TY 2020 Form 990 Schedule R

efile Public Visual Render ObjectId: 202143079349303359 - Submission: 2021-11-03 TIN: 39-0807236

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

OMB No. 1545-0047

2020

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	32,782,454	29,327,295	Agnesian Healthcare Inc
(2) Agnesian Healthcare Enterprises LLC 430 E Division Street Fond du lac,WI54935 39-2038757	Retail pharmacy	WI	8,689,112	11,692,836	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 10101 Woodfield Lane St Louis,MO63132 46-6029223	Health Care	MO	501(c)(3)	Type I	SSM Health Ministries		No
(2)SSMHC Liability Trust I 10101 Woodfield Lane St Louis,MO63132 43-6331003	Insurance	MO	501(c)(3)	Type I	SSM Health Care Corporation		No
(3)SSM Consolidated Health Services 10101 Woodfield Lane St Louis,MO63132 43-1473657	Health Care	MO	501(c)(3)	10	SSM Health Care Corporation		No
(4)SSM Policy Institute 10101 Woodfield Lane St Louis,MO63132 43-1788151	Health Care	MO	501(c)(4)		SSM Health Care Corporation		No
(5)SSM Health Care Portfolio Management Co 10101 Woodfield Lane St Louis,MO63132 43-1825256	Management	MO	501(c)(3)	Type I	SSM Health Care Corporation		No
(6)SSM Cardinal Glennon Children's Hospital 10101 Woodfield Lane St Louis,MO63132 43-0738490	Health Care	MO	501(c)(3)	3	SSM Health Care St Louis		No
(7)Cardinal Glennon Children's Foundation 10101 Woodfield Lane St Louis,MO63132 43-1754347	Fundraising	MO	501(c)(3)	7	SSM Cardinal Glennon Children's Hospital		No
(8)SSM Health Foundation - St Louis 10101 Woodfield Lane St Louis,MO63132 43-1552945	Fundraising	MO	501(c)(3)	7	SSM Health Care St Louis		No
(9)SSM Health Care of Oklahoma Inc 10101 Woodfield Lane St Louis,MO63132 73-0657693	Health Care	OK	501(c)(3)	3	SSM Health Care Corporation		No
(10)The St Anthony Hospital Foundation Inc 10101 Woodfield Lane St Louis,MO63132 73-6104300	Fundraising	OK	501(c)(3)	7	SSM Health Care of Oklahoma		No
(11)SSM Health Care of Wisconsin Inc 10101 Woodfield Lane St Louis,MO63132 43-0688874	Health Care	WI	501(c)(3)	3	SSM Health Care Corporation		No
(12)Dells Medical Building Inc 10101 Woodfield Lane St Louis,MO63132 39-1613292	MOB	WI	501(c)(2)		SSM Health Care of Wisconsin		No
(13)St Mary's Foundation Inc 10101 Woodfield Lane St Louis,MO63132 43-1940686	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin		No
(14)St Clare Health Care Foundation Inc 10101 Woodfield Lane St Louis,MO63132 43-1940683	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin		No
(15)Home Health United Inc 2802 Walton Commons Lane Madison,WI53718 39-1539827	Health Care	WI	501(c)(3)	10	SSM Health Care of Wisconsin		No
(16)Home Care United Inc 2802 Walton Commons Lane Madison,WI53718 39-1776340	Health Care	WI	501(c)(3)	10	SSM Health Care of Wisconsin		No
(17)HHU Xtra Care Inc 2802 Walton Commons Lane Madison,WI53718 39-1705111	Health Care	WI	501(c)(3)	10	SSM Health Care of Wisconsin		No
(18)SSM Health at Home Foundation of Wisconsin Inc 2802 Walton Commons Lane Madison,WI53718 39-1839309	Fundraising	WI	501(c)(3)	Type I	Home Health United Inc		No
(19)SSM Regional Health Services 10101 Woodfield Lane St Louis,MO63132 44-0579850	Health Care	MO	501(c)(3)	3	SSM Health Care Corporation		No
(20)St Mary's Health Center Jefferson City Missouri Foundation 10101 Woodfield Lane St Louis,MO63132 43-1575307	Fundraising	MO	501(c)(3)	Type I	SSM Regional Health Services		No
(21)Good Samaritan Regional Health Center 10101 Woodfield Lane St Louis,MO63132 43-0653587	Health Care	IL	501(c)(3)	3	SSM Regional Health Services		No
(22)St Mary's Hospital Centralia Illinois 10101 Woodfield Lane St Louis,MO63132 37-0662580	Health Care	IL	501(c)(3)	3	SSM Regional Health Services		No
(23)St Mary's - Good Samaritan Inc 10101 Woodfield Lane St Louis,MO63132 36-4170833	Health Care	IL	501(c)(3)	Type I	SSM Regional Health Services		No
