DOOR COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- DOOR COUNTY MEMORIAL HOSPITAL (EIN 39-0806324)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-03-10
- IRS object ID
- 202320699349300412
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-03-10T08:22:46-06:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806324 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DOOR | BusinessNameControlTxt |
| Phone | 9207435566 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREW LALUZERNE | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9207435566 | PhoneNum |
| Signature | 2023-03-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ANDREW | PersonFirstNm |
| Person Last | LALUZERNE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2023-03-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BRIAN STEPHENS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $134,504,889 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DCMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION AS A HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITY, ESPECIALLY THOSE IN NEED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 799 | TotalEmployeeCnt |
| Total Volunteers | 123 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,712,799 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,121,089 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $98,987,107 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $116,636,464 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,565,809 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,647,589 | CYInvestmentIncomeAmt |
| PY Other Revenue | $72,651 | PYOtherRevenueAmt |
| CY Other Revenue | $104,230 | CYOtherRevenueAmt |
| PY Total Revenue | $104,338,366 | PYTotalRevenueAmt |
| CY Total Revenue | $121,509,372 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $12,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $37,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $61,992,030 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $69,769,720 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $33,407,889 | PYOtherExpensesAmt |
| CY Other Expenses | $35,730,171 | CYOtherExpensesAmt |
| PY Total Expenses | $95,412,419 | PYTotalExpensesAmt |
| CY Total Expenses | $105,537,391 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,925,947 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $15,971,981 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $151,760,865 | TotalAssetsBOYAmt |
| Total Assets EOY | $145,062,000 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,736,612 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,793,608 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $118,024,253 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $125,268,392 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | DELIVERING COMPASSIONATE, QUALITY CARE THAT INSPIRES A HEALTHY COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $93,009,617 | ExpenseAmt |
| Grant | $37,500 | GrantAmt |
| Revenue | $116,390,313 | RevenueAmt |
| Desc | DOOR COUNTY MEMORIAL HOSPITAL ("THE HOSPITAL") IS A FULLY ACCREDITED, ACUTE-CARE HOSPITAL AND OUTPATIENT MEDICAL CENTER, WITH 25 LICENSED BEDS. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES AND SPECIALTIES, INCLUDING HOME HEALTH, A SKILLED NURSING FACILITY FOR LONG-TERM CARE AND REHABILITATION SERVICES, A REHAB SERVICES DEPARTMENT AND NORTH SHORE MEDICAL CLINIC. DURING FISCAL 2022, THE HOSPITAL COUNTED 5,431 INPATIENT DAYS, INCLUDING SWING BED. THE HOSPITAL'S OUTPATIENT FACILITIES, WHICH INCLUDE ITS REHABILITATION AGENCY, 30 BED EXTENDED CARE FACILITY, EMERGENCY ROOM, NORTH SHORE MEDICAL CLINIC SERVED 216,468 VISITS, AND THE NORTH SHORE MEDICAL CLINIC, INCLUDING ITS URGENT CARE FACILITY SERVED 76,035 VISITS. SEE SCHEDULE H FOR FURTHER DETAILS REGARDING THE COMMUNITY BENEFITS DOOR COUNTY MEMORIAL HOSPITAL PROVIDES. | Desc |
| Total Program Service Expenses | $93,009,617 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 85 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 799 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDREW LALUZERNE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207435566 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| DR DANIEL TOMASZEWSKI | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $1,181,078 | $0 | $34,179 | |||
| DR MARK JORDAN | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $677,800 | $0 | $41,495 | |||
| DR MARC BINARD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $637,777 | $0 | $42,465 | |||
| DR JAMES HEISE | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $526,960 | $0 | $41,163 | |||
