TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) STEVEN N LITTLE...................................................................... REGIONAL CEO SSM HEALTH- WI	50.00 .................	X	X	1,661,617	0	41,563
(2) JOAN KARSTEN...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(3) SR HERTHA LONGO...................................................................... TREASURER	1.00 .................	X	X	0	0	0
(4) THOR H GILBERTSON...................................................................... VICE CHAIRPERSON	1.00 .................	X	X	0	0	0
(5) WAYNE E MATZKE...................................................................... CHAIRPERSON	1.00 .................	X	X	0	0	0
(6) DR JEFFERY STRONG...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(7) DR JUDITH WESTPHAL...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(8) MARYSUE MICHELS...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(9) THOMAS SCHUESSLER...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(10) DR TONI STANLEY...................................................................... SECRETARY	1.00 .................	X		0	0	0
(11) SR MARIE SCOTT...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(12) SR SUSAN M STUCKI...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(13) DR MARK THOMPSON MD...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(14) DR TED MILLER MD...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(15) PAULA FRIEDMAN...................................................................... SSM VP, CHEIF STRATEGY	1.00 ................. 54.00	X	X	0	856,416	891,366
(16) JUNE PICKETT...................................................................... SSM SECRETARY, ASST VP GOVERNANCE	1.00 ................. 65.10		X	0	262,856	51,074
(17) KRIS ZIMMER...................................................................... SSM TREASURER, SENIOR VP FINANCE	1.00 ................. 57.00		X	0	973,103	961,176

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JAMES P MUGAN........................................................................ SR VP CLINICAL SERVICES	50.00 .......................	X		333,960	43,609
(19) BONNIE R SCHMITZ........................................................................ CHIEF FINANCIAL OFFICER	50.00 .......................	X		523,125	49,394
(20) SUSAN L EDMINSTER........................................................................ VP - HUMAN RESOURCES	50.00 .......................	X		360,903	38,974
(21) NANCY A BIRSCHBACH........................................................................ VP - CIO	50.00 .......................	X		381,785	47,261
(22) BARBARA L KNUTZEN........................................................................ PRES AND CEO-AHE AND PERFO	50.00 .......................	X		295,016	36,583
(23) HOLLY BRENNER........................................................................ VP STRATEGIC DEVELOPMENT/M	50.00 .......................	X		362,506	17,273
(24) MICHAEL DEGERE........................................................................ VP POPULATION HEALTH MANAG	50.00 .......................	X		389,910	43,415
(25) MICHAEL DREES........................................................................ CHIEF OPERATING OFFICER FD	50.00 .......................	X		296,651	49,143
(26) KATHERINE VERGOS........................................................................ CHIEF NURSING OFFICER	50.00 .......................	X		291,616	17,832
(27) JOHN CHOI MD........................................................................ ANESTHESIOLOGIST - PAIN RE	50.00 .......................		X	751,708	41,698
(28) YASIR HATAHET MD........................................................................ INTENSIVIST/PULMONOLOGIST	50.00 .......................		X	887,671	49,447
(29) MICHAEL VANDER KOOY MD........................................................................ RADIATION ONCOLOGIST	50.00 .......................		X	690,665	50,327
(30) STEVEN FLURRY MD........................................................................ ANESTHESIOLOGIST	50.00 .......................		X	642,056	35,882
(31) PONTUS OSTMAN MD........................................................................ PHYSICIAN-PAIN MEDICINE	50.00 .......................		X	676,214	17,219

(A) Name and business address	(B) Description of services	(C) Compensation
FOND DU LAC REGIONAL CLINIC 420 E DIVISION ST FOND DU LAC,WI54935	PHYSICIAN SERVICES	52,736,790
CERNER CORP 2800 ROCKCREEK PKWY KANSAS CITY,MO64141	COMPUTER SERVICES	11,855,139
CD SMITH CONSTRUCTION PO BOX 1066 FOND DU LAC,WI54935	CONSTRUCTION	8,597,250
MEDICAL COLLEGE OF WI 8701 WATERTOWN PLANK RD PO BOX 26 WAUWATOSA,WI53226	PHYSICIAN SERVICES	2,568,455
MI-HEALTH HOLDINGS PO BOX 128 BROWNSVILLE,WI530060128	COMPUTER SERVICES	1,169,282
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 81

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

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.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


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) 2019

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2019

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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

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

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2019

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

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.

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) .

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).

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.

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.

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.

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

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) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

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

11b

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

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

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?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization AGNESIAN HEALTHCARE INC

Part I Contributors	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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization AGNESIAN HEALTHCARE INC		Employer identification number 39-0807236

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization AGNESIAN HEALTHCARE INC			Employer identification number 39-0807236
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Part I-A

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

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

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
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) 2019

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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)

Yes|No

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

20,420

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

20,420

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Return Reference	Explanation
PART II-B, LINE 1:	LOBBYING PORTION OF WISCONSIN HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," 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 instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

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 ........

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

If the organization elected, as permitted under FASB 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

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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

Part V

Endowment Funds.
Complete if the organization answered "Yes" 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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

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 .....	6,716,640		6,716,640
b	Buildings ....	208,630,852	99,116,202	109,514,650
c	Leasehold improvements	4,006,335	2,244,961	1,761,374
d	Equipment ....	182,261,137	138,509,516	43,751,621
e	Other .....	4,421,888		4,421,888
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				166,166,173

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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)DUE FROM AFFILIATED ENTITIES				9,931,801
(2)INVESTMENT - MERCURY CLINIC				3,005,130
(3)INVESTMENT - SAH FOUNDATION				13,257,747
(4)LIMITED USE ASSETS - BOND FUNDS				18,237,877
(5)LIMITED USE ASSETS - PHYSICIAN SUPPLEMENTAL BENEFIT PLAN				46,207,334
(6)OTHER RECEIVABLES				5,055,446
(7)MISCELLANEOUS				1,739,231
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				97,434,566

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	177,468,360
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) 2019

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	393,440,538
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	0
3	Subtract line 2e from line 1..................		3	393,440,538
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	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5	393,440,538

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	378,010,693
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	0
3	Subtract line 2e from line 1...................		3	378,010,693
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	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5	378,010,693

Part XIII

Supplemental Information

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

Return Reference	Explanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:	NONOPERATING INCOME

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" 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

2019

Open to Public Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other 16500.0000000000 %

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

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

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.

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

Yes

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

Yes

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

Yes

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,126,944		1,126,944	0.300 %
b	Medicaid (from Worksheet 3, column a) . . . . .	22,920,434		22,920,434	6.060 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	24,047,378		24,047,378	6.360 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1,613,592	238,615	1,374,977	0.360 %
f	Health professions education (from Worksheet 5) . . .	732,968		732,968	0.190 %
g	Subsidized health services (from Worksheet 6) . . . .	845,520	23,650	821,870	0.220 %
h	Research (from Worksheet 7) .	5,387		5,387	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	193,620		193,620	0.050 %
j	Total. Other Benefits . .	3,391,087	262,265	3,128,822	0.820 %
k	Total. Add lines 7d and 7j .	27,438,465	262,265	27,176,200	7.180 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	15,570	15,570	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	4,249	4,249	0 %
7	Community health improvement advocacy
8	Workforce development	115,239	115,239	0.030 %
9	Other
10	Total	135,058	135,058	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

13,504,473

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

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

Section B. Medicare

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

123,744,927

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

186,521,599

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

-62,776,672

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2019

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?1Name, 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)
1	ST AGNES HOSPITAL 430 E DIVISION STREET FOND DU LAC,WI54935	X	X	X

Schedule H (Form 990) 2019

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)

	ST AGNES HOSPITAL
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):

Yes

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

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 .................

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..................................

Yes

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. ............................

