TY 2023 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/1099-NEC)
(1) STEPHEN M PETERSON...................................................................... DIRECTOR, VICE CHAIRPERSON	1.00 ................. 0.00	X	X	0	0
(2) THOR H GILBERTSON...................................................................... DIRECTOR, CHAIRPERSON	1.00 ................. 0.00	X	X	0	0
(3) SUZANNE ANDERSON...................................................................... DIRECTOR, REGIONAL PRESIDENT	1.00 ................. 42.00	X	X	1,428,914	540,322
(4) JOAN KARSTEN...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(5) MATTHEW POGODZINSKI MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(6) KATIE KENNEDY...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(7) JENNIFER MASKEL MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		142,795	14,024
(8) SR HERTHA LONGO...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(9) SR DONNA INNES...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(10) THOMAS SCHUESSLER...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(11) PAT LEITZEN FYE...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(12) WESLEY SPARKMAN...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(13) DOUG FOWNES MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(14) MARK THOMPSON MD...................................................................... DIRECTOR, REGIONAL CHIEF MEDICAL OFFICER	1.00 ................. 0.00	X		37,398	12,674
(15) SR SUSAN M STUCKI...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(16) THEODORE MILLER MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0
(17) JEFFREY STRONG MD...................................................................... DIRECTOR	1.00 ................. 0.00	X		0	0

(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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) EMMER RHEA........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(19) WAYNE MATZKE........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(20) BRET PASIUK MD........................................................................ DIRECTOR	1.00 .......................0.00	X					0	0	0
(21) MATT HANLEY........................................................................ DIRECTOR, INTERIM REGIONAL PRES - SSM WI	1.00 .......................45.00	X					0	974,654	0
(22) KATHERINE VERGOS........................................................................ PRESIDENT - ST. AGNES HOSPITAL	40.00 .......................1.00		X				674,601	0	242,929
(23) DOUG LONG........................................................................ SECRETARY, GENERAL COUNSEL AT SSM HEALTH	1.00 .......................72.20		X				0	1,425,239	777,013
(24) RANDY COMBS........................................................................ TREASURER, CHIEF FINANCIAL OFFICER AT SSM HEALTH	1.00 .......................69.00		X				0	2,182,354	1,238,074
(25) STEVE SMOOT........................................................................ VICE PRESIDENT, COO OF SSM HEALTH	1.00 .......................65.00		X				0	2,054,358	1,204,489
(26) MICHAEL DREES........................................................................ VP - OPERATIONS, FOND DU LAC CLINIC	40.00 .......................0.00			X			363,052	0	62,834
(27) TAMI SCHATTSCHNEIDER........................................................................ VP - PATIENT CARE SERVICES, CNO	40.00 .......................0.00			X			288,633	0	100,264
(28) TARA RHODES........................................................................ VP - OPERATIONS, ST. AGNES HOSPITAL	40.00 .......................0.00			X			252,246	0	92,166
(29) STEVEN FLURRY........................................................................ ANESTHESIOLOGIST	40.00 .......................0.00				X		633,603	0	61,405
(30) SYED MOHIUDDIN........................................................................ DIRECTOR	40.00 .......................0.00				X		666,956	0	55,922
(31) MICHAEL VANDER KOOY........................................................................ RADIATION ONCOLOGIST	40.00 .......................0.00				X		661,704	0	67,567
(32) KRISTOF GEHRKE........................................................................ PHYSICIAN	40.00 .......................0.00				X		659,537	0	58,792
(33) MARCIO SHIOKAWA........................................................................ PHYSICIAN	40.00 .......................0.00				X		600,929	0	57,978
(34) NANCY A BIRSCHBACH........................................................................ FORMER KEY EMPLOYEE	0.00 .......................0.00					X	0	458,076	177,602

(A) Name and business address	(B) Description of services	(C) Compensation
OWENS & MINOR DISTRIBUTION INC 9120 LOCKWOOD BOULEVARD MECHANICSVILLE,VA23116	HEALTHCARE LOGISTIC SERVICES	7,109,965
FDL REGIONAL CLINIC SC 420 E DIVISION ST FOND DU LAC,WI54935	PHYSICIAN SERVICES	6,043,134
CD SMITH CONSTRUCTION INC 125 CAMELOT DRIVE FOND DU LAC,WI54935	CONSTRUCTION SERVICES	4,851,035
MEDTRONIC USA INC 710 MEDTRONIC PARKWAY MINNEAPOLIS,MN55432	MEDICAL TECHNOLOGY SERVICES	4,719,608
BOSTON SCIENTIFIC CORPORATION 300 BOSTON SCIENTIFIC WAY MARLBOROUGH,MA017521234	BIOMEDICAL ENGINEERING SERVICES	4,607,729
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 176

- TIN:

SCHEDULE A
(Form 990)

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

2023

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 5 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 2023 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2022 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2023. 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—2022. 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—2023. 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—2022. 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) 2023

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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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) 2019	(b) 2020	(c) 2021	(d) 2022	(e) 2023	(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 on 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 5 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 2023 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2022 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2023 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2022 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2023. 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—2022. 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) 2023

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

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 on 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 on 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) 2023

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2023

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 0.015 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 0.035	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) 2023

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2023 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2023	(iii) Distributable Amount for 2023
1 Distributable amount for 2023 from Section C, line 6
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2023:
a From 2018.......
b From 2019.......
c From 2020.......
d From 2021.......
e From 2022.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2023 distributable amount
i Carryover from 2018 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2023 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2023 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2019.....
b Excess from 2020.....
c Excess from 2021.....
d Excess from 2022.....
e Excess from 2023.....

Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023

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) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2023

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) (2023)

Schedule B (Form 990) (2023) 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
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Schedule B (Form 990) (2023)

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) (2023)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

right arrow

Complete if the organization is described below. 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

2022

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 .................................................................... right arrow

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 ................................ right arrow

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... right arrow

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 ..... right arrow

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

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

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.

Cat. No. 50084S

Schedule C (Form 990) 2022

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 right arrow

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 right arrow

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) 2019	(b) 2020	(c) 2021	(d) 2022	(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) 2022

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

24,969

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

24,969

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:	THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES.

Schedule C (Form 990) 2022

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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
right arrow

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

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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 ....	2,562,797	1,488,000	1,487,797	1,487,797	1,487,297
b	Contributions ...		1,075,000			500
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...		203
f	Administrative expenses ....
g	End of year balance ......	2,562,797	2,562,797	1,487,797	1,487,797	1,487,797

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

Board designated or quasi-endowment right arrow

0 %

Permanent endowment right arrow

100.000 %

Term endowment right arrow

0 %

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)

Yes

(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 .....	15,028,937		15,028,937
b	Buildings ....	218,530,466	50,982,352	167,548,114
c	Leasehold improvements	6,954,519	4,222,196	2,732,323
d	Equipment ....	75,748,382	46,661,645	29,086,737
e	Other .....	3,440,117		3,440,117
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				217,836,228

Schedule D (Form 990) 2022

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3) Other (A) SSM COMPREHENSIVE INVESTMENT PROGRAM	340,468,887	F
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	340,468,887

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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)ESTIMATED THIRD PARTY SETTLEMENT				854,207
(2)PENSION RESTORATION & DEFERRED COMPENSATION				61,520,820
(3)COLLATERAL HELD UNDER AGREEMENT				2,189,601
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				64,564,628

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
THIRD PARTY PAYABLES	3,836,564
INTERCOMPANY PAYABLES	75,161,713
OPERATING RIGHT-OF-USE LIABILITIES	2,189,123
DEFERRED COMPENSATION PLAN LIABILITIES	61,520,820





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	142,708,220
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) 2022

Page 4

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

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

Part XIII

Supplemental Information

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

Return Reference

Explanation

PART V, LINE 4:

ENDOWMENTS ARE DESIGNATED FOR MEDICAL CARE FOR THOSE IN FINANCIAL NEED, HEART AND CANCER CARE, AND OTHER HEALTH-RELATED NEEDS.

PART X, LINE 2:

AGNESIAN HEALTHCARE INC'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2023 OR 2022.

Schedule D (Form 990) 2022

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 20a.
Medium right arrow

Attach to Form 990.
Medium right arrow

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2023

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 %

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) . . .	4,390,412	0	4,390,412	0.830 %
b	Medicaid (from Worksheet 3, column a) . . . . .	47,272,833	16,232,655	31,040,178	5.830 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	5,476,321	3,761,738	1,714,583	0.320 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	57,139,566	19,994,393	37,145,173	6.980 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	591,677	0	591,677	0.110 %
f	Health professions education (from Worksheet 5) . . .	718,193	0	718,193	0.130 %
g	Subsidized health services (from Worksheet 6) . . . .	2,267,580	0	2,267,580	0.430 %
h	Research (from Worksheet 7) .	15,182	0	15,182	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	648,507	0	648,507	0.120 %
j	Total. Other Benefits . .	4,241,139		4,241,139	0.790 %
k	Total. Add lines 7d and 7j .	61,380,705	19,994,393	41,386,312	7.770 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023

Schedule H (Form 990) 2023

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing			0	0
2	Economic development			0	0
3	Community support			0	0
4	Environmental improvements			7,750	0	7,750	0 %
5	Leadership development and training for community members			0	0
6	Coalition building			0	0
7	Community health improvement advocacy			0	0
8	Workforce development			18,705	0	18,705	0 %
9	Other			0	0
10	Total			26,455		26,455	0 %

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. ......

5,813,981

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).....

33,611,346

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

40,289,937

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

-6,678,591

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) 2023

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 HTTPS://WWW.SSMHEALTH.COM/LOCATIONS/ST 120	X	X	X

Schedule H (Form 990) 2023

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 21

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): HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH

Other website (list url):

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 22

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

Yes

If "Yes" (list url): HTTPS://WWW.SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH

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) 2023

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 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA

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

WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA

A plain language summary of the FAP was widely available on a website (list url):
WWW.SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BILL/FINANCIAL-ASSISTA