| DR JOSEPH REBHAN | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $525,515 | $0 | $38,520 | |||
| DR DORENE DEMPSTER | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | $370,979 | $0 | $44,430 | 1.00 | Yes (X) | ||
| DR RICHARD HOGAN | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | $362,127 | $0 | $41,554 | 1.00 | Yes (X) | ||
| BRIAN STEPHENS | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $305,792 | $0 | $39,195 | 1.30 | Yes (X) | Yes (X) | |
| DR PAUL BOARD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | $269,239 | $0 | $43,243 | 1.00 | Yes (X) | ||
| ANDREW LALUZERNE | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $149,598 | $0 | $34,423 | Yes (X) | |||
| WILLIAM MUNDY | ||||||||
| BOARD CHAIR | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| PATRICIA VICKMAN | ||||||||
| VICE CHAIR | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| SCOT WEDERQUIST | ||||||||
| TREASURER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| CORWIN DAHL | ||||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | Yes (X) | |
| JAMIE ALBERTS | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| ANDREW BAGNALL | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| BERNADETTE CONROY | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| REV JAMES GOMEZ | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| MITCH GROESSL | ||||||||
| BOARD MEMBER (THRU DEC) | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| JOEL KITCHENS | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| PATRICK O'HERN | ||||||||
| BOARD MEMBER (THRU DEC) | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| JEFF RABAS | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| DR ASHOK RAI | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| DREW RICHMOND | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| MEGAN SARKIS | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| MARTI SPITTELL ZIEGELBAUER | ||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | 1.00 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,006,865 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $400,667 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 83 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INFINITY HEALTHCARE INC | |||||
| 111 E WISCONSIN AVE SUITE 2000 | MILWAUKEE | WI | 54302 | ER PHYSICIANS | $2,752,394 |
| MEDICAL STAFFING SOLUTIONS | |||||
| PO BOX 101 | RICE LAKE | WI | 54868 | CONTRACT LABOR | $1,934,794 |
| ST VINCENT HOSPITAL | |||||
| PO BOX 13508 | GREEN BAY | WI | 54307 | LAB SERVICES AND CONTRACT LABOR | $933,503 |
| THE BOLDT COMPANY | |||||
| 2525 N ROEMER ROAD PO BOX 419 | APPLETON | WI | 54912 | CONSTRUCTION | $471,403 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | CONTRACT LABOR | $470,912 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $954,902 | RelatedOrganizationsAmt |
| Government Grants | $2,080,769 | GovernmentGrantsAmt |
| All Other Contributions | $85,418 | AllOtherContributionsAmt |
| Total Contributions | $3,121,089 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 900099 | $113,759,022 | $113,759,022 | |
| THERAPY OTHER REVENUES | 900099 | $432,910 | $432,910 | |
| MOB RENTAL INCOME | 900099 | $285,154 | $285,154 | |
| CAFETERIA REVENUES | 900099 | $246,151 | $246,151 | |
| OCCUPATIONAL HEALTH AND WELLNESS | 900099 | $58,186 | $58,186 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,855,041 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,855,041 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $116,636,464 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,101,565 | TotalRevenueColumnAmt |
| Exclusion | $1,101,565 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $126,734 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $22,504 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $104,230 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,230 | TotalRevenueColumnAmt |
| Exclusion | $104,230 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $13,519,037 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $12,883,480 | SecuritiesAmt |
| Other | $89,533 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $635,557 | SecuritiesAmt |
| Other | -$89,533 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $546,024 | TotalRevenueColumnAmt |
| Exclusion | $546,024 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $121,509,372 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $116,390,313 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,997,970 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,500 | TotalAmt |