Yes

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

Yes

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

Hospital facility’s website (list url): WWW.AGNESIAN.COM, SEE PART V, PAGE 8

Other website (list url): WWW.FDLCO.WI.GOV/HOME/SHOWDOCUMENT?ID=15481

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.FDLCO.WI.GOV/HOME/SHOWDOCUMENT?ID=20012

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ST AGNES HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 165.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE

The FAP application form was widely available on a website (list url):

WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE

A plain language summary of the FAP was widely available on a website (list url):
WWW.AGNESIAN.COM/PAGE/FINANCIAL-ASSISTANCE

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	ST AGNES HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	ST AGNES HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

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, 20a, 20b, 20c, 20d, 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
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 5: THE CHNA WAS COMMISSIONED BY AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), AURORA HEALTHCARE, FOND DU LAC AREA UNITED WAY, FOND DU LAC COUNTY HEALTH DEPARTMENT, FOND DU LAC FAMILY YMCA, AND FOND DU LAC SCHOOL DISTRICT. THE TASK FORCE REVIEWED COUNTY AND STATE DISEASE INCIDENCE AND DEATH DATA, AS WELL AS ECONOMIC, DEMOGRAPHIC, AND HEALTH STATUS DATA. TO SUPPLEMENT THIS DATA, COMMUNITY AND STAKEHOLDER OPINION SURVEYS WERE CONDUCTED TO DETERMINE WHAT PEOPLE IN FDL COUNTY PERCEIVED AS THE MAJOR HEALTH PROBLEMS IN THE COUNTY. COMMUNITY MEMBERS WERE SCIENTIFICALLY SELECTED SO THAT THE SURVEY WOULD BE REPRESENTATIVE OF ALL ADULTS 18 YEARS OLD AND OLDER. A TOTAL OF 400 TELEPHONE INTERVIEWS WERE COMPLETED WITH COMMUNITY MEMBERS. THE FOND DU LAC HEALTH 2020 COALITION, WHICH WAS FORMED AFTER THE 2014 SURVEY, RESPONDED TO THE NEEDS IDENTIFIED IN THE CHNA. THE HEALTHY 2020 STEERING COMMITTEE INCLUDES THE FOLLOWING MEMBERS: MICHAEL DEGERE, DPM, AGNESIAN HEALTHCARE/SSM HEALTH; ERIN GERRED, FOND DU LAC COUNTY, GREG GILES, FOND DU LAC YMCA, SARA HATHAWAY, RIPON COLLEGE, AMBER KILAWEE, FOND DU LAC AREA UNITED WAY; BILL LAMB, FOND DU LAC CITY POLICE DEPARTMENT; KIM MUELLER, FOND DU LAC COUNTY HEALTH DEPARTMENT, KELLY NORTON, ST. MARY'S SPRINGS ACADEMY; LALITHA RAMAMOORTHY, PH. D, MARION UNIVERSITY; LARRY RICHARDSON, FABOH; JACKIE RUNGE, FOND DU LAC AREA FOUNDATION; MARTY RYAN, ROTARY; JIM SALASEK, PH.D., COMMUNITY MEMBER; HEATHER SCHMIDT, DO, AGNESIAN HEALTHCARE/SSM HEALTH; LORI SCHRAGE, MORAINE PARK TECHNICAL COLLEGE; MARIAN SHERIDAN, FOND DU LAC SCHOOL DISTRICT; MICHELLE TIDEMANN, UW- EXTENSION FOND DU LAC; ERIC TONEY, FOND DU LAC COUNTY; JENNIFER WALTERS, AURORA HEALTH CARE; MELISSA WORTHINGTON, ENVISION GREATER FOND DU LAC. THE HEALTHY 2020 COALITION HAS TAKEN THE LEAD ON DISTRIBUTION OF INFORMATION TO THE PUBLIC, AS WELL AS CONTINUING COMMUNITY UPDATES AND ASSESSMENT OF PROGRESS.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 6A: HOSPITALS INCLUDED IN THE CHNA WERE AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL), WAUPUN MEMORIAL HOSPITAL AND RIPON MEDICAL CENTER.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED BY AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPON MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), AURORA HEALTHCARE, FOND DU LAC AREA UNITED WAY, FOND DU LAC COUNTY HEALTH DEPARTMENT, FOND DU LAC FAMILY YMCA, AND FOND DU LAC SCHOOL DISTRICT.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 7D: IN ADDITION TO THE HOSPITAL'S WEBSITE, THE HEALTHY 2020 COALITION MADE THE RESULTS OF THE CHNA WIDELY AVAILABLE THROUGH A SERIES OF COMMUNITY MEETINGS, DISTRIBUTION OF COMMUNITY HEALTH IMPROVEMENT PLAN FLYERS, NEWSPAPER ARTICLES, AND THE HEALTHY 2020 WEBSITE, WWW.LIVINGWELLFDL.ORG. THE FULL REPORT IS AVAILABLE ON THE FOND DU LAC COUNTY WEBSITE.PART V, LINE 7A HOSPITAL FACILITY'S WEBSITE: WWW.AGNESIAN.COM - AT BOTTOM OF HOME PAGE LABELED: "COMMUNITY HEALTH NEEDS ASSESSMENT."
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 11: AS A RESULT OF THE CHNA CONDUCTED IN 2012, 2014 AND 2017, THREE MAJOR AREAS OF FOCUS WERE DETERMINED, AND TWO OVERARCHING PRIORITIES SPANNING THE THREE AREAS OF FOCUS WERE AGREED UPON. A STRATEGIC ACTION PLAN HAS BEEN DEVELOPED FOR EACH FOCUS AREA.1) PRIORITY: NUTRITION AND PHYSICAL ACTIVITY - INCREASE THE NUMBER OF FOND DU LAC COUNTY RESIDENTS LIVING AT HEALTHY WEIGHT FOR THEIR HEIGHT THROUGH EATING HEALTHIER AND BEING MORE ACTIVE. HEALTHYOUTH IS A 4TH GRADE PROGRAM DONE AT 3 DIFFERENT ELEMENTARY SCHOOLS WITH THE HIGHEST PERCENTAGE OF FREE/REDUCED LUNCH RECIPIENTS. THE PROGRAM FOCUSES ON NUTRITION, SAFETY, PHYSICAL ACTIVITY AND EMOTIONAL WELL-BEING. EACH SESSION RUNS 5 WEEKS