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) 2023

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) 2023

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) 2023

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 3J: THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS COMPRISED OF FIVE DIFFERENT DATA COLLECTION METHODS TO INCLUDE PRIMARY, SECONDARY, QUALITATIVE, AND QUANTITATIVE DATA. ONCE IT WAS COLLECTED, IT WAS ORGANIZED INTO FIVE HEALTH FOCUS AREAS. COMMUNITY HEALTH SURVEY THE COMMUNITY HEALTH SURVEY CONDUCTED BY JKV RESEARCH, LLC., PROVIDES PRIMARY, QUANTITATIVE DATA COLLECTED FROM FOND DU LAC COUNTY RESIDENTS. THE DATA PROVIDES AN OVERVIEW OF BEHAVIORAL AND LIFESTYLE HABITS AS WELL AS PREVALENCE OF RISK FACTORS AND DISEASE CONDITIONS EXISTING WITHIN THE FOND DU LAC COUNTY ADULT POPULATION. THE SURVEY WAS MAILED OUT TO A RANDOM SAMPLE AND 674 ADULTS PARTICIPATED. AGGREGATE DATA FROM SIX SCHOOL DISTRICTS IN FOND DU LAC COUNTY IS INCLUDED IN THE COMMUNITY HEALTH SURVEY REPORT TO PROVIDE STUDENT DATA WHEN AVAILABLE. PUBLIC INPUT SURVEY THE PRIORITY HEALTH ISSUES SURVEY WAS CONDUCTED TO PROVIDE AN OUTLET FOR THE COMMUNITY AT LARGE TO PROVIDE ADDITIONAL INPUT AND VOICE THEIR CONCERNS REGARDING THE MOST PRESSING COUNTY HEAL TH ISSUES. THE SURVEY WAS AVAILABLE IN HARD COPY AT THE HEALTH DEPARTMENT AND ONLINE ON THE HEAL TH DEPARTMENT'S WEBSITE. THE SURVEY WAS AVAILABLE TO TAKE IN ENGLISH AND SPANISH. RESIDENTS WERE ENCOURAGED TO REVIEW KEY FINDINGS FROM THE 2020 COMMUNITY HEALTH SURVEY BEFOREHAND TO PROVIDE ADDITIONAL FEEDBACK. A TOTAL OF 284 FOND DU LAC COUNTY RESIDENTS COMPLETED THE SURVEY. THE HEALTH FOCUS AREAS RANKED MOST CONSISTENTLY IN THE TOP FIVE BY RESPONDENTS WERE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG USE, SOCIAL DETERMINANTS OF HEAL TH, FOOD SECURITY AND NUTRITION AND INFECTIOUS DISEASE. KEY INFORMANT INTERVIEWS A TOTAL OF 37 KEY INFORMANT INTERVIEWS WERE CONDUCTED TO PROVIDE FURTHER QUALITATIVE DATA REGARDING COMMUNITY NEEDS. KEY INFORMANTS IDENTIFIED WERE CONSIDERED COMMUNITY EXPERTS WHO CAN PROVIDE VALUABLE INSIGHT ON PRESSING HEAL TH ISSUES IN THE FOND DU LAC COUNTY COMMUNITY. THE TOP HEALTH FOCUS AREAS RANKED MOST CONSISTENTLY BY KEY INFORMANTS WERE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG USE, SOCIAL DETERMINANTS OF HEALTH, CHRONIC DISEASE, ORAL HEALTH AND FOOD SECURITY AND NUTRITION. COMMUNITY CONVERSATIONS NEW FOR THE 2021 COMMUNITY HEALTH ASSESSMENT WAS DATA COLLECTED FROM COMMUNITY CONVERSATIONS THESE CONVERSATIONS WERE ORGANIZED BY MEMBERS OF THE SSM HEALTH GREATER FOND DU LAC REGION, FOND DU LAC COUNTY HEAL TH DEPARTMENT AND OTHER ENTITIES THAT SERVED AS HOST LOCATIONS FOR THESE EVENTS. THE PURPOSE OF THESE COMMUNITY CONVERSATIONS WAS TO FURTHER ENGAGE THE PUBLIC AND PROVIDE AN OPPORTUNITY FOR VARIOUS POPULATIONS TO VOICE THEIR INPUT THAT MAY OTHERWISE HAVE NOT BEEN HEARD. 16 COMMUNITY CONVERSATIONS WERE HELD ACROSS THE COUNTY, PROVIDING FURTHER INFORMATION REGARDING THE HEAL TH NEEDS OF RESIDENTS IN FOND DU LAC COUNTY. TOP NEEDS IDENTIFIED FROM COMMUNITY CONVERSATIONS INCLUDE: ACCESS TO RESOURCES, MENTAL HEALTH, TRANSPORTATION, ACCESS TO CARE AND RACISM. HIGHLIGHTS AND THEMES FROM THESE CONVERSATIONS CAN BE FOUND THROUGHOUT THE REPORT. SECONDARY DATA SECONDARY DATA WAS COLLECTED FROM LOCAL, STATE, AND NATIONAL HEALTH SOURCES TO SUPPLEMENT THE COMMUNITY HEALTH SURVEY AND OTHER DATA COLLECTION INFORMATION LISTED ABOVE. THIS DATA HELPED BUILD A COMMUNITY HEALTH PROFILE FOR FOND DU LAC COUNTY AND ALLOWED THIS REPORT TO BE COMPARABLE TO OTHER COUNTIES AS WELL AS STATE AND NATIONAL BENCHMARKS. THE SECONDARY DATA COLLECTED IS INCLUDED IN THROUGHOUT THE HEALTH FOCUS AREA AND THE DEFINITION OF COMMUNITY PROFILES.
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: ST. AGNES HOSPITAL PARTNERED WITH THE FOND DU LAC COUNTY HEALTH DEPARTMENT AND HEALTHY FOND DU LAC COUNTY.
ST. AGNES HOSPITAL	PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED VARIOUS HEALTH NEEDS IN THE 2021 CHNA. IN ORDER TO MAKE MEANINGFUL IMPACT, AND TO USE ITS FINANCES MOST EFFECTIVELY AND EFFICIENCY, THE HOSPITAL WILL PLACE PRIMARY FOCUS ON THE FOLLOWING KEY PRIORITIES:- MENTAL HEALTH - CHRONIC DISEASE- SUBSTANCE USE MENTAL HEALTH ACCORDING TO THE WORLD HEALTH ORGANIZATION, THE DEFINITION OF HEALTH IS A "STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY." MENTAL HEALTH IS SOMETHING WE ALL HAVE, AND IT VARIES IN ITS DEGREE FROM TIME TO TIME. IF THERE IS A SIGNIFICANT IMPACT ON OUR THINKING, FEELING AND/OR BEHAVIOR, TREATMENT, SERVICES OR INTERVENTION MAY BE REQUIRED. IN GENERAL, THE SOONER ONE GETS TREATMENT, THE BETTER THE OUTCOME. HAVING AN UNTREATED MENTAL DISORDER CAN CREATE SERIOUS PROBLEMS SUCH AS INCREASING THE CHANCE OF RISKY BEHAVIORS, DRUG OR ALCOHOL ADDICTION, AND IN EXTREME CASES, DEATH. IT ALSO CAN RUIN RELATIONSHIPS, CAUSE PROBLEMS AT WORK, AND MAKE IT DIFFICULT TO OVERCOME SERIOUS ILLNESSES. MENTAL HEALTH WAS IDENTIFIED AS THE NUMBER ONE PRIORITY TO ADDRESS AS A RESULT OF THE 2021 CHNA. MENTAL HEALTH NEEDS IN FOND DU LAC COUNTY MAY INCLUDE, BUT IS NOT LIMITED TO CHALLENGES, BARRIERS OR NEEDS RELATED TO PROVIDER AVAILABILITY, AFFORDABILITY, TRANSPORTATION, INSURANCE, STIGMA, SUBSTANCE USE, CULTURALLY SENSITIVE AND DIVERSE PROVIDERS AND SERVICES, STRESS, AND SUICIDE. ADDITIONALLY, STATISTICS SHOW: - 20 DEATHS BY SUICIDE REPORTED IN FOND DU LAC COUNTY IN 2020 - 1 IN 5 ADULTS REPORTED TO HAVE A MENTAL HEALTH CONDITION IN THE PAST THREE YEARS- 1 IN 5 YOUTH REPORTED THEY ALWAYS OR NEARLY ALWAYS FELT SAD, BLUE OR DEPRESSED - 44% UNSERVED CHILDREN WITH MENTAL ILLNESS IN FOND DU LAC COUNTY- 79% ADULTS REPORT TO HAVE THEIR MENTAL HEALTH CONDITION UNDER CONTROL (DOWN FROM 96% IN 2017) IN ORDER TO DECREASE THE NUMBER OF DEATHS BY SUICIDE IN FOND DU LAC COUNTY, AS WELL AS INCREASE ACCESS TO BEHAVIORAL HEAL TH SERVICES, THE HOSPITAL'S ACTION PLAN INCLUDES THE FOLLOWING INITIATIVES: - EXPAND TRAININGS FOR QUESTION, PERSUADE, REFER (QPR), MENTAL HEAL TH FIRST AID FOR ADULTS (MHFA), YOUTH MENTAL HEALTH FIRST AID (YMHFA). EXPLORE ADDITIONAL TRAININGS AND PROGRAMS FOR SUICIDE PREVENTION AND MENTAL HEALTH- POTENTIAL NEW PARTNERS AND COLLABORATIONS: BUSINESSES AND EMPLOYERS- INCREASE MEANS FOR DATA COLLECTION, MONITORING AND EVALUATION OF MENTAL HEALTH NEEDS, WITH COMMUNITY PARTNERS SUCH AS DCP, AND PUBLIC SAFETY DEPARTMENTS- RESEARCH UNIVERSAL AND INDIVIDUAL SCREENING TOOLS FOR BEHAVIORAL AND MENTAL HEALTH NEEDS ACROSS THE LIFESPAN AND DEVELOP A PLAN TO ASSESS AND EXPAND SBIRT AT THE HOSPITAL- INCREASE MENTAL HEALTH/BEHAVIORAL HEAL TH SERVICES AND ACCESS TO THEM- INCREASE MENTAL HEALTH RESOURCES AND NAVIGATION TOOLS - DEVELOP MORE UNIVERSAL APPROACH TO SAFETY PLANNING ACROSS THE COUNTRY- DECREASE STIGMA, CAMPAIGNS, AWARENESS, TIC, ACES, BUILD COMMUNITY CHRONIC DISEASE CHRONIC DISEASES ARE ILLNESSES THAT LAST A LONG TIME, DO NOT GO AWAY ON THEIR OWN, ARE RARELY CURED, AND OFTEN RESULT IN DISABILITY LATER IN LIFE. MULTIPLE HEAL TH CONDITIONS ARE CLASSIFIED AS CHRONIC DISEASES SUCH AS HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, HEART DISEASE, OBESITY, DIABETES, ASTHMA AND MORE. NUTRITION AND PHYSICAL ACTIVITY ARE IMPORTANT TO MAINTAIN AND IMPROVE OVERALL HEALTH AND BOTH PLAY A PROMINENT ROLE IN OBESITY PREVENTION AND CONTROL. AS ESTABLISHED IN THE U.S. DIETARY GUIDELINES, GOOD NUTRITION INCLUDES MEETING NUTRIENT RECOMMENDATIONS YET KEEPING CALORIES UNDER CONTROL. PHYSICAL ACTIVITY MEANS ANY BODILY ACTIVITY THAT ENHANCES OR MAINTAINS PHYSICAL FITNESS AND OVERALL HEALTH. OBESITY IS ONE OF THE MOST CRITICAL HEALTH ISSUES OF OUR TIME AND IS A COMPLEX HEALTH ISSUE RESULTING FROM MANY INTERACTING CAUSES AND FACTORS IN OUR SOCIETY, BEHAVIOR, AND GENETICS. OBESITY IS ALSO ASSOCIATED WITH POORER MENTAL HEALTH OUTCOMES AND REDUCES QUALITY OF LIFE. THE BURDEN OF OBESITY AND OTHER DIET-RELATED CHRONIC DISEASES ARE VAST, AND RATES CONTINUE TO RISE. CHANGES AT THE COMMUNITY LEVEL, SUCH AS POLICIES, SYSTEMS, AND ENVIRONMENT, ARE MORE LIKELY TO BE EFFECTIVE, ALTHOUGH THEY MAY BE MORE DIFFICULT TO ACHIEVE. ACCORDING TO FOND DU LAC COMMUNITY MEMBERS RESPONSES THROUGHOUT THE ASSESSMENT, COMMON BARRIERS AND CHALLENGES TO CHRONIC DISEASES AND RELATED HEALTH BEHAVIORS INCLUDED, BUT NOT LIMITED TO, ACCESS AND AFFORDABILITY TO HEAL THY FOODS, AWARENESS OF NUTRITIOUS FOOD AND COOKING HEALTHY MEALS, ACCESS TO INDOOR AND OUTDOOR RECREATION, ACCESS AND AFFORDABILITY OF HEALTHCARE SERVICES. INSURANCE, STIGMA, TRANSPORTATION, AND CULTURAL COMPETENCIES. ADDITIONALLY, STATISTICS SHOW:- HEART DISEASES IS THE NUMBER ONE CAUSE OF DEATH AMONG ADULTS - 75% (3 IN 4) ADULTS WERE CLASSIFIED AS AT LEAST OVERWEIGHT - ABOUT 1 IN 3 YOUTH WERE CLASSIFIED AS AT LEAST OVERWEIGHT - 52% OF ADULTS REPORTED MEETING AEROBIC PHYSICAL ACTIVITY GUIDELINES- 23% OF ADULTS REPORTED EATING THE RECOMMENDED SERVINGS OF FRUIT PER DAY - 17% OF YOUTH REPORTED EATING THE RECOMMENDED SERVINGS OF FRUIT PER DAY - 4,920 (6%) HOUSEHOLDS REPORTED THEY WENT HUNGRY BECAUSE THEY COULDN'T AFFORD ENOUGH FOODIN ORDER TO IMPROVE RESIDENTS' WEIGHT, PHYSICAL ACTIVITY, NUTRITION, AND INCREASE BREASTFEEDING, THE HOSPITAL HAS IMPLEMENTED THE FOLLOWING ACTION ITEMS: - RESEARCH AND IDENTIFY CHRONIC DISEASE PREVENTION AND SELF-MANAGEMENT CLASSES- INCREASE TRAIL USAGE, ENHANCE BIKE AND PEDESTRIAN MASTER PLANS - IMPLEMENT A PHYSICAL ACTIVITY CAMPAIGN - INCREASE SCHOOLS PARTICIPATING IN SAFE ROUTES TO SCHOOL - IDENTIFY EXISTING EFFORTS AND ASSESS IMPACT- INCREASE SNAP USAGE- INCREASE ACCESS TO AND AFFORDABILITY OF FRUITS AND VEGETABLES- ASSESS CURRENT FOOD FORESTS OR COMMUNITY/SHARED GARDENS AND INCREASE VALUE/IMPACT- INCREASE HEAL TH PROMOTION PROGRAMS OFFERED TO LOW-INCOME HOUSING RESIDENTS- INCREASE NUMBER OF CHILDCARE CENTERS AND BUSINESS CENTERS WHO HAVE ADOPTED THE TEN STEPS TO BREASTFEEDING-FRIENDLY TOOLKIT (PROMOTE SUPPORT FOR BREASTFEEDING MOTHERS IN THE WORKPLACE, EARLY CHILDHOOD EDUCATION SETTINGS, AND THROUGHOUT THE COMMUNITY SUBSTANCE USE ALCOHOL AND OTHER DRUG USE MEANS ANY USE OF A SUBSTANCE THAT RESULT IN NEGATIVE CONSEQUENCES. THIS INCLUDES A BROAD ARRAY OF MOOD-ALTERING SUBSTANCES SUCH AS ALCOHOL, TOBACCO, PRESCRIPTION SUBSTANCES, AND ILLEGAL SUBSTANCES LIKE METHAMPHETAMINE AND HEROIN. NEGATIVE CONSEQUENCES OR UNHEALTHY USES INCLUDE BUT ARE NOT LIMITED TO, OPERATING A MOTOR VEHICLE WHILE INTOXICATED, DRINKING WHILE PREGNANT, ALCOHOL DEPENDENCE, FETAL ALCOHOL SPECTRUM DISORDER, ALCOHOL-RELATED HOSPITALIZATIONS, AND MORE. SUBSTANCE USE WAS IDENTIFIED AS THE NUMBER THREE PRIORITY TO ADDRESS IN THE 2022-2024 CHIP. SUBSTANCE USE NEEDS IN FOND DU LAC COUNTY MAY INCLUDE, BUT IS NOT LIMITED TO BARRIERS, CHALLENGES AND NEEDS RELATED TOBACCO, VAPING, DRUGS (NARCOTICS, MARIJUANA, ETC.), PRESCRIPTION MEDICATIONS, AND ALCOHOL USE, MENTAL HEAL TH AND ACCESS TO CARE. THROUGHOUT THE COMMUNITY HEAL TH NEEDS ASSESSMENT, SUBSTANCE USE WAS CONSISTENTLY RANKED AS A TOP PRIORITY. ADDITIONALLY, STATISTICS SHOW: - 25 OPIOID RELATED DEATHS IN FOND DU LAC COUNTY IN 2020, OVER DOUBLE THE DEATHS FROM 2019 - 74% OF ADULTS REPORTED DRINKING ALCOHOL IN THE PAST MONTH - 22% OF YOUTH REPORTED DRINKING ALCOHOL IN THE PAST MONTH - 37% OF ADULTS REPORTED BINGE DRINKING ALCOHOL IN THE PAST MONTH - 37% OF ADULTS REPORTED BINGE DRINKING ALCOHOL IN THE PAST MONTH THE HOSPITAL'S ACTION PLAN INCLUDES THE FOLLOWING INITIATIVES TO DECREASE UNDERAGE DRINKING AND BINGE DRINKING, AND DECREASE MISUSE OF OPIOIDS/PRESCRIPTION MEDICATION: - INCREASE FESTIVALS EVALUATED ANNUALLY USING THE COMMUNITY EVENTS BEST PRACTICES TOOLKIT - INCREASE NUMBER OF LAW ENFORCEMENT AGENCIES COMPLETING ANNUAL COMPLIANCE CHECKS - DECREASE ALCOHOL OUTLET DENSITY - AWARENESS AND EDUCATION CAMPAIGN- INCREASE NUMBER OF NARCAN TRAININGS AND KITS DISTRIBUTED- SYRINGE SERVICES PROGRAM - PRESCRIPTION MEDICATION PRESCRIBING PRACTICES AND PAIN MANAGEMENT- PRESCRIPTION MEDICATION DISPOSAL THE HOSPITAL HAS NO PLANS TO DISCONTINUE OTHER COMMUNITY BENEFIT EFFORTS ADDRESSING THE REMAINING CHNA-IDENTIFIED NEEDS.