| Program Services | $37,500 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,692,591 | TotalAmt |
| Program Services | $1,139,451 | ProgramServicesAmt |
| Management And General | $553,140 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,591,282 | TotalAmt |
| Program Services | $49,647,078 | ProgramServicesAmt |
| Management And General | $4,944,204 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,308,586 | TotalAmt |
| Program Services | $2,105,963 | ProgramServicesAmt |
| Management And General | $202,623 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,018,004 | TotalAmt |
| Program Services | $7,278,313 | ProgramServicesAmt |
| Management And General | $739,691 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,159,257 | TotalAmt |
| Program Services | $2,853,831 | ProgramServicesAmt |
| Management And General | $305,426 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,887 | TotalAmt |
| Program Services | $214,469 | ProgramServicesAmt |
| Management And General | $33,418 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,406 | TotalAmt |
| Program Services | $13,741 | ProgramServicesAmt |
| Management And General | $47,665 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,386 | TotalAmt |
| Management And General | $221,386 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,573,336 | TotalAmt |
| Program Services | $7,514,161 | ProgramServicesAmt |
| Management And General | $1,059,175 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $927,817 | TotalAmt |
| Program Services | $15,381 | ProgramServicesAmt |
| Management And General | $912,436 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,589,325 | TotalAmt |
| Program Services | $3,200,295 | ProgramServicesAmt |
| Management And General | $389,030 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,498,704 | TotalAmt |
| Program Services | $550,416 | ProgramServicesAmt |
| Management And General | $1,948,288 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,970,005 | TotalAmt |
| Program Services | $1,895,691 | ProgramServicesAmt |
| Management And General | $74,314 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,152 | TotalAmt |
| Program Services | $414,901 | ProgramServicesAmt |
| Management And General | $85,251 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,527 | TotalAmt |
| Program Services | $283,830 | ProgramServicesAmt |
| Management And General | $16,697 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,135,033 | TotalAmt |
| Program Services | $3,905,292 | ProgramServicesAmt |
| Management And General | $229,741 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $456,842 | TotalAmt |
| Program Services | $132,315 | ProgramServicesAmt |
| Management And General | $324,527 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $9,506,601 | $9,506,601 | |
| BAD DEBT EXPENSE | $1,613,862 | $1,613,862 | |
| DUES & SUBSCRIPTIONS | $216,685 | $98,280 | $118,405 |
| EQUIPMENT RENTAL | $132,724 | $132,724 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $777,879 | TotalAmt |
| Program Services | $455,522 | ProgramServicesAmt |
| Management And General | $322,357 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,537,391 | TotalAmt |
| Program Services | $93,009,617 | ProgramServicesAmt |
| Management And General | $12,527,774 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,378 | BOYAmt |
| EOY | $3,378 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,128,754 | BOYAmt |
| EOY | $22,476,900 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,360,221 | BOYAmt |
| EOY | $14,062,031 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,911 | BOYAmt |
| EOY | $75,319 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,222 | BOYAmt |
| EOY | $226,750 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,863,663 | BOYAmt |
| EOY | $2,147,413 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,839,672 | BOYAmt |
| EOY | $2,580,745 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $62,342,777 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,385,319 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,446,139 | BOYAmt |
| EOY | $41,957,458 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,088,231 | BOYAmt |
| EOY | $57,563,051 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,779,674 | BOYAmt |
| EOY | $3,968,955 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,760,865 | BOYAmt |
| EOY | $145,062,000 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,434,233 | BOYAmt |
| EOY | $7,655,940 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $623,333 | BOYAmt |