AND IS STAFFED BY MULTIPLE VOLUNTEERS FROM AGNESIAN HEALTHCARE MINISTRIES. THIS PARTNERSHIP WAS RECENTLY EXPANDED TO INCLUDE THE UNIVERSITY OF WISCONSIN EXTENSION. AGNESIAN HEALTHCARE PARTICIPATES IN LOCAL MIDDLE SCHOOL WELLNESS INSTRUCTION AND PROGRAMMING (PRIORITY-SPECIFIC: "FUEL FOR PERFORMANCE," TWICE WEEKLY) COMMUNITY PARTNERSHIPS TO PROVIDE ELDER COMMUNITY PROGRAMMING (PRIORITY-SPECIFIC: "SENIOR CENTER AGING MASTERY PROGRAM,") FOOD FOREST- AGNESIAN HEALTHCARE AND COMMUNITY PARTNERS FOCUSING ON ACCESS TO FRESH FRUITS AND VEGETABLES AND COLLABORATION WITH MULTIPLE STAKEHOLDERS TO PLANT AND MAINTAIN FREE COMMUNITY FRUIT GROVES AND VEGETABLE GARDENS. WALK WITH A DOC PROGRAM: AGNESIAN HEALTHCARE CLINICIANS MEET WITH COMMUNITY MEMBERS TO PROVIDE A BRIEF MEDICAL TOPIC REVIEW BEFORE AND DURING A WALK TOGETHER IN A MALL SETTING. 2) PRIORITY; MENTAL HEALTH - DECREASE THE NUMBER OF DEATHS BY SUICIDE IN FOND DU LAC COUNTY AND REDUCE STIGMA SURROUNDING MENTAL HEALTH. AGNESIAN HEALTHCARE: PARTICIPATES IN LOCAL MIDDLE SCHOOL WELLNESS INSTRUCTION AND PROGRAMMING (PRIORITY SPECIFIC: "BRAIN HEALTH," TWICE WEEKLY), HAS PARTNERED WITH COMMUNITY STAKEHOLDERS TO FORM TRAUMA-INFORMED CARE COMMITTEE AND PROMOTING A STIGMA-FREE APPROACH TO MENTAL/BEHAVIORAL WELLNESS, IS AN ACTIVE PARTICIPANT IN THE SUICIDE PREVENTION INITIATIVE: DESTINATION ZERO SUICIDE. 3) PRIORITY: ALCOHOL AND OTHER DRUG USE - DECREASE UNDERAGE DRINKING, ADULT BINGE DRINKING, AND THE MISUSE AND ABUSE OF DRUGS, PARTICULARLY OPIODS. AGNESIAN HEALTHCARE HAS REPRESENTATION ON DRUG-FREE COMMUNITIES, WITH FULL INTEGRATION OF A FOUR-PILLAR APPROACH TO FORM THE OPIOD INITATIVE. ACTION PLAN, GOALS AND INITIATIVES, BUILDING CAPACITY, AND DATA COLLECTION REFINEMENT HAVE ALL BEEN COMPLETED. AGNESIAN HEALTHCARE IS ACTIVELY INVOLVED IN PROVIDING DRUG DROP BOXES IN ALL FACILITIES, PARTICIPATING IN COMMUNITY NARCAN TRAINING, COMMUNITY AWARENESS, EDUCATION AND ENGAGEMENT CAMPAIGNS. ITS STRATEGIES INCLUDE IMPLEMENTING AN APPROACH TO ADDRESS HERION/OPIOD ABUSE AND IS ALSO UTILIZING A MEDIA/MARKETING CAMPAIGN TO RAISE AWARENESS AND ACTIVELY DISCOURAGE BINGE DRINKING AND OVER-CONSUMPTION. TWO OVERARCHING PRIORITIES:1) SOCIAL DETERMINANTS OF HEALTH - THE SOCIAL DETERMINANTS OF HEALTH ARE THE CONDITIONS IN WHICH PEOPLE ARE BORN, WORK AND AGE. WE RECOGNIZE THAT HEALTH BEGINS IN THESE ENVIRONMENTS WHERE WE SPEND THE MAJORITY OF OUR TIME. RESEARCH SHOWS THAT INDIVIDUAL HEALTH BEHAVIORS AND ACCESS TO CLINICAL CARE ONLY MAKE UP ABOUT HALF OF WHAT PREDICTS HEALTH. SOCIAL, ECONOMIC, AND PHYSICAL ENVIRONMENTS (OFTEN REFERRED TO AS THE SOCIAL DETERMINANTS OF HEALTH) MAKE UP THE OTHER 50% OF WHAT PREDICTS HEALTH OUTCOMES. EXAMPLES OF SOCIAL DETERMINANTS INCLUDE: AVAILABILITY OF COMMUNITY-BASED RESOURCES TO MEET DAILY NEEDS (E.G. ACCESS TO HEALTHY FOODS, SAFE HOUSING), TRANSPORTATION OPTIONS, EDUCATION, LANGUAGE, AND LITERACY, ACCESS TO HEALTH CARE, SOCIAL COHESION AND SOCIAL SUPPORT, SOCIOECONOMIC CONDITIONS, AND NEIGHBORHOOD AND BUILT ENVIRONMENT OUR GOALS: 1) INCREASE AWARENESS OF THE INFLUENCE SOCIAL DETERMINANTS HAVE IN SHAPING HEALTHY OUTCOMES. 2) IMPROVE HEALTH CONSIDERATIONS IN DECISION-MAKING.2) TRAUMA- INFORMED CARE - TRAUMAIES ON TRAUMA-INFORMED CARE IN FOND DU LAC COUNTY. 3). IMPLEMENT A TRAMA-INFORMED CARE ASSESSMENT AMONG A VARIETY OF COMMUNITY ORGANIZATIONS.THE HOSPITAL IS PARTICIPATING IN THE INITIATIVES NOTED ABOVE TO ADDRESS THE NEEDS IDENTIFIED IN CHNA. OUR INITIATIVES ARE ALREADY SHOWING POSITIVE RESULTS. THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE PRODUCES A WELL-KNOWN DOCUMENT TITLED "COUNTY HEALTH RANDINGS AND ROADMAPS". THE MOST CURRENT REPORT SHOWS THAT FOND DU LAC COUNTY HAS IMPROVED FROM THE HEALTH FACTORS RANK OF 20 RANK OF 16 IN THE STATE. IN ORDER TO FURTHER HELP COMMUNITY MEMBERS TAKE POSITIVE STEPS IN IMPROVING THEIR HEALTH, AGNESIAN HEALTHCARE DISTRIBUTED 2018 WELLNESS CALENDARS TO 75,000 RESIDENTS.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 13B: PATIENTS AND THEIR GUARANTOR'S INCOME IS USED IN DETERMINING INCOME LEVEL FOR FREE OR DISCOUNTED CARE.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 18E: COLLECTION AGENCIES ARE ENGAGED TO COLLECT UNPAID BALANCES. THESE AGENCIES ARE AUTHORIZED TO REPORT TO CREDIT AGENCIES. COLLECTION AGENCIES ARE AUTHORIZED BY THE HOSPITAL TO ESTABLISH GARNISHMENT AGAINST WAGES ON UNPAID BALANCES THEY ARE ATTEMPTING TO COLLECT. THESE ACTIONS ARE NOT UNDERTAKEN UNTIL REASONABLE EFFORTS TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE FAP HAVE BEEN MADE.AGNESIAN HEALTHCARE DOES NOT TAKE ANY OF THE ACTIONS AGAINST AN INDIVIDUAL THAT ARE LISTED IN 18A - 18D.
PART V, LINE 22	UNINSURED PATIENTS RECEIVE A DISCOUNT AT THE TIME THE UNDISCOUNTED CHARGES ARE RENDERED. THIS APPLIES TO PATIENTS WITH NO COVERAGE FOR PAYMENT FROM HEALTH CARE INSURANCE AND/OR OTHER THIRD PARTY PAYORS.