Schedule H (Form 990) 2023

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?4
Name and address		Type of Facility (describe)
1	1 - FOND DU LAC REGIONAL CLINIC 420 E DIVISION STREET FOND DU LAC,WI54935	OUTPATIENT CLINIC
2	2 - CONSULTANTS LAB OF WISCONSIN LLC 430 E DIVISION STREET FOND DU LAC,WI54935	LABORATORY AND TESTING
3	3 - AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC,WI54935	PHARMACEUTICALS, HOME HEALTH, AND MEDICAL SUPPLIES
4	4 - SSM HEALTH EYE CARE 421 CAMELOT DRIVE FOND DU LAC,WI54935	OUTPATIENT CLINIC
5
6
7
8
9
10

Schedule H (Form 990) 2023

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:	PATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF THE HOSPITAL; HOWEVER THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO COMMERCIALLY INSURED [OR MEDICARE] PATIENTS. IN SUCH CASES, OTHER FACTORS MAY BE CONSIDERED IN DETERMINING THEIR ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES, INCLUDING: BANK ACCOUNTS, INVESTMENTS AND OTHER ASSETSEMPLOYMENT STATUS AND EARNING CAPACITYAMOUNT AND FREQUENCY OF BILLS FOR HEAL TH CARE SERVICESOTHER FINANCIAL OBLIGATIONS AND EXPENSES*GENERALLY, FINANCIAL RESPONSIBILITY WILL BE NO MORE THAN 25% OF GROSS FAMILY INCOME. THE HOSPITAL MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. THIS PROCESS IS CALLED "PRESUMPTIVE ELIGIBILITY."
PART I, LINE 6A:	SSM HEALTH CARE CORPORATION, 46-6029223
PART I, LINE 7:	THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A, 7B, AND 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E, 7F, 7G, 7H, AND 71 ARE REPORTED AT COST AS REPORTED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE CALCULATION OF SCHEDULE H, PART I, LINE 7, COLUMN F UTILIZES 990, PART IX, LINE 25, COLUMN A, WHICH DOES NOT INCLUDE BAD DEBT EXPENSE.
PART II, COMMUNITY BUILDING ACTIVITIES:	AGNESIAN HEALTHCARE INC PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEALTH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: ENVIRONMENTAL IMPROVEMENTS: SAFE SHARPS DISPOSAL; LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: SUPPORT TO HELP PROGRAMMING AND TUITION FOR VULNERABLE STUDENTS AT MARIAN UNIVERSITY; WORKFORCE DEVELOPMENT: YOUTH APPRENTICESHIP AND JOB SHADOWING; SUPPORT FOR THE FOND DU LAC WORKS PROGRAM AND ECONOMIC FORECAST BREAKFAST.
PART III, LINE 2:	AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE.
PART III, LINE 3:	FOR FINANCIAL STATEMENT PURPOSES, SSM HEALTH HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THEREFORE, THERE IS NO AMOUNT REPORTED ON PART III, LINE 3 FOR THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER SSM HEALTH'S FINANCIAL ASSISTANCE POLICY.
PART III, LINE 4:	AGNESIAN HEALTHCARE INC IS PART OF THE SSM HEALTH CONSOLIDATED AUDIT. THE FOOTNOTE THAT REFERENCES THE TREATMENT OF UNCOLLECTIBLE ACCOUNTS AND IMPLICIT PRICE CONCESSIONS IN THE DECEMBER 31, 2023 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS.
PART III, LINE 8:	THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEAL TH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST.
PART III, LINE 9B:	AGNESIAN HEALTHCARE INC HAS ESTABLISHED A WRITTEN CREDIT AND COLLECTION POLICY AND PROCEDURES. THE BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES OF SSM HEALTH, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. AGNESIAN HEALTHCARE INC EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH IT PARTICIPATES BY ESTABLISHING SOUND BUSINESS PRACTICES. AGNESIAN HEALTHCARE INC'S BILLING AND COLLECTION PRACTICES WILL BE FAIRLY AND CONSISTENTLY APPLIED. ALL STAFF AND VENDORS ARE EXPECTED TO TREAT ALL PATIENTS CONSISTENTLY AND FAIRLY REGARDLESS OF THEIR ABILITY TO PAY. THEY RESPOND TO PATIENTS IN A PROMPT AND COURTEOUS MANNER REGARDING ANY QUESTIONS ABOUT THEIR BILLS AND PROVIDE NOTIFICATION OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL UNINSURED PATIENTS WILL BE PROVIDED A STANDARD DISCOUNT FOR MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES, INCLUDING SERVICES PROVIDED AT OFF-CAMPUS OUTPATIENT SITES. THE HOSPITAL DETERMINED THE AMOUNT OF THE DISCOUNT BASED ON THE LOCAL MANAGED CARE MARKET, APPLICABLE STATUTORY REQUIREMENTS AND OTHER RELEVANT LOCAL CIRCUMSTANCES. THE RATE MUST BE NO LESS THAN THE LOWEST EFFECTIVE DISCOUNT RATE AND NO GREATER THAN THE HIGHEST EFFECTIVE DISCOUNT RATE FOR THE CURRENT MANAGED CARE CONTRACTS OF THE HOSPITAL. UNINSURED PATIENTS MAY ALSO QUALIFY FOR AN ADDITIONAL DISCOUNT BASED UPON FINANCIAL NEED UNDER THE SYSTEM FINANCIAL ASSISTANCE POLICY. ALL ACCOUNTS DUE FROM THE PATIENT WILL RECEIVE A STATEMENT AFTER DISCHARGE OR AFTER FINAL ADJUDICATION FROM PATIENT'S INSURANCE. GENERALLY THE PATIENT WILL RECEIVE 4 MONTHS (120 DAYS) OF IN-HOUSE COLLECTION EFFORTS (INCLUDING EARLY OUT VENDORS) AND 12 MONTHS OF BAD DEBT COLLECTION EFFORTS. THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO DETERMINE FAP ELIGIBILITY INCLUDING: 1. THE FINANCIAL ASSISTANCE SUMMARY WILL BE INCLUDED WITH EACH BILLING STATEMENT 2. EXTRAORDINARY COLLECTION ACTIVITY (ECAS) MAY NOT OCCUR UNTIL BAD DEBT PLACEMENT AND ONLY AFTER 120 DAYS. 3. ECAS MUST BE SUSPENDED IF A GUARANTOR SUBMITS A FAP APPLICATION DURING THE APPLICATION PERIOD. 4. REASONABLE MEASURES MUST BE TAKEN TO REVERSE ECAS IF THE APPLICATION IS APPROVED WHICH MAY INCLUDE REFUNDING ANY PAYMENTS MADE IN EXCESS OF AMOUNTS OWED AS AN FAP-ELIGIBLE INDIVIDUAL. 5. BAD DEBT VENDORS WILL GAIN WRITTEN APPROVAL FROM SSM PRIOR TO ENGAGING IN ECAS. SSM WILL REVIEW THE ACCOUNTS AND VERIFY SATISFACTORY COMPLETION OF REASONABLE EFFORTS DURING THE NOTIFICATION AND APPLICATION PERIOD. A WAIVER IS NOT CONSIDERED REASONABLE EFFORTS. OBTAINING A SIGNED WAIVER THAT AN INDIVIDUAL DOES NOT WISH TO APPLY FOR FAP ASSISTANCE OR RECEIVE FAP APPLICATION INFORMATION WILL NOT MEET THE REQUIREMENT TO MAKE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE BEFORE ENGAGING IN ECAS. ALL OUTSIDE COLLECTION AGENCIES MUST COMPLY WITH STATE AND FEDERAL LAWS, COMPLY WITH THE ASSOCIATION OF CREDIT AND COLLECTION PROFESSIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY AND COMPLY WITH AGNESIAN HEALTHCARE INC'S COLLECTION AND FINANCIAL ASSISTANCE POLICIES.
PART VI, LINE 2:	SSM HEALTH (SSMH) PARTICIPATES IN COMMUNITY BENEFIT ACCORDING TO OUR VISION, THROUGH OUR PARTICIPATION IN THE HEALING MINISTRY OF JESUS CHRIST, COMMUNITIES, ESPECIALLY THOSE THAT ARE ECONOMICALLY, PHYSICALLY, AND SOCIALLY MARGINALIZED, WILL EXPERIENCE IMPROVED HEALTH IN MIND, BODY, SPIRIT AND ENVIRONMENT. IN THE TRADITION OF OUR FOUNDERS, THE FRANCISCAN SISTERS OF MARY, CARING FOR THOSE IN GREATEST NEED REMAINS OUR ORGANIZATIONAL PRIORITY. TODAY OUR SYSTEM BOARD MONITORS COMMUNITY BENEFIT EFFORTS, AND VIEWS ACHIEVEMENT OF OUR VISION AS A PRIMARY RESPONSIBILITY. THE PURPOSE OF SSMH'S COMMUNITY BENEFIT PROGRAM IS TO ASSESS AND ADDRESS COMMUNITY HEAL TH NEEDS. MAKING OUR COMMUNITIES HEALTHIER IN MEASURABLE WAYS IS ALWAYS OUR GOAL. TO FULFILL THIS COMMITMENT, SSMH'S COMMUNITY BENEFIT IS DIVIDED INTO TWO PARTS: 1) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND 2) COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CHNA IS AN ASSESSMENT AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS AND THE ADOPTION AND IMPLEMENTATION OF STRATEGIES TO ADDRESS THOSE NEEDS. A CHNA IS CONDUCTED EVERY THREE YEARS BY EACH HOSPITAL ACCORDING TO THE FOLLOWING STEPS: ASSESS AND PRIORITIZE COMMUNITY HEALTH NEEDS: GATHER CHNA DATA FROM SECONDARY SOURCES; OBTAIN INPUT FROM STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY THROUGH INTERVIEWS AND FOCUS GROUPS; USE DATA TO SELECT TOP HEALTH