| EOY | $400,000 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,834,700 | BOYAmt |
| EOY | $5,371,378 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,564,422 | BOYAmt |
| EOY | $1,985,132 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,279,924 | BOYAmt |
| EOY | $4,381,158 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,736,612 | BOYAmt |
| EOY | $19,793,608 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,779,878 | BOYAmt |
| EOY | $124,733,719 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $244,375 | BOYAmt |
| EOY | $534,673 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,024,253 | BOYAmt |
| EOY | $125,268,392 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,760,865 | BOYAmt |
| EOY | $145,062,000 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $15,971,981 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$9,018,140 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $290,298 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | 0 | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $14,385 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $14,385 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT ARE SPECIFICALLY ALLOCABLE TO LOBBYING. DOOR COUNTY MEMORIAL HOSPITAL DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,630,520 | OtherCostOrOtherBasisAmt |
| Book Value | $4,630,520 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $33,407,356 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,887,340 | DepreciationAmt |
| Book Value | $21,520,016 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,354 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,354 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,141,120 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,491,625 | DepreciationAmt |
| Book Value | $11,649,495 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,157,427 | OtherCostOrOtherBasisAmt |
| Book Value | $4,157,427 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $41,957,458 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO 3RD-PARTY REIMBURSEMENT PROGRAMS | $2,570,304 |
| LEASE OBLIGATION | $1,810,854 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,381,158 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $110,678,488 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$9,018,140 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$9,018,140 | RevenueNotReportedAmt |
| Revenue Subtotal | $119,696,628 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $221,386 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $1,591,358 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,812,744 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $121,509,372 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $103,724,647 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $103,724,647 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $221,386 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $1,591,358 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,812,744 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $105,537,391 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -22,504. BAD DEBT EXPENSE 1,613,862. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -22,504. BAD DEBT EXPENSE 1,613,862. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $799,487 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $799,487 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,925,861 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,623,235 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $302,626 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,725,348 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,623,235 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,102,113 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01060 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $139,004 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $139,004 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $411,556 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $411,556 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $908,941 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $238,402 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $670,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $524,721 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $524,721 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,984,222 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $238,402 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,745,820 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01680 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,709,570 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,861,637 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,847,933 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,613,862 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,792,830 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $30,724,790 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $68,040 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DCMEDICAL.ORG | WebsiteAddressTxt |