Schedule H (Form 990) 2019

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?3
Name and address		Type of Facility (describe)
1	1 - AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC,WI54935	PHARMACEUTICALS, HOME HEALTH, MEDICAL SUPPLIES
2	2 - CONSULTANTS LAB OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC,WI54935	LABORATORY AND TESTING
3	3 - FOND DU LAC REGIONAL CLINIC 420 E DIVISION STREET FOND DU LAC,WI54935	OUTPATIENT PHYSICIAN CLINIC
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

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
PART I, LINE 3C:	AGNESIAN HEALTHCARE DOES NOT USE ANY OTHER FACTORS THAN FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY.
PART I, LINE 6A:	THE CHNA WAS COMMISSIONED BY AGNESIAN HEALTHCARE, COUNTY HEALTH DEPARTMENT, FOND DU LAC COUNTY YMCA, AND FOND DU LAC SCHOOL DISTRICT. AN ANNUAL COMMUNITY BENEFIT REPORT IS COMPLETED BY THE FINANCE DEPARTMENT AND DISTRIBUTED TO THE PUBLIC THROUGH THE PUBLIC RELATIONS OFFICE OF AGNESIAN HEALTHCARE, INC.
PART I, LINE 7:	A COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST OF COMMUNITY BENEFIT SERVICES. OVERALL COSTS LESS TAXES WERE DIVISIBLE BY TOTAL CHARGES.
PART I, LINE 7G:	AGNESIAN HEALTHCARE SUBSIDIZES A SAMARITAN CLINC AND PALLIATIVE CARE FOR THOSE THAT QUALIFY.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE THAT WAS INCLUDED ON FORM 990, PART VIII AND THEREFORE NOT CONSIDERED IN THE PERCENTAGE CALCULATION FOR PURPOSES OF PART I, LINE 7, COL(F) IS 13,504,473.
PART II, COMMUNITY BUILDING ACTIVITIES:	AGNESIAN HEALTHCARE PROVIDES COMMUNITY SUPPORT, LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, COALITION BUILDING AND WORKFORCE DEVELOPMENT THROUGH THEIR COMMUNITY BENEFIT ACTIVITIES.
PART III, LINE 4:	THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO CONTRACTUAL ADJUSTMENTS AND A CREDIT TO THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY FOR DETERMINING BAD DEBTS IS A COST TO CHARGE RATIO.
PART III, LINE 8:	MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES, THE TOTAL EXPENSE LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE.ALTHOUGH MEDICARE SHORTFALL HAS NOT BEEN REPORTED AS A COMMUNITY BENEFIT, IT SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE IT PROMOTES ACCESS TO HEALTHCARE TO THE UNDERSERVED ELDERLY POPULATION, WHO WOULD NOT HAVE ACCESS TO LOCAL CARE IF WE WERE NOT ABLE TO SERVE THEM. ALTHOUGH OUR HOSPITAL IS EFFICIENTLY OPERATED, THE CALCULATIONS USED FOR MEDICARE REIMBURSEMENT DO NOT ALLOW FOR PAYMENTS THAT COVER COSTS OF NECESSARY SERVICES.
PART III, LINE 9B	ST. AGNES HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. PAYMENT IS DUE WITHIN 30 DAYS OF RECEIPT OF A STATEMENT. IF PATIENTS DO NOT SET UP ACCEPTABLE PAYMENT ARRANGEMENTS, BILLS WILL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY. FINANCIAL COUNSELORS WORK WITH ALL PATIENTS ON AN INDIVIDUAL BASIS AND MAY OFFER EXTENDED MONTHLY PAYMENTS WITHOUT INTEREST BASED ON DOLLAR AMOUNT, PRIVATE PAY DISCOUNTS (INDIVIDUALS WHO DO NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE BILLED AT A REDUCED RATE), OR GUARANTEED BANK LOANS.A ZERO DOLLAR AMOUNT WAS ESTIMATED FOR THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. IF PATIENTS QUALIFY, THEIR EXPENSES ARE RECLASSIFIED AS CHARITY CARE. PATIENTS WHO RECEIVED A COLLECTION NOTICE COULD APPLY FOR CHARITY CARE. IF THEIR APPLICATION IS APPROVED, THIS WOULD TRIGGER A TRANSFER OF EXPENSES FROM BAD DEBT TO CHARITY CARE.
PART VI, LINE 2:	IN ADDITION TO THE CHNA NOTED ABOVE, THE HOSPITAL'S SENIOR LEADERS MEET REGULARLY WITH COMMUNITY LEADERS TO GATHER INPUT FROM AND RESPOND TO PATIENT AND CUSTOMER NEEDS. SENIOR LEADERS AND MEMBERS OF THE WORKFORCE PARTICIPATE IN A VARIETY OF ORGANIZATIONS IN SUPPORT OF ST. AGNES HOSPITAL'S KEY COMMUNITIES. THROUGH THE HOSPITAL'S PARTICIPATION IN THESE ACTIVITIES, COMMUNITY MEMBERS LEARN OF THE HOSPITAL'S COMMITTMENT TO COMMUNITY-WIDE HEALTHCARE AND PROVIDE AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL, WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER), WITH INSIGHTS INTO COMMMUNITY HEALTH NEEDS AND DESIRES.
PART VI, LINE 3:	FINANCIAL COUNSELORS AT ST. AGNES HOSPITAL ASSIST PATIENTS WITH APPLICATION FOR COMMUNITY CARE. PATIENTS CAN BE REFERRED TO COMMUNITY CARE BY CLERGY, DEPARTMENTS OF ST. AGNES HOSPITAL, SISTERS OF ST. AGNES, PHYSICIANS, AREA SOCIAL AND HEALTH AGENCIES, FAMILY OR SELF. THE APPLICATION IS COMPLETED BY THE PATIENT WITH ASSISTANCE FROM THE FINANCIAL COUNSELOR IF NEEDED. THE FINANCIAL COUNSELOR WILL COMMUNICATE TO THE PATIENT WHAT PROGRAMS THEY WILL BE ELIGIBLE FOR, AS WELL AS PROVIDE NOTIFICATION OF APPROVAL OR DENIAL OF THEIR APPLICATION IN A TIMELY MANNER.
PART VI, LINE 4:	COMMUNITY CARE APPLICATIONS ARE ACCEPTED ONLY FROM PATIENTS OF ST. AGNES HOSPITAL WHO RESIDE IN THE COUNTIES OF DODGE, FOND DU LAC OR GREEN LAKE IN THE STATE OF WISCONSIN. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THESE AREAS FOR A MINIMUM OF THREE MONTHS AND PROVIDE SUPPORTING DOCUMENTATION. ON OCCASION, INDIVIDUALS WHO ARE NOT COMMUNITY MEMBERS BUT MAY NEED ASSISTANCE; THOSE APPLICATIONS ARE CONSIDERED ON A CASE-BY-CASE BASIS.
PART VI, LINE 5:	WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THIS IS A WORK IN PROGRESS. OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFIT AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT, WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY, BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: DIALYSIS CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH AND AUDIOLOGY, SURGICAL SERVICES, AND WOMEN'S SERVICES.
PART VI, LINE 6:	ST. AGNES HOSPITAL IS PART OF SSM HEALTH, AN INTEGRATED, COMPREHENSIVE NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM COMPRISED OF NUMEROUS MINISTRIES LISTED ON SCHEDULE R. SSM HEALTH PROVIDES A CONTINUUM OF HEALTHCARE FROM BIRTH TO END OF LIFE, PREVENTATIVE CARE, DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT AND SKILLED CARE SERVICES. AGNESIAN HEALTHCARE IS COMMITTED TO ENSURING THAT INDIVIDUALS NEEDING VITAL HEALTHCARE SERVICES GET THE HELP THEY NEED AND DESERVE.
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