PRIORITIES; AND COMPLETE WRITTEN CHNA. DEVELOP, ADOPT, AND IMPLEMENT STRATEGIES TO ADDRESS TOP-HEAL TH PRIORITIES: ESTABLISH STRATEGIES TO ADDRESS PRIORITIES; COMPLETE STRATEGIC IMPLEMENTATION PLAN; OBTAIN REGIONAUDIVISIONAL BOARD APPROVAL; AND INTEGRATE STRATEGIES INTO OPERATIONAL PLAN. MAKE CHNA WIDELY AVAILABLE TO THE PUBLIC: PUBLISH CHNA AND SUMMARY DOCUMENT ON HOSPITAL'S WEBSITE. MONITOR, TRACK, AND REPORT PROGRESS ON TOP HEAL TH PRIORITIES: COLLECT DATA AND EVALUATE PROGRESS; REPORT TO REGIONAUDIVISIONAL BOARD EVERY SIX MONTHS AND SYSTEM BOARD EVERY YEAR; SHARE FINDINGS WITH COMMUNITY STAKEHOLDERS; AND SEND RESULTS TO FINANCE FOR SUBMISSION TO THE INTERNAL REVENUE SERVICE (IRS). SYSTEM OFFICE STAFF AND LEADERS OVERSEE AND MONITOR SSMH'S COMMUNITY BENEFIT PROGRAM, AND ENSURE REPORTING IS IN COMPLIANCE WITH IRS REGULATIONS. IN COLLABORATION WITH COMMUNITY STAKEHOLDERS AND PARTNER ORGANIZATIONS, SSM HEALTH CARE CORPORATION ALSO IDENTIFIES NEEDS BASED ON ASSESSMENTS AND RESEARCH, AND SSMH FACILITIES ALSO INVOLVE CASE MANAGERS AND CARE TEAM STAFF TO PINPOINT CRITICAL HEAL TH ISSUES IN THE COMMUNITY. ALL HOSPITAL CHNAS ARE COMPLETED, APPROVED, AND INTEGRATED INTO THE ORGANIZATION'S STRATEGIC PLAN. WE CONTINUE TO MONITOR AND ASSESS THE PROGRESS OF OUR LOCAL EFFORTS IN THE SPIRIT OF CARING FOR OTHERS AND IMPROVING COMMUNITY HEALTH.
PART VI, LINE 3:	EACH ENTITY PROVIDING MEDICAL SERVICE SHALL PROVIDE INFORMATION TO THE PUBLIC REGARDING ITS CHARITY CARE POLICIES AND THE QUALIFICATION REQUIREMENTS FOR EACH OF ITS FACILITIES. WHEN STANDARD SYSTEM NOTICES AND COMMUNICATION REGARDING CHARITY CARE ARE AVAILABLE, THESE MUST BE USED. MODIFICATIONS TO THE STANDARD MAY BE MADE TO COMPLY WITH STATE AND LOCAL LAWS, AS WELL AS REFLECT CULTURALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES ARE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY PROVIDE INFORMATION ABOUT: * THE PATIENT'S RESPONSIBILITY FOR PAYMENT,* THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND ENTITY CHARITY CARE AND PAYMENT ARRANGEMENTS* THE ENTITY'S CHARITY POLICY AND APPLICATION PROCESS, AND* WHO TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELINGTHE FOLLOWING TYPES OF NOTICES TO THE PUBLIC ARE PROVIDED: SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS. BROCHURES OR FLIERS PROVIDED AT TIME OF REGISTRATION AND AVAILABLE IN THE FINANCIAL COUNSELING AREAS. NOTICES SENT WITH OR ON PATIENT BILLS OR COMMUNICATIONS SENT TO PATIENTS AND GUARANTORS RELATED TO MEDICAL SERVICES. APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION. THE APPLICATION FOR CHARITY CARE, TOGETHER WITH ANY INSTRUCTIONS, MUST CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES IS ALSO PROVIDED TO PUBLIC AGENCIES.
PART VI, LINE 4:	ST. AGNES HOSPITAL DEFINES ITS COMMUNITY AS FOND DU LAC COUNTY AND THE SURROUNDING PORTIONS OF ADJACENT DODGE AND GREEN LAKE COUNTIES WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL'S SECONDARY SERVICE AREAS ALSO INCLUDE A SMALL PORTION OF SHEBOYGAN AND CALUMET COUNTIES. ST. AGNES HOSPITAL IS LOCATED IN FOND DU LAC, WISCONSIN, WHICH HAD AN ESTIMATED POPULATION OF 43,263 ACCORDING TO THE U.S. CENSUS. THE COUNTY AS A WHOLE WAS ESTIMATED AT 103,403 ADULTS. WHEN COMPARED TO WISCONSIN, FOND DU LAC COUNTY'S POPULATION IS SLIGHTLY OLDER AND LESS DIVERSE. THE POPULATION IN FOND CU LAC COUNTY AND THE GREATER FOND DU LAC MARKET IS PREDOMINANTLY WHITE WITH 90.8 PERCENT AND 91.6PERCENT WHITE POPULATION, RESPECTIVELY. ADDITIONAL RACES AND ETHNICITIES THAT MAKE UP THE POPULATION IN FOND DU LAC COUNTY INCLUDE 3.3 PERCENT BLACK/AFRICAN AMERICAN, 5.3 PERCENT HISPANIC/LATINO, AND 1.9 PERCENT ASIAN. FOND DU LAC COUNTY HAS A GREATER PERCENT OF THE POPULATION WITH A HIGH SCHOOL AND SOME COLLEGE EDUCATION AND HAS A LARGER PERCENT OF POPULATION AGE 65 AND OLDER, COMPARED TO WISCONSIN. THE PERCENT OF POPULATION IN FOND DU LAC COUNTY WITH A HOUSEHOLD INCOME OF $50,000-$75,000 IS GREATER COMPARED TO WISCONSIN, AND THE PERCENT OF INDIVIDUALS LIVING IN POVERTY IN FOND DU LAC COUNTY IS LESS COMPARED TO WISCONSIN. ADDITIONALLY, ACCORDING TO THE ASSET LIMITED, INCOME CONSTRAINED, EMPLOYED (ALICE) 24 PERCENT OF HOUSEHOLDS ARE CONSIDERED AN ALICE HOUSEHOLD, COMPARED TO 23 PERCENT IN WISCONSIN. AN ALICE HOUSEHOLD DESCRIBES FAMILIES WHO WORK, EARN ABOVE THE FEDERAL POVERTY LEVEL, BUT DO NOT ENOUGH TO AFFORD A BASIC HOUSEHOLD BUDGET, DRIVING FAMILIES TO MAKE TOUGH CHOICES TO SUPPORT THEIR FAMILIES, SURVIVE AND THRIVE IN THE COMMUNITY. THE HIGHEST RATES OF ALICE ARE AMONG ADULTS 65 YEARS AND OLDER. ADDITIONAL DEMOGRAPHIC AND STATISTICAL DATA ON FOND DU LAC COUNTY'S RESIDENTS AND THEIR HEALTH CAN BE FOUND THROUGHOUT THE 2021 CHNA.
PART VI, LINE 5:	AGNESIAN HEALTHCARE INC PARTICIPATES IN A WIDE ARRAY OF COMMUNITY PROGRAMS THROUGHOUT THE AREA TO FURTHER ITS EXEMPT PURPOSE OF PROMOTING THE HEAL TH OF THE COMMUNITY. THE COMMUNITY INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. COMMUNITY BENEFIT INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. OUR COMMUNITY HEALTH PROGRAMS PROVIDE COMPASSIONATE AND COMPETENT CARE WHILE THEY PROMOTE HEAL TH IMPROVEMENT BY REACHING DIRECTLY INTO THE COMMUNITY TO ENSURE THAT LOW-INCOME AND UNDER-SERVED PERSONS CAN ACCESS HEAL TH CARE SERVICES. IN RESPONSE TO THE GLOBAL CORONAVIRUS PANDEMIC, AGNESIAN HEALTHCARE INC WORKED RELENTLESSLY TO RESPOND TO COMMUNITY NEEDS BY DEVELOPING AND IMPLEMENTING STRATEGIES TO ADDRESS SOCIAL NEEDS OF THOSE SERVED, PROVIDING SCREENING & TESTING SERVICES, PERSONAL PROTECTIVE EQUIPMENT AND EDUCATION THROUGHOUT THE COMMUNITY, AS WELL AS TREATMENT FOR THOSE WHO PRESENTED WITH COVID-19. AGNESIAN HEALTHCARE INC PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE COMMUNITY HEALTH. AGNESIAN HEALTHCARE INC ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, ENGAGES IN THE TRAINING AND EDUCATION OF HEAL TH CARE PROFESSIONALS, PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS *ALL SURPLUS FUNDS GENERATED BY SSMH ENTITIES ARE REINVESTED IN IMPROVING OUR PATIENT CARE DELIVERY SYSTEM.
PART VI, LINE 6:	AGNESIAN HEALTHCARE INC IS A 501 (C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEALTH CARE SYSTEM KNOW AS SSM HEALTH. SSM HEALTH (SSMH) IS A CENTRALLY MANAGED, FULLY INTEGRATED HEAL TH CARE DELIVERY SYSTEM WITH ITS HEADQUARTERS BASED IN ST. LOUIS, MISSOURI. SSM HEALTH CARE CORPORATION (SSMHCC) (DOING BUSINESS AS SSMH) IS THE PRINCIPAL NOT-FOR-PROFIT CORPORATION AND HAS BEEN ESTABLISHED AS THE PARENT CORPORATION. SSMH OWNS AND OPERATES 22 ADULT HOSPITALS, ONE PEDIATRIC HOSPITAL, THIRTEEN POST-ACUTE CARE FACILITIES, A NATIONAL PHARMACY BENEFIT MANAGEMENT COMPANY (PBM), AN EXTENSIVE NETWORK OF PHYSICIAN PRACTICE OPERATIONS, AND OTHER HEAL TH CARE BUSINESSES. SSMH'S HOSPITAL OPERATIONS ARE LOCATED PRIMARILY IN MISSOURI, WISCONSIN, OKLAHOMA AND ILLINOIS, AND ITS RELATED BUSINESSES PROVIDE HEALTH RELATED SERVICES IN 50 STATES. SSMH'S MISSION STATEMENT IS AS FOLLOWS: THROUGH OUR EXCEPTIONAL HEALTH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. SSMHCC AND MOST OF ITS AFFILIATED SUBSIDIARY CORPORATIONS HAVE BEEN GRANTED EXEMPTION FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). CERTAIN SUBSIDIARIES OF SSMH ARE FOR-PROFIT ENTITIES THAT ARE TAXABLE UNDER THE IRC. SSMH IS SPONSORED BY SSM HEALTH MINISTRIES, AN INDEPENDENT NINE-MEMBER BODY COMPOSED OF TWO FRANCISCAN SISTERS OF MARY, ONE SISTER OF ST. AGNES, ONE JESUIT PRIEST, AND FIVE LAY PERSONS WHO COLLECTIVELY HOLD CERTAIN RESERVED POWERS OVER SSMH.
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