| State License | 1054 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.DCMEDICAL.ORG/ABOUT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.DCMEDICAL.ORG/ABOUT | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SUPPLEMENTAL SECTION | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SUPPLEMENTAL SECTION | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SUPPLEMENTAL SECTION | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DOOR COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: IN RECENT MONTHS DOOR COUNTY MEMORIAL HOSPITAL HAS HAD TWO COMMUNITY STAKEHOLDER MEETINGS LEAD BY PUBLIC HEALTH TO PREPARE FOR THE NEXT CHNA PLAN DEVELOPMENT FOR JANUARY 2023. THE CHNA PROCESS LISTED BELOW HAPPENS EVERY THREE YEARS. DOOR COUNTY MEDICAL CENTER'S CHNA PROCESS SOUGHT INPUT FROM COMMUNITY MEMBERS, INCLUDING MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND FROM ORGANIZATIONS THAT SERVE THOSE POPULATIONS. IN JANUARY 2020, A COMMUNITY STAKEHOLDER MEETING WAS HELD. DOOR COUNTY MEDICAL CENTER INTENTIONALLY INVITED ORGANIZATIONS THAT REPRESENT MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE STAKEHOLDER MEETING ATTENDEES PARTICIPATED IN A FACILITATED DISCUSSION ABOUT THE COMMUNITY HEALTH DATA, PROGRESS ON THE PREVIOUS PRIORITY AREAS, AND ANY EMERGING NEEDS. THE LIST OF ORGANIZATIONS PARTICIPATING IN THE JANUARY 2020 STAKEHOLDER MEETING IS BELOW. DOOR COUNTY DEPARTMENT OF PUBLIC HEALTH STAFF* MINISTRY DOOR COUNTY MEDICAL CENTER UNITED WAY OF DOOR COUNTY* DOOR COUNTY PUBLIC LIBRARY MINISTRY DENTAL CLINIC* UW-EXTENSION, DOOR COUNTY UW-GREEN BAY DOOR COUNTY PUBLIC SCHOOLS* BOYS AND GIRLS CLUB OF DOOR COUNTY* DOOR COUNTY YMCA SENIOR RESOURCE CENTER* MINISTRY HOME CARE STURGEON BAY FIRE DEPARTMENT NORTHEAST WISCONSIN TECHNICAL COLLEGE (NWTC) DOOR COUNTY BOARD OF HEALTH BELLIN COLLEGE GOOD SAMARITAN- SCANDIA VILLAGE LAKESHORE CAP FOOD PANTRY* DOOR COUNTY SHERIFF'S DEPARTMENT**DENOTES ORGANIZATIONS OR PROGRAMS |
| DOOR COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: PRIORITY NEED #1. MENTAL HEALTH AND WELL-BEINGDCMC IS A MAJOR SPONSOR AND PARTICIPANT OF THE "LEARNING TO EMPOWER AND APPRECIATE ALL PEOPLE" (LEAP) PROJECT. LEAP IS A COMMUNITY PRODUCTION FEATURING OVER 50 DOOR COUNTY HIGH SCHOOL STUDENTS EACH YEAR IN AN EFFORT TO REACH OUT TO SCHOOLS, FAMILIES, AND YOUTH TO PROMOTE PHYSICAL AND MENTAL WELLNESS. IN 2018 LEAP PROJECT'S THEME WAS "INCLUSION IS THE SOLUTION". IN APRIL 2019 THE PRODUCTION WAS PRESENTED TO HIGH SCHOOL PEERS AND COMMUNITY SERVING OVER 1,500 HIGH SCHOOL STUDENTS AND 800 ADULTS. BARB JOHNSON-GIESE WAS THERE TO ANSWER QUESTIONS ABOUT MENTAL HEALTH AND ISSUES SUCH AS SUICIDE. THE LEAP PROJECT WAS CANCELLED IN 2020 DUE TO COVID19 PANDEMIC. MAY 2021 LEAP: THE HUMAN KINDNESS PROJECT DID A VIRTUAL PERFORMANCE AND THE THEME WAS "COPING WITH COVID 19". ELEVEN LEAP ALUMNI STUDENTS PERFORMED AN ORIGINAL CREATION OF MUSIC, DANCE, MULTIMEDIA, SPOKEN WORD, AND THEATER, THROUGH WHICH THE STUDENTS EXPRESS THEIR APPROACH TO THE ISSUE OF COPING WITH COVID 19. THESE YOUNG ADULTS CREATED BEAUTIFUL INDIVIDUAL PERFORMANCES WHILE BEING ISOLATED THROUGHOUT THE PANDEMIC.JANUARY 2019 DCMC, ALONG WITH UNITED WAY OF DOOR COUNTY, STARTED THE DOOR COUNTY COLLABORATIVE SCHOOL MENTAL HEALTH PROJECT (STRIDE). THIS PROGRAM ALLOWS MENTAL HEALTH PROVIDERS FROM DCMC TO HAVE COUNSELING SESSIONS WITH STUDENTS AND FAMILIES AT LOCAL SCHOOL DISTRICTS. THE PROGRAM ALSO INCLUDES TIME FOR DCMC MENTAL HEALTH PROVIDERS TO EDUCATE AND TRAIN SCHOOL STAFF REGARDING SCHOOL-BASED MENATL HEALTH. PRIORITY NEED #2. FOOD, NUTRITION, AND EXERCISEDCMC OFFERS SPACE FOR A COMMUNITY GARDEN WHICH IS A WAY TO HELP LOCAL, LOW-INCOME FAMILIES ENJOY NOT ONLY THE HEALTH BENEFITS ASSOCIATED WITH GROWING THEIR OWN FOOD, BUT THE FINANCIAL BENEFITS AS WELL. AT THE COMMUNITY GARDEN, THE $40 RENTAL FEE FOR A 20' X 20' PLOT IS WAIVED FOR FAMILIES THAT RECEIVE WIC OR SNAP BENEFITS THROUGH FOODSHARE, WI. ALL OF THE START-UP COSTS ASSOCIATED WITH A NEW FOOD GARDEN ARE NON-EXISTENT DUE TO ALL TOOLS AND TILLING PROVIDED AND DONE BY DCMC AND THE CITY