Schedule H (Form 990) 2019

Additional Data

Software ID:
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- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" 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

2019

Open to Public Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes on 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 .........

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 on Line 1a? ..

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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:

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

Yes

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

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

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:

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

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

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

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 ............

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 ..........................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2019

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1STEVEN N LITTLE REGIONAL CEO SSM HEALTH- WI	(i) (ii)	721,252 ------------- 0	926,023 ------------- 0	14,342 ------------- 0	16,025 ------------- 0	25,538 ------------- 0	1,703,180 ------------- 0	0 ------------- 0
2PAULA FRIEDMAN SSM VP, CHEIF STRATEGY	(i) (ii)	0 ------------- 706,550	0 ------------- 0	0 ------------- 149,866	0 ------------- 871,392	0 ------------- 19,974	0 ------------- 1,747,782	0 ------------- 0
3JUNE PICKETT SSM SECRETARY, ASST VP GOVERNANCE	(i) (ii)	0 ------------- 229,924	0 ------------- 0	0 ------------- 32,932	0 ------------- 34,295	0 ------------- 16,779	0 ------------- 313,930	0 ------------- 0
4KRIS ZIMMER SSM TREASURER, SENIOR VP FINANCE	(i) (ii)	0 ------------- 870,069	0 ------------- 0	0 ------------- 103,034	0 ------------- 930,581	0 ------------- 30,595	0 ------------- 1,934,279	0 ------------- 0
5JAMES P MUGAN SR VP CLINICAL SERVICES	(i) (ii)	286,665 ------------- 0	32,521 ------------- 0	14,774 ------------- 0	16,002 ------------- 0	27,607 ------------- 0	377,569 ------------- 0	0 ------------- 0
6BONNIE R SCHMITZ CHIEF FINANCIAL OFFICER	(i) (ii)	415,077 ------------- 0	92,022 ------------- 0	16,026 ------------- 0	18,675 ------------- 0	30,719 ------------- 0	572,519 ------------- 0	0 ------------- 0
7SUSAN L EDMINSTER VP - HUMAN RESOURCES	(i) (ii)	286,593 ------------- 0	71,988 ------------- 0	2,322 ------------- 0	15,901 ------------- 0	23,073 ------------- 0	399,877 ------------- 0	0 ------------- 0
8NANCY A BIRSCHBACH VP - CIO	(i) (ii)	305,911 ------------- 0	74,884 ------------- 0	990 ------------- 0	14,925 ------------- 0	32,336 ------------- 0	429,046 ------------- 0	0 ------------- 0
9BARBARA L KNUTZEN PRES AND CEO-AHE AND PERFO	(i) (ii)	244,530 ------------- 0	47,281 ------------- 0	3,205 ------------- 0	13,222 ------------- 0	23,361 ------------- 0	331,599 ------------- 0	0 ------------- 0
10HOLLY BRENNER VP STRATEGIC DEVELOPMENT/M	(i) (ii)	275,246 ------------- 0	71,791 ------------- 0	15,469 ------------- 0	15,709 ------------- 0	1,564 ------------- 0	379,779 ------------- 0	0 ------------- 0
11MICHAEL DEGERE VP POPULATION HEALTH MANAG	(i) (ii)	319,218 ------------- 0	37,753 ------------- 0	32,939 ------------- 0	16,025 ------------- 0	27,390 ------------- 0	433,325 ------------- 0	0 ------------- 0
12MICHAEL DREES CHIEF OPERATING OFFICER FD	(i) (ii)	249,207 ------------- 0	29,663 ------------- 0	17,781 ------------- 0	15,416 ------------- 0	33,727 ------------- 0	345,794 ------------- 0	0 ------------- 0
13KATHERINE VERGOS CHIEF NURSING OFFICER	(i) (ii)	255,783 ------------- 0	29,325 ------------- 0	6,508 ------------- 0	13,655 ------------- 0	4,177 ------------- 0	309,448 ------------- 0	0 ------------- 0
14JOHN CHOI MD ANESTHESIOLOGIST - PAIN RE	(i) (ii)	624,553 ------------- 0	124,833 ------------- 0	2,322 ------------- 0	16,025 ------------- 0	25,673 ------------- 0	793,406 ------------- 0	0 ------------- 0
15YASIR HATAHET MD INTENSIVIST/PULMONOLOGIST	(i) (ii)	489,346 ------------- 0	313,296 ------------- 0	85,029 ------------- 0	14,599 ------------- 0	34,848 ------------- 0	937,118 ------------- 0	0 ------------- 0
16MICHAEL VANDER KOOY MD RADIATION ONCOLOGIST	(i) (ii)	638,020 ------------- 0	0 ------------- 0	52,645 ------------- 0	16,025 ------------- 0	34,302 ------------- 0	740,992 ------------- 0	0 ------------- 0
17STEVEN FLURRY MD ANESTHESIOLOGIST	(i) (ii)	641,246 ------------- 0	0 ------------- 0	810 ------------- 0	16,025 ------------- 0	19,857 ------------- 0	677,938 ------------- 0	0 ------------- 0
18PONTUS OSTMAN MD PHYSICIAN-PAIN MEDICINE	(i) (ii)	400,000 ------------- 0	272,650 ------------- 0	3,564 ------------- 0	16,025 ------------- 0	1,194 ------------- 0	693,433 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
PART I, LINE 1A	THERE WERE NOT ANY GROSSUP PAYMENTS OR SOCIAL CLUB DUES FOR THIS TAX YEAR. THERE IS A WRITTEN POLICY IF ANY PAYMENTS OCCUR. THESE PAYMENTS WOULD POTENTIALLY BE MADE TO SURRENT AND FORMER MEMBERS OF THE BOARD OF DIRECTORS IF APPLICABLE AND WOULD REQUIRE SUBSTANTIATION FOR THE EXPENSE(S).
PART I, LINE 4B	ALL EXECUTIVES PARTICIPATE IN A 457(B) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN.
PART I, LINE 5	COMPENSATION FOR SOME EMPLOYED PHYSICIANS IS BASED ON A PERCENTAGE OF GROSS BILLINGS.