Schedule H (Form 990) 2023

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
AGNESIAN HEALTHCARE INC

Employer identification number
39-0807236

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) SOCIETY OF ST VINCENT DE PAUL FOND DU LAC COUNTY 330 N PETERS AVENUE FOND DU LAC,WI54935	39-0824875	501(C)(3)	101,000	GENERAL SUPPORT
(2) BOYS & GIRLS CLUB OF FOND DU LAC INC 6 WEST 2ND STREET FOND DU LAC,WI54936	39-1896496	501(C)(3)	60,000	GENERAL SUPPORT
(3) FOND DU LAC COUNTY 160 S MACY ST FOND DU LAC,WI54935	39-6005696	FOND DU LAC COUNTY	40,000	GENERAL SUPPORT
(4) FOND DU LAC FAMILY YMCA ATTN KATE MUELLER 90 W SECOND ST FOND DU LAC,WI54935	39-0806436	501(C)(3)	30,000	GENERAL SUPPORT
(5) MARIAN UNIVERSITY 3200 COLD SPRING ROAD INDIANAPOLIS,IN46222	35-0868175	501(C)(3)	30,000	GENERAL SUPPORT
(6) HOLY FAMILY CONGREGATION 271 FOURTH STREET WAY FOND DU LAC,WI54937	39-1998002	501(C)(3)	20,000	GENERAL SUPPORT
(7) FONDY FOOD PANTRY INC PO BOX 492 FOND DU LAC,WI54936	51-0156435	501(C)(3)	16,980	GENERAL SUPPORT
(8) SOLUTIONS CENTER INC 39 N SOPHIA STREET FOND DU LAC,WI54935	39-1452956	501(C)(3)	15,000	GENERAL SUPPORT
(9) THE ARC FOND DU LAC INC 500 N PARK AVE FOND DU LAC,WI54935	39-1034161	501(C)(3)	15,000	GENERAL SUPPORT
(10) FRIENDS OF WOMEN IN RECOVERY INC DBA BEACON HOUSE PO BOX 1524 FOND DU LAC,WI549361524	39-1678741	501(C)(3)	10,000	GENERAL SUPPORT
(11) FDL SCHOOL DISTRICT ADMINISTRATIVE OFFICES 72 W NINTH STREET FOND DU LAC,WI54935	39-1411371	SCHOOL DISTRICT	20,000	GENERAL SUPPORT
(12) EBONY VISION 14 WESTERN AVE SUITE 203 FOND DU LAC,WI54936	27-4179193	501(C)(3)	10,000	GENERAL SUPPORT
(13) FOND DU LAC LITERACY SVCS INC 32 SHEBOYGAN ST FOND DU LAC,WI54935	39-1901303	501(C)(3)	10,000	GENERAL SUPPORT
(14) CHILDRENS MUSEUM OF FOND DU LAC INC 75 W SCOTT ST FOND DU LAC,WI54935	56-2471187	501(C)(3)	10,000	GENERAL SUPPORT
(15) BLANDINE HOUSE INC 25 N PARK AVE FOND DU LAC,WI54935	23-7025601	501(C)(3)	10,000	GENERAL SUPPORT
(16) FOND DU LAC AREA ASSOCIATION OF COMMERCE FOUNDATION 1020 S MAIN ST SUITE E FOND DU LAC,WI54935	51-0181570	501(C)(3)	10,000	GENERAL SUPPORT
(17) TREFFERT WAY FOR THE EXCEPTIONAL MIND CHARTER SCHOOL 706 MINNESOTA AVE NORTH FOND DU LAC,WI54937	99-9999999	501(C)(3)	10,000	GENERAL SUPPORT
(18) NATIONAL ALLIANCE OF MENTAL ILLNESS OF FOND DU LAC CO WI 86 S MACY STREET FOND DU LAC,WI54935	39-1466269	501(C)(3)	7,500	GENERAL SUPPORT
(19) FONDY FOOD PANTRY INC PO BOX 492 FOND DU LAC,WI54936	51-0156435	501(C)(3)	7,500	GENERAL SUPPORT
(20) BIG BROTHERS BIG SISTERS OF FOND DU LAC CO 448 S MILITARY RD FOND DU LAC,WI54935	39-1330971	501(C)(3)	7,500	GENERAL SUPPORT
(21) BISHOP & CHAPTER OF ST PAULS CATHEDRAL - BROKEN BREAD FOOD 51 WEST DIVISION STREET FOND DU LAC,WI54935		501(C)(3)	7,500	GENERAL SUPPORT
(22) MAHALA'S HOPE INC N4590 HWY 45 EDEN,WI53019	84-1680693	501(C)(3)	6,000	GENERAL SUPPORT
(23) FOND DU LAC COUNTY UNITED WAY 74 S MAIN ST FOND DU LAC,WI54935	39-0806194	501(C)(3)	6,000	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2023

Page 2

Part III

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

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference	Explanation

Schedule I (Form 990) 2023

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic

Attach to Form 990.
medium right arrow graphic

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

OMB No. 1545-0047

2023

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 .....

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed 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? ....................