(24)Good Samaritan Regional Health Center Foundation 10101 Woodfield Lane St Louis,MO63132 26-2884795	Fundraising	IL	501(c)(3)	7	St Mary's-Good Samaritan Inc		No
(25)St Mary's Hospital Foundation 10101 Woodfield Lane St Louis,MO63132 36-4636691	Fundraising	IL	501(c)(3)	7	St Mary's-Good Samaritan Inc		No
(26)St Mary's Hospital Auxiliary 400 N Pleasant Centralia,IL62801 23-7126345	Fundraising	IL	501(c)(3)	10	St Mary's Hospital Foundation		No
(27)SSM Health Businesses 10101 Woodfield Lane St Louis,MO63132 43-1333488	Health Care	MO	501(c)(3)	10	SSM Health Care Corporation		No
(28)SSM Health Care St Louis 10101 Woodfield Lane St Louis,MO63132 43-1343281	Health Care	MO	501(c)(3)	3	SSM Health Care Corporation		No
(29)Centralia Medical Services Bldg Assoc 10101 Woodfield Lane St Louis,MO63132 23-7408025	MOB	IL	501(c)(3)	Type I	SSM Regional Health Services		No
(30)St Mary's Janesville Foundation Inc 10101 Woodfield Lane St Louis,MO63132 27-3439133	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin		No
(31)SSM Health Ministries 3221 McKelvey Road Suite 107 Bridgeton,MO63044 43-1012492	Religious Organization	MO	501(c)(3)	1	NA		No
(32)Lee Dewey Corporation 10101 Woodfield Lane St Louis,MO63132 73-1279603	MOB	OK	501(c)(3)	Type I	SSM Health Care of Oklahoma		No
(33)SSM Hospice & Home Care Foundation 10101 Woodfield Lane St Louis,MO63132 30-0012246	Fundraising	MO	501(c)(3)	7	SSM Health Businesses		No
(34)St Mary's Hospital Auxiliary 100 St Marys Medical Plaza Jefferson City,MO65101 43-6049878	Fundraising	MO	501(c)(3)	Type II	NA		No
(35)Good Samaritan Hospital Auxiliary 1 Good Samaritan Way Mount Vernon,IL62864 23-7049599	Fundraising	IL	501(c)(3)	Type III-FI	NA		No
(36)St Anthony Shawnee Hospital Inc 1000 N Lee Ave Oklahoma City,OK73102 45-5055149	Health Care	OK	501(c)(3)	3	SSM Health Care of Oklahoma		No
(37)SSM Audrain Health Care Inc 10101 Woodfield Lane St Louis,MO63132 43-1550298	Health Care	MO	501(c)(3)	3	SSM Regional Health Services		No
(38)Audrain Medical Center Foundation Inc 620 E Monroe St Mexico,MO65265 43-1265060	Fundraising	MO	501(c)(3)	Type I	NA		No
(39)SSM-SLUH Inc 10101 Woodfield Lane St Louis,MO63132 47-4196634	Health Care	MO	501(c)(3)	3	SSM Health Care St Louis		No
(40)SSM Health Plan 1277 Deming Way Madison,WI53717 83-1979548	Insurance	MO	501(c)(4)		SSM Health Businesses		No
(41)Ripon Medical Center Inc 845 Parkside Street Ripon,WI54971 39-1101287	Health Care	WI	501(c)(3)	3	Agnesian Healthcare Inc	Yes
(42)Waupun Memorial Hospital Inc 620 West Brown Street Waupun,WI53963 39-0806265	Health Care	WI	501(c)(3)	3	Agnesian Healthcare Inc	Yes
(43)St Francis Home of Fond du Lac Wisconsin Inc 33 Everett Street Fond du Lac,WI54935 39-1029998	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	Yes
(44)Sister Servants of Christ the King Villa Loretto N8114 County WW Mount Calvary,WI53057 39-1022770	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	Yes
(45)Villa Rosa Inc N8120 County WW Mount Calvary,WI53057 42-1670962	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	Yes
(46)The Christian Home and Rehabilitation Center Incorporated 331 Bly Street Waupun,WI53963 39-0884514	Health Care	WI	501(c)(3)	10	Agnesian Healthcare Inc	Yes
(47)The Monroe Clinic Inc 515 22nd Avenue Monroe,WI53566 39-0808509	Health Care	WI	501(c)(3)	3	SSM Health Care of Wisconsin		No
(48)Monroe Clinic and Hospital Foundation Inc 515 22nd Avenue Monroe,WI53566 20-5769038	Fundraising	WI	501(c)(3)	7	SSM Health Care of Wisconsin		No
(49)Agnesian Healthcare Foundation Inc 430 E Division St Fond du Lac,WI54935 39-1684956	Fundraising	WI	501(c)(3)	Type I	SSM Health Care of Wisconsin		No
(50)Shared Magnetic Resonance Imaging Facility Inc 1104 John Nolen Drive Madison,WI53713 39-1534744	Health Care	WI	501(c)(3)	Type I	SSM Health Care of Wisconsin		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2020