Schedule J (Form 990) 2019

Additional Data

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Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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) 2019

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) THOR GILBERTSON	DIRECTOR	121,817	THOR GILBERTSON IS THE PRESIDENT OF HOLIDAY AUTOMOTIVE, A DEALERSHIP IN FOND DU LAC. HOLIDAY HAS SOLD AND SERVICED VEHICLES OWNED BY AGNESIAN HEALTHCARE IN THE AMOUNT OF $121,817		No
(2) WAYNE MATZKE	CHAIRPERSON	2,655,206	WAYNE MATZKE FORMER PRESIDENT OF GRANDE CHEESE AND RETIRED IN FEBRUARY 2017. AGNESIAN HEALTHCARE, INC PROVIDES A HEALTH CARE CLINIC TO GRANDE CHEESE, BILLING $2,655,206 OF THESE SERVICES IN FISCAL YEAR 2018.		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) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 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

2019

Open to Public
Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Return Reference	Explanation
FORM 990 ATTACHEMENT	ATTACHED IS A 409A RELIEF UNDER VI.C. OF NOTICE 2008-113 AGNESIAN HEALTHCARE, INC. 409A RELIEF UNDER VI.C. OF NOTICE 2008-113 NAME OF AFFECTED EMPLOYEE: AVAILABLE UPON REQUEST (THE "AFFECTED EMPLOYEE") EMPLOYEE'S TAXPAYER IDENTIFICATION NUMBER: AVAILABLE UPON REQUEST NAME OF NQDC PLAN: AGNESIAN HEALTHCARE, INC. EMPLOYER DEFERRAL ACCOUNT PLAN (457(F)) (THE "PLAN") DESCRIPTION OF 409A COMPLIANCE FAILURE: THE PLAN IS AN INELIGIBLE DEFERRED COMPENSATION PLAN SUBJECT TO INTERNAL REVENUE CODE ("CODE") SECTIONS 457(F) AND 409A. THE PLAN DOCUMENT, AS WRITTEN, COMPLIES WITH THE REQUIREMENTS OF CODE SECTION 409A. THE PLAN IS ADMINISTERED BY A THIRD-PARTY ADMINISTRATOR (THE "TPA"). PURSUANT TO THE PLAN'S TERMS, THE AFFECTED EMPLOYEE HAD AN ACCOUNT BALANCE UNDER THE PLAN THAT VESTED ON JANUARY 1, 2016. THE PLAN DOCUMENT PROVIDED THAT THE VESTED ACCOUNT WAS TO BE PAID WITHIN 15 BUSINESS DAYS OF THE DATE ON WHICH THE ACCOUNT VESTED. AS A RESULT, THE TPA SHOULD HAVE DISTRIBUTED THE AFFECTED EMPLOYEE'S ACCOUNT BALANCE NO LATER THAN JANUARY 18, 2016. UNFORTUNATELY, THE TPA DID NOT DISTRIBUTE THE AFFECTED EMPLOYEE'S VESTED ACCOUNT UNTIL AUGUST, 2017. UNDER CODE SECTION 457(F), THE BALANCE OF THE AFFECTED EMPLOYEE'S ACCOUNT AS OF JANUARY 1, 2016 WAS PROPERLY TAXED IN 2016 AND WAS DEEMED PAID. (SEE CODE SECTION 457(F)(1)(A) AND PROPOSED TREASURY REGULATION SECTION 1.409A-1(Q).) THE FAILURE TO DISTRIBUTE THE ACCOUNT TIMELY, HOWEVER, RESULTED IN ADDITIONAL EARNINGS ACCRUING ON THE ACCOUNT AND THESE EARNINGS WERE NOT DISTRIBUTED OR TAXED UNTIL AUGUST 9, 2017. (SEE TREASURY REGULATION SECTION 1.457-11(A)(3) AND PROPOSED TREASURY REGULATION SECTION 1.457-12(A)(3).) THERE WAS NO PROVISION IN THE PLAN THAT PROVIDED FOR THE DEFERRAL OF THE PAYMENT OF THE ADDITIONAL EARNINGS ON THE AFFECTED EMPLOYEE'S ACCOUNT UNTIL 2017. THEREFORE, WHEN PAYMENT OF THE EARNINGS DID NOT OCCUR IN 2016, THE PLAN VIOLATED CODE SECTION 409A DURING THE 2016 TAX YEAR. THE AMOUNT INVOLVED IN THE OPERATIONAL FAILURE WAS THE ADDITIONAL EARNINGS THAT ACCRUED ON THE VESTED ACCOUNT FROM THE DATE THE ACCOUNT SHOULD HAVE BEEN DISTRIBUTED IN 2016 UNTIL THE DATE THE ACCOUNT WAS DISTRIBUTED IN 2017. THIS AMOUNT TOTALED $4,819.45 AND, PURSUANT TO SECTION VI.C. OF NOTICE 2008-113 IS THE AMOUNT SUBJECT TO THE 20% CODE SECTION 409A TAX. STEPS TAKEN TO AVOID RECURRENCE: SINCE DISCOVERING THE ERROR IN MAY OF 2017, AGNESIAN HEALTHCARE, INC. HAS WORKED WITH THE TPA TO IMPROVE PROCEDURES FOR MONITORING VESTING DATES UNDER THE PLAN. THE TPA HAS IDENTIFIED THE CAUSE OF THE ERROR AND ASSURED AGNESIAN HEALTHCARE, INC. THAT THE TPA WILL MONITOR PLAN PARTICIPANT VESTING DATES MORE CLOSELY TO PREVENT FUTURE ERRORS. ELIGIBILITY FOR CORRECTION: THE OPERATIONAL FAILURE REFERENCED ABOVE IS ELIGIBLE FOR THE CORRECTION UNDER SECTION VI.C. OF NOTICE 2008-113. AGNESIAN HEALTHCARE, INC., THE SERVICE RECIPIENT, HAS TAKEN ALL ACTIONS REQUIRED, AND OTHERWISE MET ALL REQUIREMENTS, FOR CORRECTION.
FORM 990, PART VI, SECTION A, LINE 4	AS OF JANUARY 1, 2018, AGNESIAN HEALTHCARE INC. IS PART OF SSM HEALTH CARE CORPORATION, A MISSOURI NONPROFIT CORPORATION, WHICH IS THE SOLE MEMBER OF THE CORPORATION. THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE CORPORATION SHALL BE SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH CARE CORPORATION IS THE SOLE MEMBER OF THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	SSM HEALTH CARE CORPORATION, HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS, TO APPOINT AND REMOVE THE DIRECTORS, AND TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF AN OPERATING DIVISION OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B	CERTAIN POWERS WITH RESPECT TO THE CORPORATION ARE RESERVED TO SSM HEALTH CARE CORPORATION (SSMHCC) AS THE SOLE MEMBER OF THE MEMBER. SSMHCC MAY EXERCISE ANY OF ITS RESERVED POWERS THROUGH AUTHORITY DELEGATED TO THE OFFICERS OR MANAGEMENT OF SSMHCC OR THE BOARD OR OFFICERS OF THE CORPORATION PURSUANT TO CORPORATE RESOLUTIONS AND POLICIES WHICH MAY BE ADOPTED BY SSMHCC, PROVIDED THAT THE EXERCISE OF THE RESERVED POWERS REMAINS THE ULTIMATE RESPONSIBILITY OF SSMHCC.
FORM 990, PART VI, SECTION B, LINE 11B	THE FINANCE DEPARTMENT PREPARES THE FORM 990 AND THE RETURN IS REVIEWED BY THE DIRECTOR OF FINANCE. A FINAL COPY OF THE 2017 FORM 990 IS PROVIDED TO THE BOARD EXECUTIVE COMMITTEE FOR REVIEW AND APPROVAL TO THE AGNESIAN HEALTHCARE BOARD BEFORE THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON AN ANNUAL BASIS TO THE DESIGNATED AUTHORITY A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DESIGNATED AUTHORITY ENSURES THAT ALL STATEMENTS ARE COMPLETED, REVIEWS THEM FOR CONFLICTS, AND SUBMITS TO THE BOARD FOR REVIEW ANY CONFLICT OF INTEREST DISCLOSURE STATEMENTS THAT DISCLOSE ACTUAL OR POTENTIAL CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15	FORM 990, PART VI, SECTION B, LINE 15(A): DETERMINATION OF COMPENSATION OF THE CEO AND OFFICERS INCLUDES ANALYSIS OF COMPARABLE COMPENSATION SURVEYS BY AN INDEPENDENT COMPENSATION CONSULTANT, WHO RECOMMENDS RANGES OF APPROPRIATE COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS APPROVES THE COMPENSATION PACKAGE FOR OFFICERS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATIONS AND DECISION IS INCLUDED IN THE BOARD MINUTES. THE FINAL AGREEMENT IS DOCUMENTED WITH A WRITTEN CONTRACT, WHICH IS SIGNED BY BOTH PARTIES. FORM 990, PART VI, SECTION B, LINE 15(B): AN ANNUAL SURVEY IS PERFORMED BY AN OUTSIDE COMPANY
FORM 990, PART VI, SECTION C, LINE 19	AGNESIAN HEALTHCARE'S POLICY AND PROCEDURE FIN1069 DEFINES THE PROCEDURE FOR MAKING ANNUAL INFORMATION RETURNS AVAILABLE FOR PUBLIC INSPECTION. INDIVIDUALS REQUESTING INSPECTION ARE REFERRED TO THE ADMINISTRATION OFFICE, WHERE THEY ARE PROVIDED WITH THE DOCUMENTS AND A CONFERENCE ROOM FOR INSPECTING DOCUMENTS. PHOTOCOPIES WILL BE PROVIDED TO THE REQUESTOR. ANYONE MAY INSPECT THE RETURNS UPON DEMAND, WITHOUT AN APPOINTMENT OR ANY FOREWARNING, DURING AGNESIAN HEALTHCARE INC'S NORMAL BUSINESS HOURS. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST STATEMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION, BUT CAN BE MADE AVAILABLE IF THE REQUESTING PARTY HAS A BONAFIDE REASON.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES - PHYSICIANS: PROGRAM SERVICE EXPENSES 8,329,670. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,329,670. PURCHASED SERVICES - LABORATORY: PROGRAM SERVICE EXPENSES 205,764. MANAGEMENT AND GENERAL EXPENSES 402. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 206,166. PURCHASED SERVICES - ELEVATOR: PROGRAM SERVICE EXPENSES 1,599. MANAGEMENT AND GENERAL EXPENSES 137,107. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,706. PURCHASED SERVICES - MISCELLANEOUS: PROGRAM SERVICE EXPENSES 59,510,643. MANAGEMENT AND GENERAL EXPENSES 2,258,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,769,035. PURCHASED SERVICES - TEMPORARY STAFF: PROGRAM SERVICE EXPENSES 822,655. MANAGEMENT AND GENERAL EXPENSES 84,825. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 907,480. PURCHASED SERVICES - REFERENCE TESTS: PROGRAM SERVICE EXPENSES 1,052,817. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,052,817. PURCHASED SERVICES - HOUSEKEEPING: PROGRAM SERVICE EXPENSES 58,870. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,870. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 512,363. MANAGEMENT AND GENERAL EXPENSES 238,550. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 750,913. PROFESSIONAL FEES - MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 267,538. MANAGEMENT AND GENERAL EXPENSES 6,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 273,538. PROFESSIONAL FEES - COLLECTION: PROGRAM SERVICE EXPENSES 6,206. MANAGEMENT AND GENERAL EXPENSES 856,879. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 863,085. PURCHASED SERVICES - LAUNDRY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 709,587. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 709,587. PURCHASED SERVICES - TRANSCRIPTION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 28,822. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,822.
FORM 990, PART XI, LINE 9:	CHANGE IN SWAP FUND BALANCE 1,032,207. CHANGE IN FUND BALANCE - SAH FOUNDATION -147,052. CAPITAL CONTRIBUTIONS - FOUNDATION 302,370. CSA LEGACY CONTRIBUTIONS -840,000. FUND BALANCE TRANSFER SSM HEALTH 23,601,353.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