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) 2023

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1RANDY COMBS TREASURER, CHIEF FINANCIAL OFFICER A	(i) (ii)	0 ------------- 1,242,308	0 ------------- 669,269	0 ------------- 270,777	0 ------------- 1,203,989	0 ------------- 34,085	0 ------------- 3,420,428	0 ------------- 669,269
2STEVE SMOOT VICE PRESIDENT, COO OF SSM HEALTH	(i) (ii)	0 ------------- 1,173,646	0 ------------- 737,192	0 ------------- 143,520	0 ------------- 1,164,125	0 ------------- 40,364	0 ------------- 3,258,847	0 ------------- 878,090
3DOUG LONG SECRETARY, GENERAL COUNSEL AT SSM HE	(i) (ii)	0 ------------- 759,270	0 ------------- 495,539	0 ------------- 170,430	0 ------------- 753,634	0 ------------- 23,379	0 ------------- 2,202,252	0 ------------- 495,539
4SUZANNE ANDERSON DIRECTOR, REGIONAL PRESIDENT	(i) (ii)	0 ------------- 765,767	0 ------------- 330,759	0 ------------- 332,388	0 ------------- 520,449	0 ------------- 19,873	0 ------------- 1,969,236	0 ------------- 253,821
5MATT HANLEY DIRECTOR, INTERIM REGIONAL PRES - SS	(i) (ii)	0 ------------- 0	0 ------------- 974,654	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 974,654	0 ------------- 0
6KATHERINE VERGOS PRESIDENT - ST. AGNES HOSPITAL	(i) (ii)	495,539 ------------- 0	140,411 ------------- 0	38,651 ------------- 0	200,445 ------------- 0	42,484 ------------- 0	917,530 ------------- 0	177,206 ------------- 0
7MICHAEL VANDER KOOY RADIATION ONCOLOGIST	(i) (ii)	656,802 ------------- 0	0 ------------- 0	4,902 ------------- 0	18,669 ------------- 0	48,898 ------------- 0	729,271 ------------- 0	0 ------------- 0
8SYED MOHIUDDIN DIRECTOR	(i) (ii)	664,361 ------------- 0	0 ------------- 0	2,595 ------------- 0	16,385 ------------- 0	39,537 ------------- 0	722,878 ------------- 0	0 ------------- 0
9KRISTOF GEHRKE PHYSICIAN	(i) (ii)	657,003 ------------- 0	0 ------------- 0	2,534 ------------- 0	17,205 ------------- 0	41,587 ------------- 0	718,329 ------------- 0	0 ------------- 0
10STEVEN FLURRY ANESTHESIOLOGIST	(i) (ii)	630,981 ------------- 0	0 ------------- 0	2,622 ------------- 0	28,279 ------------- 0	33,126 ------------- 0	695,008 ------------- 0	0 ------------- 0
11MARCIO SHIOKAWA PHYSICIAN	(i) (ii)	593,244 ------------- 0	6,001 ------------- 0	1,684 ------------- 0	15,623 ------------- 0	42,355 ------------- 0	658,907 ------------- 0	0 ------------- 0
12NANCY A BIRSCHBACH FORMER KEY EMPLOYEE	(i) (ii)	0 ------------- 339,363	0 ------------- 86,372	0 ------------- 32,341	0 ------------- 151,485	0 ------------- 26,117	0 ------------- 635,678	0 ------------- 114,067
13MICHAEL DREES VP - OPERATIONS, FOND DU LAC CLINIC	(i) (ii)	299,423 ------------- 0	44,945 ------------- 0	18,684 ------------- 0	32,646 ------------- 0	30,188 ------------- 0	425,886 ------------- 0	56,410 ------------- 0
14TAMI SCHATTSCHNEIDER VP - PATIENT CARE SERVICES, CNO	(i) (ii)	249,646 ------------- 0	37,384 ------------- 0	1,603 ------------- 0	61,324 ------------- 0	38,940 ------------- 0	388,897 ------------- 0	37,384 ------------- 0
15TARA RHODES VP - OPERATIONS, ST. AGNES HOSPITAL	(i) (ii)	219,826 ------------- 0	31,297 ------------- 0	1,123 ------------- 0	53,432 ------------- 0	38,734 ------------- 0	344,412 ------------- 0	31,297 ------------- 0
16JENNIFER MASKEL MD DIRECTOR	(i) (ii)	0 ------------- 142,370	0 ------------- 0	0 ------------- 425	0 ------------- 10,628	0 ------------- 3,396	0 ------------- 156,819	0 ------------- 0

Schedule J (Form 990) 2023

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	AN INDIVIDUAL LISTED ON PART VII, SECTION A RECEIVED A TAX INDEMNIFICATION/GROSSUP PAYMENT IN 2023. THE PAYMENT WAS INCLUDED IN TAXABLE COMPENSATION.
PART I, LINE 3	THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, PRESIDENT, IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4B	SSM HEAL TH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2023. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2023: SUE ANDERSON $153,458 JENNIFER MASKEL $2,131 STEVE SMOOT $249,972 RANDY COMBS $261,633 DOUGLAS LONG $161,286 KATHERINE VERGOS $47,060 MICHAEL DREES $14,170 TARA RHODES $10,459 TAMI SCHATTSCHNEIDER $11,913 STEVEN FLURRY $9,623 NANCY BIRSCHBACH $32,541 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. SUE ANDERSON $132,843 STEVE SMOOT $140,898 KATHERINE VERGOS $37,026 NANCY BIRSCHBACH $28,799

Schedule J (Form 990) 2023

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization
AGNESIAN HEALTHCARE INC

Employer identification number
39-0807236

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	39-1337855	97712DXT8	08-10-2017	62,792,652	(1) FINANCE CAPITAL IMPROVEMENTS AND (2) REFUND 2010 AND 2012 BONDS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	8,815,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	63,094,342
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	656,999
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	23,301,620
11 Other spent proceeds .............	39,135,724
12 Other unspent proceeds .............
13 Year of substantial completion .............	2020
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........	X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2023

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2023

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X

Part Ⅴ

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation

Schedule K (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

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.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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. ........................... $

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $

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) 2023

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) FOND DU LAC REGIONAL CLINIC SC	DIRECTORS ARE EMPLOYEE-OWNERS OF INTERESTED PERSON	6,043,134	PHYSICIAN SERVICES		No
(2) HOLIDAY AUTO	ENTITY OWNED BY THOR H GILBERTSON, DIRECTOR/OFFICER	190,584	SALES AND SERVICE TO VEHICLES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART IV, COLUMN(B) - FOND DU LAC REGIONAL CLINIC SC OWNERS	THE FOLLOWING DIRECTORS LISTED ON FORM 990, PART VII ARE EMPLOYEE OWNERS OF THE FOND DU LAC REGIONAL CLINIC: DR BRET PATSIUK, DR JEFFREY STRONG AND DR THEODORE MILLER

Schedule L (Form 990) 2023

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

AGNESIAN HEALTHCARE INC

Employer identification number

39-0807236

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	DR JEFFREY STRONG, DR BRET PASIUK AND DR THEODORE MILLER - BUSINESS RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE CORPORATION IS SSM HEALTH CARE OF WISCONSIN, INC. SSM HEALTH CARE OF WISCONSIN, INC, IS A NONPROFIT 501(C)(3) ORGANIZATION. BOTH AGNESIAN HEALTHCARE INC AND SSM HEALTH CARE OF WISCONSIN, INC. ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION; B. TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS; C. TO APPOINT AND REMOVE THE DIRECTORS; D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION; E. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN; F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY; L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS; M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION; N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION; O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION; P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO SSMHCC OR TO ANY OTHER ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY SSMHCC, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF SSMHCC AS DETERMINED BY SSMHCC; Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN SSMHCC, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO SSMHCC WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION (SSM). THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SSM PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED BOARD MEETING
FORM 990, PART VI, 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 A 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 C, LINE 19	A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY EXISTS WHICH REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON A 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 IX, LINE 11G	OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 17,361,646. MANAGEMENT AND GENERAL EXPENSES 86,403,243. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 103,764,889.
FORM 990, PART XI, LINE 9:	CHANGE IN TEPORARILY RESTRICTED NET ASSETS -1,274,236. BENEFICIAL INTEREST IN FOUNDATION 2,456,167.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