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Schedule R (Form 990) 2020

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Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SSM St Joseph Endoscopy Center LLC 10101 Woodfield Lane St Louis,MO63132 27-0046559	Surgery Services	MO	NA	N/A
(2) St Clare Imaging Services LLC 707 14th Street Suite A Baraboo,WI53913 20-0122365	Diag. Services	WI	NA	N/A
(3) Mt Vernon Radiation Therapy Center LLC 10101 Woodfield Lane St Louis,MO63132 20-1382620	Radiation Therapy	IL	NA	N/A
(4) Sleep & Neurology Center of Southern Illinois LLC 10101 Woodfield Lane St Louis,MO63132 20-8468195	Diag. Services	IL	NA	N/A
(5) CHOWSMGSI Office Building LLC 10101 Woodfield Lane St Louis,MO63132 37-1383861	MOB	IL	NA	N/A
(6) Oza Cancer Center LLC 10101 Woodfield Lane St Louis,MO63132 20-1382727	MOB	IL	NA	N/A
(7) Shawnee Real Estate Holdings LLC 1000 N Lee Ave Oklahoma City,OK73102 45-5458304	MOB	OK	NA	N/A
(8) Dean Clinic & St Mary's Hospital Accountable Care Organization LLC 1808 West Beltline Highway Madison,WI53713 45-2995500	Accountable Care Organization	WI	NA	N/A
(9) Wisconsin Integrated Information Technology and Telemedicine Systems LLC 1808 West Beltline Highway Madison,WI53713 39-2016715	Information Technology Services	WI	NA	N/A
(10) Dean Health Holdings LLC 1277 Deming Way Madison,WI53717 26-1594709	Support Services	WI	NA	N/A
(11) Wingra Building Group 1808 West Beltline Highway Madison,WI53713 39-0237060	MOB	WI	NA	N/A
(12) Janesville Riverview Clinic Building Partnership 1808 West Beltline Highway Madison,WI53713 39-6220698	MOB	WI	NA	N/A
(13) 1110 N Classen Blvd LLC 1110 N Classen Boulevard Oklahoma City,OK73106 73-1158158	MOB	OK	NA	N/A
(14) SSM St Clare Surgical Center LLC 10101 Woodfield Lane St Louis,MO63132 26-1439695	Surgery Services	MO	NA	N/A
(15) Windmill LLP 50 Village View Lane Chesterfield,MO63017 43-1804651	Investments	MO	NA	N/A
(16) Navitus Holdings LLC 1808 West Beltline Highway Madison,WI53713 80-0968174	Pharmacy Benefits	WI	NA	N/A

