 %   No
(9) SSMHC Liability Trust II

10101 Woodfield Lane
St Louis,MO63132
81-6128118 		Insurance MO NA
  		C Corporation 0 0 0 %   No
(10) SSM Neurosciences Inc

10101 Woodfield Lane
St Louis,MO63132
26-3413981 		Health Care MO NA
  		C Corporation 0 0 0 %   No
(11) SSM Medical Group Inc

10101 Woodfield Lane
St Louis,MO63132
43-1664107 		Physician Offices MO NA
  		C Corporation 0 0 0 %   No
(12) SSMHC Insurance Company

10101 Woodfield Lane
St Louis,MO63132
03-0310431 		Insurance   NA
  		C Corporation 0 0 0 %   No
(13) SSM Orthopedic Inc

10101 Woodfield Lane
St Louis,MO63132
27-1557033 		Health Care MO NA
  		C Corporation 0 0 0 %   No
(14) SSM Cancer Care Inc

10101 Woodfield Lane
St Louis,MO63132
27-1557324 		Health Care MO NA
  		C Corporation 0 0 0 %   No
(15) Physicians Services Corp of Southern Illinois Inc

10101 Woodfield Lane
St Louis,MO63132
36-4161526 		Health Care IL NA
  		C Corporation 0 0 0 %   No
(16) Dean Health Systems Inc

1808 West Beltline Highway
Madison,WI53713
39-1128616 		Physician Offices WI NA
  		C Corporation 0 0 0 %   No
(17) Dean Health Insurance Inc

PO Box 56099
Madison,WI53705
39-1830837 		Insurance WI NA
  		C Corporation 0 0 0 %   No
(18) Dean Health Plan Inc

PO Box 56099
Madison,WI53705
39-1535024 		Insurance WI NA
  		C Corporation 0 0 0 %   No
(19) SMDV Office Building

1808 West Beltline Highway
Madison,WI53713
39-1628491 		Physician Offices WI NA
  		C Corporation 0 0 0 %   No
(20) Dean Retail Services Inc

1808 West Beltline Highway
Madison,WI53713
39-1717636 		Property Services WI NA
  		C Corporation 0 0 0 %   No
(21) Navitus Holdings LLC

1808 West Beltline Highway
Madison,WI53713
80-0968174 		Pharmacy Benefits WI NA
  		C Corporation 0 0 0 %   No
(22) Oza Oncology Inc

4117 Veterans Memorial Drive
Mt Vernon,IL62804
37-1343746 		Physician Offices IL NA
  		C Corporation 0 0 0 %   No
(23) SSM Health Janesville Campus Condominium Association Inc

1808 West Beltline Highway
Madison,WI53713
83-2038674 		Condo association WI NA
  		C Corporation 0 0 33.33 %   No
(24) SSM Health Pharmacy LLC

10101 Woodfield Lane
St Louis,MO63132
26-4031708 		Pharmacy MO NA
  		C Corporation 0 0 0 %   No
Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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
No
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 .....................
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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 4,240,719 Cash
(2) St Clare Health Care Foundation Inc

 C 207,068 Cash
(3) Dells Medical Building Inc

 A 37,244 Cash
(4) St Mary's Janesville Foundation Inc

 C 61,368 Cash
(5) St Clare Health Care Foundation Inc

 B 22,353 Cash

Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2018
Schedule R (Form 990) 2018
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) 2018

Additional Data


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