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	12,599,477	4,381,478	AGNESIAN HEALTHCARE INC
(2) AGNESIAN HEALTHCARE ENTERPRISES LLC 430 E DIVISION STREET FOND DU LAC,WI54935 39-2038757	RETAIL PHARMACY	WI	-2,471,070	3,573,315	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)SSM HEALTH CARE CORPORATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 46-6029223	HEALTH CARE	MO	501(C)(3)	LINE 12A, I	SSM HEALTH MINISTRIES	Yes
(2)SSMHC LIABILITY TRUST I 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-6331003	INSURANCE	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION	Yes
(3)SSM CONSOLIDATED HEALTH SERVICES 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1473657	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE CORPORATION	Yes
(4)SSM POLICY INSTITUTE 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1788151	HEALTH CARE	MO	501(C)(4)		SSM HEALTH CARE CORPORATION	Yes
(5)SSM HEALTH CARE PORTFOLIO MANAGEMENT CO 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1825256	MANAGEMENT	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION	Yes
(6)SSM CARDINAL GLENNON CHILDREN'S HOSPITAL 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-0738490	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS	Yes
(7)CARDINAL GLENNON CHILDREN'S FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1754347	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM CARDINAL GLENNON CHILDREN'S HOSPITAL	Yes
(8)SSM HEALTH FOUNDATION - ST LOUIS 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1552945	FUNDRAISING	MO	501(C)(3)	LINE 7	SSM HEALTH CARE ST LOUIS	Yes
(9)SSM HEALTH CARE OF OKLAHOMA INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 73-0657693	HEALTH CARE	OK	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	Yes
(10)THE ST ANTHONY HOSPITAL FOUNDATION INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 73-6104300	FUNDRAISING	OK	501(C)(3)	LINE 7	SSM HEALTH CARE OF OKLAHOMA	Yes
(11)SSM HEALTH CARE OF WISCONSIN INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-0688874	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	Yes
(12)DELLS MEDICAL BUILDING INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 39-1613292	MOB	WI	501(C)(2)		SSM HEALTH CARE OF WISCONSIN	Yes
(13)ST MARY'S FOUNDATION INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1940686	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(14)ST CLARE HEALTH CARE FOUNDATION INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1940683	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(15)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	Yes
(16)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	Yes
(17)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	Yes
(18)SSM HEALTH AT HOME FOUNDATION OF WISCONSIN INC 2802 WALTON COMMONS LANE MADISON,WI53718 39-1839309	FUNDRAISING	WI	501(C)(3)	LINE 12A, I	HOME HEALTH UNITED INC	Yes
(19)SSM REGIONAL HEALTH SERVICES 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 44-0579850	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	Yes
(20)ST MARY'S HEALTH CENTER JEFFERSON CITY MISSOURI FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1575307	FUNDRAISING	MO	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES	Yes
(21)GOOD SAMARITAN REGIONAL HEALTH CENTER 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-0653587	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES	Yes
(22)ST MARY'S HOSPITAL CENTRALIA ILLINOIS 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 37-0662580	HEALTH CARE	IL	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES	Yes
(23)ST MARY'S - GOOD SAMARITAN INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 36-4170833	HEALTH CARE	IL	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES	Yes
(24)GOOD SAMARITAN REGIONAL HEALTH CENTER FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 26-2884795	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S-GOOD SAMARITAN INC	Yes
(25)ST MARY'S HOSPITAL FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 36-4636691	FUNDRAISING	IL	501(C)(3)	LINE 7	ST MARY'S-GOOD SAMARITAN INC	Yes
(26)ST MARY'S HOSPITAL AUXILIARY 400 N PLEASANT CENTRALIA,IL62801 23-7126345	FUNDRAISING	IL	501(C)(3)	LINE 10	ST MARY'S HOSPITAL FOUNDATION		No
(27)SSM HEALTH BUSINESSES 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1333488	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE CORPORATION	Yes
(28)SSM HEALTH CARE ST LOUIS 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1343281	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE CORPORATION	Yes
(29)CENTRALIA MEDICAL SERVICES BLDG ASSOC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 23-7408025	MOB	IL	501(C)(3)	LINE 12A, I	SSM REGIONAL HEALTH SERVICES	Yes
(30)ST MARY'S JANESVILLE FOUNDATION INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 27-3439133	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(31)SSM HEALTH MINISTRIES 3221 MCKELVEY ROAD SUITE 107 BRIDGETON,MO63044 43-1012492	RELIGIOUS ORGANIZATION	MO	501(C)(3)	LINE 1	N/A		No
(32)LEE DEWEY CORPORATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 73-1279603	MOB	OK	501(C)(3)	LINE 12A, I	SSM HEALTH CARE OF OKLAHOMA	Yes
(33)ST MARY'S HOSPITAL AUXILIARY 100 ST MARYS MEDICAL PLAZA JEFFERSON CITY,MO65101 43-6049878	FUNDRAISING	MO	501(C)(3)	LINE 12B, II	N/A		No
(34)GOOD SAMARITAN HOSPITAL AUXILIARY 1 GOOD SAMARITAN WAY MOUNT VERNON,IL62864 23-7049599	FUNDRAISING	IL	501(C)(3)	LINE 12C, III-FI	N/A		No
(35)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	Yes
(36)SSM AUDRAIN HEALTH CARE INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1550298	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM REGIONAL HEALTH SERVICES	Yes
(37)SSM-SLUH INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 47-4196634	HEALTH CARE	MO	501(C)(3)	LINE 3	SSM HEALTH CARE ST LOUIS	Yes
(38)AGNESIAN HEALTHCARE INC 430 E DIVISION ST FOND DU LAC,WI54935 39-0807236	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH CARE OF WISCONSIN	Yes
(39)RIPON MEDICAL CENTER INC 845 PARKSIDE STREET RIPON,WI54971 39-1101287	HEALTH CARE	WI	501(C)(3)	LINE 3	AGNESIAN HEALTHCARE INC	Yes
(40)WAUPUN MEMORIAL HOSPITAL INC 620 WEST BROWN STREET WAUPUN,WI53963 39-0806265	HEALTH CARE	WI	501(C)(3)	LINE 3	AGNESIAN HEALTHCARE INC	Yes
(41)ST FRANCIS HOME OF FOND DU LAC WISCONSIN INC 33 EVERETT STREET FOND DU LAC,WI54935 39-1029998	HEALTH CARE	WI	501(C)(3)	LINE 10	AGNESIAN HEALTHCARE INC	Yes
(42)SISTER SERVANTS OF CHRIST THE KING VILLA LORETTO N8114 COUNTY WW MOUNT CALVARY,WI53057 39-1022770	HEALTH CARE	WI	501(C)(3)	LINE 10	AGNESIAN HEALTHCARE INC	Yes
(43)VILLA ROSA INC N8120 COUNTY WW MOUNT CALVARY,WI53057 42-1670962	HEALTH CARE	WI	501(C)(3)	LINE 10	AGNESIAN HEALTHCARE INC	Yes
(44)THE CHRISTIAN HOME AND REHABILITATION CENTER INCORPORATED 331 BLY STREET WAUPUN,WI53963 39-0884514	HEALTH CARE	WI	501(C)(3)	LINE 10	AGNESIAN HEALTHCARE INC	Yes
(45)THE MONROE CLINIC INC 515 22ND AVENUE MONROE,WI53566 39-0808509	HEALTH CARE	WI	501(C)(3)	LINE 3	SSM HEALTH CARE OF WISCONSIN	Yes
(46)MONROE CLINIC AND HOSPITAL FOUNDATION INC 515 22ND AVENUE MONROE,WI53566 20-5769038	FUNDRAISING	WI	501(C)(3)	LINE 7	SSM HEALTH CARE OF WISCONSIN	Yes
(47)AGNESIAN HEALTHCARE FOUNDATION INC 430 E DIVISION ST FOND DU LAC,WI54935 39-1684956	FUNDRAISING	WI	501(C)(3)	LINE 12A, I	SSM HEALTH CARE OF WISCONSIN	Yes
(48)SHARED MAGNETIC RESONANCE IMAGING FACILITY INC 1104 JOHN NOLEN DRIVE MADISON,WI53713 39-1534744	HEALTH CARE	WI	501(C)(3)	LINE 12A, I	SSM HEALTH CARE OF WISCONSIN	Yes
(49)SSM HEALTH CARDINAL GLENNON TRANSPORT 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 86-3519607	HEALTH CARE	MO	501(C)(3)	LINE 12A, I	SSM CARDINAL GLENNON CHILDREN'S HOSPITAL	Yes
(50)SSM HEALTH FOUNDATION 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 87-4109859	FUNDRAISING	MO	501(C)(3)	LINE 12A, I	SSM HEALTH CARE CORPORATION	Yes
(51)SSM HEALTH CARE GROUP 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 88-0988603	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH CARE ST LOUIS	Yes
(52)THE SARAH COMMUNITY 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1784657	HEALTH CARE	MO	501(C)(3)	LINE 10	SSM HEALTH BUSINESSES	Yes
(53)VISITING NURSE ASSOCIATION OF GREATER ST LOUIS 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-0567000	HEALTH CARE	MO	501(C)(3)	LINE 7	SSM HEALTH BUSINESSES	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) SSM ST JOSEPH ENDOSCOPY CENTER LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 27-0046559	SURGERY SERVICES	MO	N/A				No			No
(2) ST CLARE IMAGING SERVICES LLC 707 14TH STREET SUITE A BARABOO,WI53913 20-0122365	DIAG. SERVICES	WI	N/A				No			No
(3) MT VERNON RADIATION THERAPY CENTER LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 20-1382620	RADIATION THERAPY	IL	N/A				No		Yes
(4) SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 20-8468195	DIAG. SERVICES	IL	N/A				No			No
(5) CHOWSMGSI OFFICE BUILDING LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 37-1383861	MOB	IL	N/A				No			No
(6) OZA CANCER CENTER LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 20-1382727	MOB	IL	N/A				No			No
(7) SHAWNEE REAL ESTATE HOLDINGS LLC 1000 N LEE AVE OKLAHOMA CITY,OK73102 45-5458304	MOB	OK	N/A				No			No
(8) DEAN CLINIC & ST MARY'S HOSPITAL ACCOUNTABLE CARE ORGANIZATION LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 45-2995500	ACCOUNTABLE CARE ORGANIZATION	WI	N/A				No			No
(9) WISCONSIN INTEGRATED INFORMATION TECHNOLOGY AND TELEMEDICINE SYSTEMS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-2016715	INFORMATION TECHNOLOGY SERVICES	WI	N/A				No			No
(10) WINGRA BUILDING GROUP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-0237060	MOB	WI	N/A				No			No
(11) JANESVILLE RIVERVIEW CLINIC BUILDING PARTNERSHIP 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-6220698	MOB	WI	N/A				No			No
(12) 1110 N CLASSEN BLVD LLC 1110 N CLASSEN BOULEVARD OKLAHOMA CITY,OK73106 73-1158158	MOB	OK	N/A				No		Yes
(13) SSM ST CLARE SURGICAL CENTER LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 26-1439695	SURGERY SERVICES	MO	N/A				No			No
(14) WINDMILL LLP 50 VILLAGE VIEW LANE CHESTERFIELD,MO63017 43-1804651	INVESTMENTS	MO	N/A				No			No
(15) NAVITUS HEALTH SOLUTIONS LLC 361 INTEGRITY DRIVE MADISON,WI53717 04-3608530	PHARMACY BENEFIT MANAGEMENT	WI	N/A				No			No
(16) SSM SELECT REHAB ST LOUIS LLC 4714 GETTYSBURG ROAD MECHANICSBURG,PA17055 26-3694972	HEALTH CARE	DE	N/A				No			No
(17) EPIPHANY RX LLC 361 INTEGRITY DRIVE MADISON,WI53717 36-4855405	PHARMACY BENEFIT MANAGEMENT	DE	N/A				No			No
(18) RXPRECHECK LL 278 FRANKLIN RD BRENTWOOD,TN37027 81-2842151	PHARMACY BENEFIT MANAGEMENT	TN	N/A				No			No
(19) ARCHIMEDES LLC 278 FRANKLIN RD BRENTWOOD,TN37027 81-1158028	PHARMACY BENEFIT MANAGEMENT	TN	N/A				No			No
(20) BLOOM TREE LONG-ONLY FUND QP LP FKA BLOOM TREE PONDEROSA FUNDS QP LP 101 PARK AVENUE 33RD FL NEW YORK,NY10178 82-3704522	INVESTMENTS	DE	N/A				No			No
(21) NECICF II AIV2-B LP 300 DELAWARE AVE STE 210 WILMINGTON,DE19801 84-5058167	INVESTMENTS	DE	N/A				No			No
(22) BISON CAPITAL PARTNERS VI-A LP 233 WILSHIRE BLVD STE 425 SANTA MONICA,CA90401 87-4006968	INVESTMENTS	DE	N/A				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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) SSM MANAGED CARE ORGANIZATION LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1708511	HEALTH PROMOTION	MO	N/A	C					No
(2) FPP INC & SUBS 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1465174	HEALTH CARE	MO	N/A	C					No
(3) DIVERSIFIED HEALTH SERVICES CORP 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1369305	MEDICAL EQUIPMENT	MO	N/A	C					No
(4) SSM PROPERTIES INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1462486	PROPERTY SERVICES	MO	N/A	C					No
(5) HEALTHFIRST PHYSICIAN MANAGEMENT SERVICES 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 73-1534336	MEDICAL SERVICES	OK	N/A	C					No
(6) SSMHC LIABILITY TRUST II 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 81-6128118	INSURANCE	MO	N/A	C					No
(7) SSM MEDICAL GROUP INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 43-1664107	PHYSICIAN OFFICES	MO	N/A	C					No
(8) SSMHC INSURANCE COMPANY PO BOX 1051 GT CJ 03-0310431	INSURANCE	CJ	N/A	C					No
(9) PHYSICIANS SERVICES CORP OF SOUTHERN ILLINOIS INC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 36-4161526	HEALTH CARE	IL	N/A	C					No
(10) DEAN HEALTH SYSTEMS INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1128616	PHYSICIAN OFFICES	WI	N/A	C					No
(11) DEAN RETAIL SERVICES INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 39-1717636	PROPERTY SERVICES	WI	N/A	C					No
(12) SSM HEALTH JANESVILLE CAMPUS CONDOMINIUM ASSOCIATION INC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 83-2038674	CONDO ASSOCIATION	WI	N/A	C					No
(13) SSM HEALTH PHARMACY LLC 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 26-4031708	PHARMACY	MO	N/A	C					No
(14) NAVITUS HOLDINGS LLC 1808 WEST BELTLINE HIGHWAY MADISON,WI53713 80-0968174	PHARMACY	WI	N/A	C					No
(15) MS COMMUNITY JV LLC 401 CARLSON PARKWAY CP330 MINNETONKA,MN55305 87-3240022	INSURANCE	DE	N/A	C					No
(16) QUALITY DRUG CORPORATION 239 BROADWAY LAGUNA BEACH,CA92651 33-0644268	PHARMACY BENEFITS	CA	N/A	C					No
(17) ST MARY'S HOSPITAL CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC 707 SOUTH MILLS STREET MADISON,WI53715 000000000	CONDO ASSOCIATION	WI	N/A	C					No
(18) PARTNERS GROUP PMC PRIVATE CREDIT LP C/O MAPLES CORPORATE SERVICES LTD CJ 98-1439264	INVESTMENT	CJ	N/A	C					No
(19) OMNINHEALTH HOLDINGS 12800 CORPORATE HILL DRIVE ST LOUIS,MO63131 88-4144276	HEALTH CARE CONSULTING	DE	N/A	C					No

Schedule R (Form 990) 2023

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) ............................