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) SSM Managed Care Organization LLC 10101 Woodfield Lane St Louis,MO63132 43-1708511	Health Promotion	MO	NA	C Corporation				No
(2) FPP INC & Subs 10101 Woodfield Lane St Louis,MO63132 43-1465174	Health Care	MO	NA	C Corporation				No
(3) Diversified Health Services Corp 10101 Woodfield Lane St Louis,MO63132 43-1369305	Medical Equipment	MO	NA	C Corporation				No
(4) SSM Properties Inc 10101 Woodfield Lane St Louis,MO63132 43-1462486	Property Services	MO	NA	C Corporation				No
(5) HealthFirst Physician Management Services 10101 Woodfield Lane St Louis,MO63132 73-1534336	Medical Services	OK	NA	C Corporation				No
(6) SSMHC Liability Trust II 10101 Woodfield Lane St Louis,MO63132 81-6128118	Insurance	MO	NA	C Corporation				No
(7) SSM Medical Group Inc 10101 Woodfield Lane St Louis,MO63132 43-1664107	Physician Offices	MO	NA	C Corporation				No
(8) SSMHC Insurance Company 10101 Woodfield Lane St Louis,MO63132 03-0310431	Insurance	CJ	NA	C Corporation				No
(9) Physicians Services Corp of Southern Illinois Inc 10101 Woodfield Lane St Louis,MO63132 36-4161526	Health Care	IL	NA	C Corporation				No
(10) Dean Health Systems Inc 1808 West Beltline Highway Madison,WI53713 39-1128616	Physician Offices	WI	NA	C Corporation				No
(11) Dean Health Insurance Inc PO Box 56099 Madison,WI53705 39-1830837	Insurance	WI	NA	C Corporation				No
(12) Dean Health Plan Inc PO Box 56099 Madison,WI53705 39-1535024	Insurance	WI	NA	C Corporation				No
(13) Dean Retail Services Inc 1808 West Beltline Highway Madison,WI53713 39-1717636	Property Services	WI	NA	C Corporation				No
(14) Oza Oncology Inc 4117 Veterans Memorial Drive Mt Vernon,IL62804 37-1343746	Physician Offices	IL	NA	S Corporation				No
(15) SSM Health Janesville Campus Condominium Association Inc 1808 West Beltline Highway Madison,WI53713 83-2038674	Condo association	WI	NA	C Corporation				No
(16) SSM Health Pharmacy LLC 10101 Woodfield Lane St Louis,MO63132 26-4031708	Pharmacy	MO	NA	C Corporation				No
(17) Dane County Cytology Center Inc 2000 Engel Street Suite 201 Madison,WI53713 39-1414219	Medical Services	WI	NA	C Corporation				No
(18) SSM Health Insurance Company 1277 Deming Way Madison,WI53717 83-4718249	Insurance	MO	NA	C Corporation				No
(19) St Mary's Hospital Campus Condominium Owners Association Inc 707 South Mills Street Madison,WI53715 000000000	Condo association	WI	NA	C Corporation				No

Schedule R (Form 990) 2020

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Schedule R (Form 990) 2020

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

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) Agnesian Healthcare Foundation Inc	C	1,166,096	Book
(2) The Christian Home and Rehabilitation Center Incorporated	M	112,118	Cash payments
(3) St Francis Home of Fond du Lac Wisconsin	M	453,006	Cash payments
(4) Ripon Medical Center	M	2,175	Cash payments
(5) Waupun Memorial Hospital	M	2,500	Cash payments

Schedule R (Form 990) 2020

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Schedule R (Form 990) 2020

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Part VI

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

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

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

Schedule R (Form 990) 2020

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Schedule R (Form 990) 2020

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Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2020

Additional Data

Software ID:	20011424
Software Version:	2020v4.0