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
(1) CONSULTANTS LABORATORY OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC,WI54935 39-1528550	LAB SERVICES	WI	28,968,376	37,881,889	AGNESIAN HEALTHCARE INC
(2) AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC,WI54935 39-2038757	RETAIL PHARMACY	WI	10,925,768	9,250,133	AGNESIAN HEALTHCARE INC

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ST FRANCIS HOME OF FOND DU LAC 33 EVERETT STREET FOND DU LAC,WI54935 39-1029998	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN		No
(2)AGNESIAN HEALTHCARE FOUNDATION 430 E DIVISION STREET FOND DU LAC,WI54935 39-1684956	FOUNDATION	WI	501(C)(3)	LINE 7	SSM HEALTH OF WISCONSIN		No
(3)WAUPUN MEMORIAL HOSPITAL 620 WEST BROWN STREET WAUPUN,WI53963 39-0806265	HOSPITAL	WI	501(C)(3)	LINE 3	SSM HEALTH OF WISCONSIN		No
(4)RIPON MEDICAL CENTER 845 PARKSIDE STREET RIPON,WI54971 39-1101287	HOSPITAL	WI	501(C)(3)	LINE 3	SSM HEALTH OF WISCONSIN		No
(5)VILLA ROSA INC N8114 COUNTY WW FOND DU LAC,WI53057 42-1670962	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN		No
(6)SISTER SERVANTS OF CHRIST THE KING N8114 COUNTY WW FOND DU LAC,WI53057 39-1022770	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN		No
(7)THE CHRISTIAN HOME & REHABILITATION CENTER 331 BLY STREET WAUPUN,WI53963 39-0884514	NURSING HOME	WI	501(C)(3)	LINE 10	SSM HEALTH OF WISCONSIN		No
(8)THE MONROE CLINIC INC 515 22 ND AVENUE MONROE,WI53566 39-0808509	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH OF WISCONSIN		No
(9)MONROE CLINIC AND HOSPITAL FOUNDATION 515 22 ND AVENUE MONROE,WI53566 20-5769038	SUPPORT THE MISSION	WI	501(C)(3)	LINE 7	SSM HEALTH OF WISCONSIN		No
(10)GOOD SAMARITAN REGIONAL HEALTH CENTER 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0653587	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES		No
(11)ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1575307	FUNDRAISING	MO	501(C)(3)	LINE 12B, II	SSM REGIONAL HEALTH SERVICES		No
(12)ST MARY'S FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1940686	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH OF WISCONSIN		No
(13)ST MARY'S HOSPITAL CENTRALIA ILLINIOS 10101 WOODFIELD LANE ST LOUIS,MO63132 37-0662580	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES		No
(14)ST MARY'S - GOOD SAMARITAN INC 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4170833	HEALTH CARE	IL	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES		No
(15)GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 26-2884795	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S - GOOD SAMARITAN		No
(16)ST MARY'S HOSPITAL FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4636691	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S - GOOD SAMARITAN		No
(17)ST MARY'S HOSPITAL AUXILIARY 400 N PLEASANT CENTRALIA,IL62801 23-7126345	FUNDRAISING	IL	501(C)(3)	LINE 10	ST MARY'S HOSPITAL		No
(18)SSM HEALTH BUSINESSES 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1333488	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE CORPORATION		No
(19)SSM HEALTH CARE ST LOUIS 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1343281	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(20)CENTRALIA MEDICAL SERVICES BLDG ASSOC 10101 WOODFIELD LANE ST LOUIS,MO63132 23-7408025	MOB	IL	501(C)(3)	LINE 12B, II	SSM REGIONAL HEALTH SERVICES		No
(21)ST MARY'S JANESVILLE FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-3439133	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN		No
(22)SSM HEALTH MINISTRIES 3221 MCKELVEY ROAD SUITE 107 ST LOUIS,MO63044 43-1012492	RELIGIOUS ORGANIZATION	MO	501(C)(3)	LINE 1			No
(23)LEE DEWEY CORPORATION 10101 WOODFIELD LANE ST LOUIS,MO63132 73-1279603	MOB	OK	501(C)(3)	LINE 12A, I	SSM HEALTH CARE OF OKLAHOMA		No
(24)SSM HOSPICE AND HOME CARE FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 30-0012246	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH BUSINESSES		No
(25)ST MARY'S HOSPITAL AUXILIARY 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 43-6049878	FUNDRAISING	MO	501(C)(3)	LINE 12B, II			No
(26)GOOD SAMARITAN HOSPITAL AUXILIARY 1 GOOD SAMARITAN WAY MT VERNON,IL62864 23-7049599	FUNDRAISING	IL	501(C)(3)	LINE 12C, III-FI			No
(27)ST ANTHONY SHAWNEE HOSPITAL INC 1000 N LEE AVE OKLAHOMA CITY,OK73102 45-5055149	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE OF OKLAHOMA		No
(28)SSM AUDRAIN HEALTH CARE INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1550298	HEALTH CARE	MO	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES		No
(29)AUDRAIN MEDICAL CENTER FOUNDATION INC 620 E MONROE STREET MEXICO,MO65265 43-1265060	FUNDRAISING	MO	501(C)(3)	LINE 12A, I	SSM AUDRAIN HEALTH CARE INC		No
(30)SSM HEALTH AT HOME FOUNDATION OF WISCONSIN INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1839309	FUNDRAISING	WI	501(C)(3)	LINE 12A, I			No
(31)SSM-SLUH INC 10101 WOODFIELD LANE ST LOUIS,MO63132 47-4196634	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS		No
(32)SSM HEALTH CARE CORPORATION 10101 WOODFIELD LANE ST LOUIS,MO63132 46-6029223	HEALTH CARE	MO	501(C)(3)	LINE 12A, I	SSM HEALTH MINISTRIES		No
(33)SSMHC LIABILITY TRUST I 10101 WOODFIELD LANE ST LOUIS,MO63132 43-6331003	INSURANCE	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION		No
(34)SSM CONSOLIDATED HEALTH SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1473657	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE CORPORATION		No
(35)SSM POLICY INSTITUTE 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1788151	HEALTH CARE	MO	501(C)(4)		SSM HEALTH CARE CORPORATION		No
(36)SSM HEALTH CARE PORTFOLIO MANAGEMENT CO 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1825256	MANAGEMENT	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION		No
(37)SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0738490	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS		No
(38)CARDINAL GLENNON CHILDREN'S FOUNDATION 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1754347	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM CARDINAL GLENNON HOSPITAL		No
(39)SSM HEALTH FOUNDATION - ST LOUIS 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1552945	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS		No
(40)SSM HEALTH CARE OF OKLAHOMA INC 10101 WOODFIELD LANE ST LOUIS,MO63132 73-0657693	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(41)ST ANTHONY HOSPITAL FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 73-6104300	FUNDRAISING	OK	501(C)(3)	LINE 7	SSM HEALTH CARE OF OKLAHOMA		No
(42)SSM HEALTH CARE OF WISCONSIN INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0688874	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No
(43)DELLS MEDICAL BUILDING INC 10101 WOODFIELD LANE ST LOUIS,MO63132 39-1613292	MOB	WI	501(C)(2)		SSM HEALTH CARE OF WISCONSIN		No
(44)ST CLARE HEALTH CARE FOUNDATION INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1940683	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN		No
(45)HOME HEALTH UNITED INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1539827	HEALTH CARE	WI	501(C)(3)	LINE 10	SSM HEALTH CARE OF WISCONSIN		No
(46)HOME CARE UNITED INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1776340	HEALTH CARE	WI	501(C)(3)	LINE 10	SSM HEALTH CARE OF WISCONSIN		No
(47)HHU XTRA CARE INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1705111	HEALTH CARE	WI	501(C)(3)	LINE 10	SSM HEALTH CARE OF WISCONSIN		No
(48)SSM REGIONAL HEALTH SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 44-0579850	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SSM ST JOSEPH ENDOSCOPY CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-0046559	SURGERY SERVICES	MO					No			No
(2) ST CLARE IMAGING SERVICES 707 14TH STREET SUITE A BARABOO,WI53913 20-0122365	DIAG SERVICES	WI					No			No
(3) MT VERNON RADIATION THERAPY CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-1382620	RADIATION THERAPY	IL					No			No
(4) SLEEP & NEUROLOGY CENTER OF S ILLINIOS LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-8468195	DIAG SERVICES	IL					No			No
(5) CHOWSMGSI OFFICE BUILDING LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 37-1383861	MOB	IL					No			No
(6) OZA CANCER CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 20-1382727	MOB	IL					No			No
(7) SHAWNEE REAL ESTATE HOLDINGS LLC 1000 N LEE AVE OKLAHOMA CITY,OK73102 45-5458304	MOB	OK					No			No
(8) DEAN CLINIC & ST MARYS HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 45-2995500	ACCOUNTABLE CARE ORGANIZATION	WI					No			No
(9) WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-2016715	INFORMATION TECHNOLOGY SERVICES	WI					No			No
(10) DEAN HEALTH HOLDINGS LLC 1277 DEMING WAY MADISON,WI53717 26-1594709	SUPPORT SERVICES	WI					No			No
(11) WINGRA BUILDING GROUP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-0237060	MOB	WI					No			No
(12) JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-6220698	MOB	WI					No			No
(13) WINDMILL LLP 50 VILLAGE VIEW LANE CHESTERFIELD,MO63017 43-1804651	INVESTMENTS	MO					No			No
(14) B & J OFFICE BUILDING LLC 1000 N LEE AVE OKLAHOMA CITY,OK73102 73-1533449	MOB	OK					No			No
(15) 1110 N CLASSEN BOULEVARD LLC 1110 N CLASSEN BOULEVARD OKLAHOMA CITY,OK73106 73-1158158	MOB	OK					No			No
(16) SSM ST CLARE SURGICAL CENTER LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-1439695	SURGERY SERVICES	MO					No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) SSM MANAGED CARE ORGANIZATION LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1708511	HEALTH PROMOTION	MO	N/A	C				No
(2) FPP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1465174	HEALTH CARE	MO	N/A	C				No
(3) DIVERSIFIED HEALTH SERVICES CORP 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1369305	MEDICAL EQUIPMENT	MO	N/A	C				No
(4) SSM CARDIOVASCULAR AND THORACIC SERVICES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-0286559	HEALTH CARE	MO	N/A	C				No
(5) SSM PROPERTIES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1462486	PROPERTY SERVICES	MO	N/A	C				No
(6) SSM DEPAUL MEDICAL GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1715106	HEALTH CARE	MO	N/A	C				No
(7) SSM ST CHARLES CLINIC MED GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-0626408	PHYSICIAN OFFICES	MO	N/A	C				No
(8) HEALTH FIRST PHYSICIAN MANAGEMENT SERVICES 10101 WOODFIELD LANE ST LOUIS,MO63132 73-1534336	MEDICAL SERVICES	OK	N/A	C				No
(9) SSMHC LIABILITY TRUST II 10101 WOODFIELD LANE ST LOUIS,MO63132 81-6128118	INSURANCE	MO	N/A	C				No
(10) SSM NEUROSCIENCES INC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-3413981	HEALTH CARE	MO	N/A	C				No
(11) SSM MEDICAL GROUP INC 10101 WOODFIELD LANE ST LOUIS,MO63132 43-1664107	PHYSICIAN OFFICES	MO	N/A	C				No
(12) SSMHC INSURANCE COMPANY 10101 WOODFIELD LANE ST LOUIS,MO63132 03-0310431	INSURANCE	CA	N/A	C				No
(13) SSM ORTHOPEDIC INC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-1557033	HEALTH CARE	MO	N/A	C				No
(14) SSM CANCER CARE INC 10101 WOODFIELD LANE ST LOUIS,MO63132 27-1557324	HEALTH CARE	MO	N/A	C				No
(15) PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS 10101 WOODFIELD LANE ST LOUIS,MO63132 36-4161526	HEALTH CARE	IL	N/A	C				No
(16) DEAN HEALTH SYSTEMS INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1128616	PHYSICIAN OFFICES	WI	N/A	C				No
(17) DEAN HEALTH INSURANCE INC PO BOX 56099 MADISON,WI53705 39-1830837	INSURANCE	WI	N/A	C				No
(18) DEAN HEALTH PLAN INC PO BOX 56099 MADISON,WI53705 39-1535024	INSURANCE	WI	N/A	C				No
(19) SMDV OFFICE BUILDING 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1628491	PHYSICIAN OFFICES	WI	N/A	C				No
(20) DEAN RETAIL SERVICES INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1717636	PROPERTY SERVICES	WI	N/A	C				No
(21) NAVITUS HOLDINGS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 80-0968174	PHARMACY BENEFITS	WI	N/A	C				No
(22) OZA ONCOLOGY INC 4117 VETERANS MEMORIAL DRIVE MT VERNON,IL62804	PHYSICIAN OFFICES	IL	N/A	C				No
(23) SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 83-2038674	CONDO ASSOCIATION	WI	N/A	C				No
(24) SSM HEALTH PHARMACY LLC 10101 WOODFIELD LANE ST LOUIS,MO63132 26-4031708	PHARMACY	MO	N/A	C				No