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) .......................

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST FRANCIS HOME OF FOND DU LAC	M	986,001	BOOK
(2) THE CHRISTIAN HOME AND REHABILITATION CENTER INC	M	390,324	BOOK
(3) RIPON MEDICAL CENTER	M	4,560,817	BOOK
(4) WAUPUN MEMORIAL HOSPITAL	M	5,807,931	BOOK
(5) AGNESIAN HEALTHCARE FOUNDATION INC	C	2,502,029	BOOK
(6) AGNESIAN HEALTHCARE FOUNDATION INC	L	685,121	BOOK
(7) RIPON MEDICAL CENTER	L	3,483,517	BOOK
(8) SISTER SERVANTS OF CHRIST THE KING	M	198,703	BOOK
(9) ST FRANCIS HOME OF FOND DU LAC	L	1,054,595	BOOK
(10) THE CHRISTIAN HOME AND REHABILITATION CENTER INC	L	254,614	BOOK
(11) WAUPUN MEMORIAL HOSPITAL	K	128,352	BOOK
(12) WAUPUN MEMORIAL HOSPITAL	L	6,035,965	BOOK

Schedule R (Form 990) 2023

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2023

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) 2023

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	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	3,830
6	Total number of volunteers (estimate if necessary) .............	6	354
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	699,745

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,057,580	2,755,200
9	Program service revenue (Part VIII, line 2g) .........	459,604,910	500,366,408
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	5,610,312	15,045,228
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	8,010,341	3,305,704
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	474,283,143	521,472,540
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	444,254	693,525
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)	196,454,202	205,645,124
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 610,691
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	292,856,999	325,738,591
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	489,755,455	532,077,240
19	Revenue less expenses. Subtract line 18 from line 12.......	-15,472,312	-10,604,700
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	639,250,818	689,139,561
21	Total liabilities (Part X, line 26).............	140,433,680	176,384,478
22	Net assets or fund balances. Subtract line 21 from line 20.....	498,817,138	512,755,083

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 406,849,254 including grants of $ 693,525 ) (Revenue $ 500,366,408 )
	SINCE IT WAS FOUNDED IN 1872 BY CATHOLIC SISTERS, SSM HEALTH (SSMH) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. SSMH IS A CATHOLIC, NOT-FOR-PROFIT HEALTH SYSTEM SERVING THE COMPREHENSIVE HEALTH NEEDS OF COMMUNITIES ACROSS THE MIDWEST THROUGH ONE OF THE LARGEST INTEGRATED DELIVERY SYSTEMS IN THE NATION. WITH CARE DELIVERY SITES IN ILLINOIS, MISSOURI, OKLAHOMA, AND WISCONSIN, SSMH INCLUDES 23 ACUTE CARE HOSPITALS, ONE CHILDREN'S HOSPITAL, MORE THAN 650 PHYSICIAN OFFICES AND OTHER OUTPATIENT AND VIRTUAL CARE SERVICES, 12 POST-ACUTE FACILITIES, COMPREHENSIVE HOME CARE AND HOSPICE SERVICES, A PHARMACY BENEFIT COMPANY, AND AN ACCOUNTABLE CARE ORGANIZATION. THE HEALTH SYSTEM EMPLOYS NEARLY 40,000 PEOPLE AND IS AFFILIATED WITH 13,900 PHYSICIANS MAKING IT ONE OF THE LARGEST EMPLOYERS IN EVERY COMMUNITY IT SERVES. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMH STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL HEALTH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. ABOUT AGNESIAN HEALTHCARE INC:AGNESIAN HEALTHCARE INC, OPERATING AS ST. AGNES HOSPITAL, HAS BEEN PROVIDING HEALING CARE FOR ALMOST 125 YEARS. THE HOSPITAL HAS GROWN INTO BOTH AN INPATIENT AND OUTPATIENT FACILITY PROVIDING INNOVATIVE COMMUNITY AND REGIONAL HEALTHCARE SERVICES TO THE GREATER FOND DU LAC AREA. AS A NONPROFIT CATHOLIC INSTITUTION, ST. AGNES HOSPITAL SERVES PEOPLE OF ALL FAITHS AND BELIEFS. IT IS A LEADER IN PROVIDING QUALITY STATE-OF-THE-ART HEALTHCARE SERVICES, WHETHER IT IS CANCER TREATMENT; COMPREHENSIVE HEART CARE THROUGH THE DALE MICHELS CENTER FOR HEART CARE, INCLUDING ANGIOPLASTY AND OPEN-HEART SURGERY; HOME OR HOSPICE CARE; MATERNITY SERVICES; LASER SURGERY; SPORTS MEDICINE; BEHAVIORAL HEALTH SERVICES; WOMEN'S HEALTH SERVICES; OCCUPATIONAL HEALTH SERVICES; REHABILITATION SERVICES AND 24-HOUR EMERGENCY CARE. IN 2018, ST. AGNES HOSPITAL RECEIVED THE AMERICAN HEART ASSOCIATION'S GET WITH THE GUIDELINES - HEART FAILURE SILVER PLUS QUALITY ACHIEVEMENT AWARD. THE AWARD RECOGNIZES THE HOSPITAL'S COMMITMENT TO ENSURING HEART FAILURE PATIENTS RECEIVE THE MOST APPROPRIATE TREATMENT ACCORDING TO NATIONALLY RECOGNIZED, RESEARCH-BASED GUIDELINES FOUNDED IN THE LATEST SCIENTIFIC EVIDENCE. ST. AGNES HOSPITAL EARNED THE AWARD BY MEETING SPECIFIC QUALITY ACHIEVEMENT MEASURES FOR THE DIAGNOSIS AND TREATMENT OF HEART FAILURE PATIENTS AT A SET LEVEL FOR A DESIGNATED PERIOD. ST. AGNES ALSO EARNED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION'S HEART-CHECK MARK FOR ADVANCED CERTIFICATION AND QUALITY FOR PRIMARY STROKE CENTERS. THE HOSPITAL WAS ALSO ONE OF THE 250 RECIPIENTS OF HEALTHGRADES' 2018 DISTINGUISHED HOSPITAL AWARD FOR CLINICAL EXCELLENCE. AGNESIAN HEALTHCARE INC ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: * OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY * HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA * ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, * PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS * ALL SURPLUS FUNDS GENERATED BY SSMH ENTITIES ARE REINVESTED IN IMPROVING OUR PATIENT CARE DELIVERY SYSTEM QUANTIFIABLE UNCOMPENSATED CARE: THIS SECTION INCLUDES A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE QUANTIFIED AS UNCOMPENSATED CARE: TRADITIONAL CHARITY CARE $ 1,608,151 UNPAID COST OF MEDICAID $ 34,431,126 UNPAID COST OF OTHER GOVERNMENT PROGRAMS $ 2,128,800 UNPAID COST OF MEDICARE $ 7,205,249 TOTAL QUANTIFIABLE UNCOMPENSATED CARE $ 45,373,326

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses406,849,254

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	4,801,261	8,703,788	4,764,055

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,502,029
e	Government grants (contributions)		1e	236,165

f	All other contributions, gifts, grants, and similar amounts not included above		1f	17,006

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

h Total. Add lines 1a-1f.......		2,755,200

		Business Code
2a	NET PATIENT SERVICE REVENUE	623000	440,013,715	440,013,715
b	PHARMACY REVENUE	456110	28,090,236	28,090,236
c	CORPORATE FEES	623000	25,343,705	25,343,705
d	OTHER PROGRAM REVENUE	623000	6,918,752	6,918,752
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		500,366,408

3 Investment income (including dividends, interest, and othersimilar amounts) ......			7,994,791			7,994,791
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a	899,376
b	Less: rental expenses	6b	0
c	Rental income or (loss)	6c	899,376
d	Net rental income or (loss).......			899,376			899,376
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	7,020,638	29,799
b	Less: cost or other basis and sales expenses	7b	0	0
c	Gain or (loss)	7c	7,020,638	29,799
d	Net gain or (loss).........			7,050,437			7,050,437
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	935,948
b	Less: cost of goods sold ..		10b	120,432
c	Net income or (loss) from sales of inventory..			815,516			815,516

Business Code
11a	CAFETERIA REVENUE		722514	1,206,128			1,206,128
b	OTHER REVENUE		900099	384,684			384,684
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,590,812
12	Total revenue. See instructions.....			521,472,540	500,366,408	0	18,350,932

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	693,525	693,525
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 ...........
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........	160,205,260	156,502,194	3,319,061	384,005
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,036,207	7,850,454	166,491	19,262
9	Other employee benefits .......	26,277,887	25,670,487	544,413	62,987
10	Payroll taxes ...........	11,125,770	10,868,603	230,499	26,668
11	Fees for services (non-employees):
a	Management ......	602,031	185,564	416,467
b	Legal .........	317,102	60,146	256,956
c	Accounting ...........
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)	103,764,889	17,361,646	86,403,243
12	Advertising and promotion ....	102,975	49,187	11,671	42,117
13	Office expenses .......	6,775,526	5,996,681	785,092	-6,247
14	Information technology ......	15,268,982	15,268,982
15	Royalties ..
16	Occupancy ...........	10,319,856	8,175,876	2,143,980
17	Travel ............	873,442	795,913	74,858	2,671
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	151,635	108,181	40,778	2,676
20	Interest ...........	-795	-460	-335
21	Payments to affiliates .......	56,763,968	29,979,804	26,784,164
22	Depreciation, depletion, and amortization ..	15,501,535	15,285,100	215,575	860
23	Insurance ...	1,769,604	1,170,657	598,947
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES AND EQ	108,723,723	108,656,164	67,545	14
b	TAXES	5,126,935	35	5,126,900
c	LICENSES, DUES & SUBSRI	1,712,494	1,334,499	366,510	11,485
d	BANK FEES	767,542	411,027	356,515
e	All other expenses	-2,802,853	424,989	-3,292,035	64,193
25	Total functional expenses. Add lines 1 through 24e	532,077,240	406,849,254	124,617,295	610,691
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 ........			7,659,554	1	757,223
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			48,737,014	4	35,084,645
5	Loans and other receivables from 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 ............			5,502,193	8	5,692,450
9	Prepaid expenses and deferred charges ......			1,266,415	9	679,607
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	319,702,421
b	Less: accumulated depreciation	10b	101,866,193	214,767,807	10c	217,836,228
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			302,032,449	12	340,468,887
13	Investments—program-related. See Part IV, line 11 ..			21,702,615	13	22,864,017
14	Intangible assets ...............				14	1,191,876
15	Other assets. See Part IV, line 11 ...........			37,582,771	15	64,564,628
16	Total assets. Add lines 1 through 15 (must equal line 33)...			639,250,818	16	689,139,561

17	Accounts payable and accrued expenses .....	16,914,743	17	33,265,095
18	Grants payable ...		18
19	Deferred revenue .........	58,782	19	411,163
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to 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	123,460,155	25	142,708,220
26	Total liabilities. Add lines 17 through 25..	140,433,680	26	176,384,478

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	490,640,609	27	502,372,074
28	Net assets with donor restrictions ...........	8,176,529	28	10,383,009
	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 ...........	498,817,138	32	512,755,083
33	Total liabilities and net assets/fund balances ........	639,250,818	33	689,139,561