Waupun Memorial Hospital

“A related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.”

“A related organization utilized the following to determine compensation: (1) independent compensation consultant; (2) compensation survey or study; (3) approval by the board or compensation committee.”

“The sole member of the corporation is Agnesian Healthcare Inc. Agnesian Healthcare Inc is a nonprofit 501(C)(3) organization. Both Waupun Memorial Hospital and Agnesian Healthcare Inc are part of the integrated health care system known as SSM Health.”

“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.”

“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 Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, or the corresponding provision of any future United States Internal Revenue Law, which is controlled by 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.”

“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.”

“The organization has a written conflict of interest and insider transaction policy that 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.”

“The year-end audited consolidated financial statements and unaudited quarterly consolidated financial statements for the SSM Health System are made available to the public on SSM Health's website. The organization's Articles of Incorporation are available on the Missouri Secretary of State's website. Copies of the Form 990 and the conflict of interest policy are available to the public upon request.”

“All other program service revenue - Total Revenue: 262629, Related or Exempt Function Revenue: 262629, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“Briefly describe the organization's mission: Since it was founded in 1872 by Catholic sisters, SSM Health (SSMH) has existed to meet the health needs of the communities it serves. SSMH is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through one of the largest integrated delivery systems in the nation. With care delivery sites in Illinois, Missouri, Oklahoma, and Wisconsin, SSMH includes 23 acute care hospitals, one children's hospital, more than 300 physician offices and other outpatient and virtual care services, 10 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company, and an Accountable Care Organization. The health system employs nearly 40,000 people and is affiliated with 11,000 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 Waupun Memorial Hospital: Waupun Memorial Hospital is a critical access hospital located in Waupun, Wisconsin, and provides a full range of inpatient and outpatient services to Waupun and the surrounding rural areas. Waupun Memorial Hospital features a two-story provider clinic, consolidating all its provider services into one facility with a direct connection to the larger resources of the hospital. A state-of-the-art surgery area features three high-tech operating rooms, an endoscopy procedure room, 11 pre/postoperative patient rooms, four post anesthesia recovery rooms and centralized sterile processing area. The hospital's staff of associates and volunteers is dedicated to providing services in the areas of laboratory, cardiopulmonary, rehabilitation, radiology, ultrasound, MRI, surgical, emergency, outpatient dialysis, medical/surgical services, intensive care and obstetrics. In 2018, Waupun Memorial Hospital received certification of its Cardiac Rehab program by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). WMH was recognized for its commitment to improving the quality of life by enhancing standards of care. AACVPR Program Certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other professional societies. Each program is reviewed by the AACVPR Program Certification Committee and Certification is awarded by the AACVPR Board of Directors. AACVPR-certified programs are recognized as leaders in the field of cardiovascular and pulmonary rehabilitation because they offer the most advanced practices available. Waupun Memorial Hospital 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 $ 203,384 Unpaid Cost of Medicaid $ 586,386 Total Quantifiable Uncompensated Care $ 789,770”

“All applicable 1099 and 1096 irs tax forms are reported and filed by a related organization, ssm health care corporation, ein 46-6029223.”

“All applicable w-2 and w-3 irs tax forms are reported and filed by a related organization, agnesian healthcare inc, ein 39-0807236.”

“Medical and other professional services - Total Expense: 7674749, Program Service Expense: 5922194, Management and General Expenses: 1752555, Fundraising Expenses: ;”

“Change in beneficial interest in foundation - -28645;”