Schedule R (Form 990) 2019

Page 3

Part V

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

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

Yes

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

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

Yes

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

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

Yes

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

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

Yes

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

Yes

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

Yes

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

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) AGNESIAN HEALTHCARE FOUNDATION INC	C	1,861,609	CASH RECEIPTS
(2) ST FRANCIS HOME	M	60,633	CASH PAYMENTS
(3) WAUPUN MEMORIAL HOSPITAL	P	419,875	CASH TRANSFER
(4) RIPON MEDICAL CENTER	P	84,065	CASH TRANSFER
(5) THE CHRISTIAN HOME & REHABILITATION CENTER	M	73,559	CASH PAYMENTS

Schedule R (Form 990) 2019

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	4,494
6	Total number of volunteers (estimate if necessary) .............	6	575
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	4,449,246
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	450,708

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	985,901	1,861,609
9	Program service revenue (Part VIII, line 2g) .........	353,753,153	367,524,738
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	9,341,789	8,486,861
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	16,571,485	15,567,330
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	380,652,328	393,440,538
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	165,819,796	165,388,485
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	208,046,706	212,622,208
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	373,866,502	378,010,693
19	Revenue less expenses. Subtract line 18 from line 12.......	6,785,826	15,429,845
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	587,595,135	611,748,301
21	Total liabilities (Part X, line 26).............	253,246,914	227,032,946
22	Net assets or fund balances. Subtract line 21 from line 20.....	334,348,221	384,715,355

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 260,327,040 including grants of $ ) (Revenue $ 358,222,720 )
	AGNESIAN HEALTHCARE OPERATES ST. AGNES HOSPITAL, A 146-LICENSED BED GENERAL/SURGICAL ACUTE CARE HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO RESIDENTS OF FOND DU LAC AND THE SURROUNDING COUNTIES. DURING FISCAL YEAR 2018, ST. AGNES HOSPITAL HAD 6,574 INPATIENT ADMISSIONS, WITH TOTAL PATIENT DAYS OF 26,469. THERE WAS A TOTAL OF 31,169 EMERGENCY ROOM VISITS AND 13,874 SURGERIES PERFORMED IN FY18. IN ADDITION, ST. AGNES HOSPITAL PROVIDED 424,881 PHYSICIAN CLINIC VISITS, 81,181 MEDICAL IMAGING PROCEDURES, AND 36,553 PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY UNITS. THERE WERE 2,135 CARDIAC CATH LAB VISITS AND 52,805 HOSPICE DAYS. THE HOSPITAL ALSO OPERATES SAMARITAN CLINIC, A FREE CLINIC OFFERING MEDICAL SERVICES TO QUALIFIED INDIVIDUALS. SAMARITAN CLINIC PROVIDED 649 VISITS TO PATIENTS, AT A COST OF $307,822 FOR FY18. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY IT PROVIDES TO ITS PATIENTS. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS $1,101,543. IN ADDITION TO QUALITY HEALTH CARE SERVICES, ST. AGNES HOSPITAL PROVIDES ITS COMMUNITIES WITH EDUCATION, SUPPORT GROUPS AND OTHER COMMUNITY BENEFITS. THE NET COST OF THESE COMMUNITY BENEFITS WAS $3,101,976.

4b	(Code: ) (Expenses $ 7,697,171 including grants of $ ) (Revenue $ 4,521,247 )
	AGNESIAN HEALTHCARE OPERATES AGNESIAN ENTERPRISES, WHICH IS COMPRISED OF PHARMACIES SERVING FOND DU LAC AND SURROUNDING TOWNS, AS WELL AS AGNESIAN HEALTH SHOPPE, WHICH SERVES THE POPULATION WITH HOSPITAL (INPATIENT AND OUTPATIENT), CLINIC AND HOME HEALTH EQUIPMENT. AGNESIAN ENTERPRISES FILLED 460,526 PRESCRIPTIONS DURING FY18. AGNESIAN HEALTH SHOPEE PROVIDES RETAIL SALES OF DURABLE MEDICAL EQUIPMENT, AS WELL AS TELECARE AND HOME OXYGEN SERVICES. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER AHE'S CHARITY CARE POLICY WAS $1,699. AGNESIAN HEALTHCARE ENTERPRISES CONTRIBUTES TO COMMUNITY BENEFIT WITH SEVERAL SUPPORT GROUPS. THE COST OF THE COMMUNITY BENEFIT WAS $1,743.

4c	(Code: ) (Expenses $ 527,088 including grants of $ ) (Revenue $ 14,505,306 )
	AGNESIAN HEALTHCARE OPERATES CONSULTANTS LABORATORY OF WISCONSIN, AN INDEPENDENT REFERENCE LAB SERVING FOND DU LAC, DODGE, OUTAGAMIE, WINNEBAGO AND COLUMBIA COUNTIES. CLW PROVIDED 1,096,843 TESTS DURING FISCAL YEAR 2018. THE LABORATORY ALSO PROVIDES THE COMMUNITY WITH CAREER EDUCATION, CONTRIBUTIONS AND SERVICES TO SAMARITAN CLINIC. THE NET COST OF THESE COMMUNITY BENEFITS WAS $25,102. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY WAS $23,702.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses268,551,299

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,545,403	2,092,375	2,483,236

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,861,609
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,861,609

		Business Code
2a	NET PATIENT SERVICE REVENUE	621400	223,635,455	222,525,083	1,110,372
b	MEDICARE/MEDICAID REVENUE	621400	143,889,283	143,889,283
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		367,524,738

3 Investment income (including dividends, interest, and othersimilar amounts) ......			7,137,691			7,137,691
4 Income from investment of tax-exempt bond proceeds			35,161			35,161
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	369,106	22,204,305	7a
b	Less: cost or other basis and sales expenses	545,382	20,714,020	7b
c	Gain or (loss)	-176,276	1,490,285	7c
d	Net gain or (loss).........			1,314,009			1,314,009
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	38,544,445
b	Less: cost of goods sold ..		10b	27,472,892
c	Net income or (loss) from sales of inventory..			11,071,553	7,835,450	3,236,103
Business Code			Miscellaneous Revenue
11a	WORK INJURY/OCC HEALTH		621990	1,887,457	1,887,457
b	CAFETERIA SALES		900099	1,496,320		102,771	1,393,549
c	MEDICARE EHR		900099	52,947	52,947
d	All other revenue ....			1,059,053	1,059,053
e	Total. Add lines 11a–11d ......			4,495,777
12	Total revenue. See instructions.....			393,440,538	377,249,273	4,449,246	9,880,410

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	4,340,242		4,340,242
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........	140,313,402	109,213,478	31,099,924
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,560,435	6,345,175	2,215,260
9	Other employee benefits .......	2,232,333	1,561,024	671,309
10	Payroll taxes ...........	9,942,073	7,330,049	2,612,024
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,935,470	730,133	1,205,337
c	Accounting ...........	131,124		131,124
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)	75,088,689	70,768,125	4,320,564
12	Advertising and promotion ....	877,242	46,488	830,754
13	Office expenses .......	58,569,901	56,716,245	1,853,656
14	Information technology ......	28,599,036	2,076,010	26,523,026
15	Royalties ..
16	Occupancy ...........	13,804,295	5,215,690	8,588,605
17	Travel ............	676,429	535,106	141,323
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	714,921	397,926	316,995
20	Interest ...........	4,436,510		4,436,510
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	17,454,783	798,487	16,656,296
23	Insurance ...	1,706,349	1,018,025	688,324
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	HOSPITAL ASSESSMENT	5,116,412	5,116,412
b	MISCELLANEOUS	2,110,806	420,281	1,690,525
c	INVESTMENT FEES	656,893		656,893
d	DUES, SUBSCRIPTIONS, LI	631,571	262,645	368,926
e	All other expenses	111,777		111,777
25	Total functional expenses. Add lines 1 through 24e	378,010,693	268,551,299	109,459,394	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,371,979	1	23,450,028
2	Savings and temporary cash investments .........			6,584,344	2	10,982,903
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			57,466,984	4	66,464,368
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			5,347,100	8	4,771,573
9	Prepaid expenses and deferred charges ......			3,765,809	9	3,731,614
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	406,036,852
b	Less: accumulated depreciation	10b	239,870,679	172,400,872	10c	166,166,173
11	Investments—publicly traded securities .			227,296,330	11	238,747,076
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			110,361,717	15	97,434,566
16	Total assets. Add lines 1 through 15 (must equal line 33)...			587,595,135	16	611,748,301

17	Accounts payable and accrued expenses .....	43,689,173	17	49,564,586
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	165,518,041	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	44,039,700	25	177,468,360
26	Total liabilities. Add lines 17 through 25..	253,246,914	26	227,032,946

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	334,348,221	32	384,715,355
33	Total liabilities and net assets/fund balances ........	587,595,135	33	611,748,301