OF STURGEON BAY. EACH YEAR, ABOUT 43 GARDENERS ARE HARVESTING 42 PLOTS, ROUNDING OUT ANOTHER SUCCESSFUL GROWING SEASON.DCMC SPONSORS A FOOD VOUCHER PROGRAM AT THE STURGEON BAY FARMER'S MARKET. THE DOUBLE YOUR FOODSHARE DOLLARS PROGRAM AIMS TO INCENTIVIZE HEALTHY EATING BY DOUBLING AVAILABLE FUNDS. THE VOUCHER IS BOUGHT FOR $10 ON A QUEST CARD AND IS WORTH $20 IN FOODSHARE TOKENS TO BE USED AT THE FARMERS MARKET.OVER THE PAST SEVERAL YEARS, DCMH HAS ALSO ASSISTED CROSSROADS OF BIG CREEK WITH THE CREATING OF WALKING PATHS AND CROSS-COUNTRY SKI AND SNOW-SHOE TRAILS. THESE EFFORTS ALSO ENCOURAGE PHYSICAL EXERCISE AND THE APPRECIATION OF BEING OUTDOORS DURING ALL FOUR SEASONS.COMMUNITY HEALTH FAIRS ARE HELD SEVERAL TIMES DURING THE YEAR, WITH DIFFERENT HEALTH AND WELLNESS PARTNERS SUCH AS THE YMCA OF DOOR COUNTY, AND KEWAUNEE COUNTY AGING HEALTH SERVICES. THESE HEALTH FAIRS INCLUDE FREE HEALTH CARE SERVICES FOR THE PUBLIC SUCH AS CHOLESTEROL AND BLOOD PRESSURE SCREENINGS, AS WELL AS SEMINARS FACILITATED BY OUR CLINICAL STAFF AND PHYSICIANS.PRIORITY NEED #3. ORAL HEALTHDCMC HAS A DENTAL CLINIC, WHICH CURRENTLY OPERATES 5 DAYS A WEEK, 8 HOURS A DAY. IN FISCAL YEAR 2022, THE DENTAL CLINIC SERVED 2,326 PATIENTS AND 55% WERE CHILDREN. THE DENTAL CLINIC PERFORMED 17,374 PROCEDURES. THIS CLINIC IS UNIQUE IN THAT IT IS THE ONLY ORAL HEALTH CLINIC OF ITS KIND IN THE AREA. THE PATIENTS SERVED ARE ON MEDICAID AND/OR ARE LOW INCOME WITH NO DENTAL INSURANCE AND WOULD HAVE NO OTHER PLACE TO TURN FOR DENTAL CARE. THE TREATMENT PROVIDED IS BOTH RESTORATIVE AND PREVENTATIVE.THE SEAL A SMILE PROGRAM IS AN OUTREACH PROGRAM WHERE A HYGIENST FROM THE DENTAL CLINIC BRINGS PORTABLE DENTAL EQUIPMENT INTO THE AREA SCHOOLS AND PROVIDE FLUORIDE VARNISH AND SEALENTS TO 2ND AND 3RD GRADERS, WITH THE CONSENT OF THEIR PARENTS. IN 2019 WE PLACED SEALANTS AND PROVIDED ORAL HEALTH EDUCAITON TO 225 STUDENTS. WITH THE HELP OF THE ORAL HEALTH COALITION TEAM OF DOOR COUNTY WE ALSO WENT TO HEADSTART AND WASHINGTON ISLAND WHERE WE PROVIDED FLUORIDE VARNISH TO 200 CHILDREN. DUE TO COVID19 THE DENTAL CLINIC WAS UNABLE TO PROVIDE THIS SERVICE, BUT PLANS TO START AGAIN OCTOBER 2022.ANOTHER SERVICE THE DENTAL CLINIC PROVIDES IS FLUORIDE VARNISH AND EXAMS TO OUR SKILLIED NURSING FACILITY (SNF) RESIDENTS. ON A QUARTERLY BASIS ONE OF OUR DENTISTS VISITS OUR SNF AND DOES EXAMS ON THE RESIDENTS. WHILE THERE, ONE OF OUR HYGIENISTS GOES TO EACH OF THE RESIDENTS AND APPLIES FLUORIDE VARNISH. THE VARNISH HELPS WITH DRY MOUTH SYNDROME THAT IS A REACTION FROM MANY TYPES OF PRESCRIPTION DRUGS. THIS ALSO HELPS PREVENT CAVITIES, SINCE MOST OF THESE RESIDENTS DO NOT SEE A DENTIST ON A REGULAR BASIS FOR TEETH CLEANING. |
| PART V, LINES 16A | HTTPS://WWW.DCMEDICAL.ORG/BILLING-AND-PAYMENTS |
| PART V, LINES 16B | HTTPS://WWW.DCMEDICAL.ORG/BILLING-AND-PAYMENTS |
| PART V, LINES 16A | HTTPS://WWW.DCMEDICAL.ORG/BILLING-AND-PAYMENTS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - DCMC - STURGEON BAY CLINIC | ||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | OP PHYS CLINIC |
| 2 - DCMC - FISH CREEK CLINIC | ||||
| 3711 HIGHWAY 42 | FISH CREEK | WI | 54212 | OP PHYS CLINIC |
| 3 - DCMC - ALGOMA CLINIC | ||||
| 815 JEFFERSON STREET | ALGOMA | WI | 54201 | OP PHYS CLINIC |
| 4 - DCMC - WASHINGTON ISLAND CLINIC | ||||
| 910 MAIN ROAD | WASHINGTON ISLAND | WI | 54246 | OP PHYS CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS FOR SCHEDULE H, LINE 7, IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. THE ACTUAL COST OF SUPPLIES USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A RATIO OF ALL BENEFITS RELATED TO THE WAGE CALCULATION. NO COST TO CHARGE RATIO IS USED. |
| PART I, LN 7 COL(F): | PATIENT PAYMENTS OR DISCOUNTS ARE APPLIED PRIOR TO DETERMINING BAD DEBT EXPENSE AND ARE NOT INCLUDED IN THE BAD DEBT WRITE-OFF REPORTED ON THE AUDITED FINANCIAL STATEMENTS. DEDUCTIBLES AND COINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF EITHER TO BAD DEBT EXPENSE OR, IF APPLICABLE, TO CHARITY CARE IF THE PATIENT SO QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON GROSS CHARGES TO PATIENTS AFTER REFLECTING ANY PAYMENTS OR DISCOUNTS, OR AMOUNTS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE. |
| PART I, LINE 7B, COLUMN D | THE DIRECT OFFSETTING REVENUE FOR MEDICAID INCLUDES $1,845,650 OF PRIOR YEAR COST REPORT SETTLEMENTS. WITHOUT THE PRIOR YEAR SETTLEMENTS, THE DIRECT OFFSETTING REVENUE ON LINE 7B WOULD BE $8,777,585 AND THE PERCENTAGE RESULT ON LINE 7K COL (F) WOULD BE 4.5%. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | DOOR COUNTY MEDICAL CENTER PARTICIPATES IN COMMUNITY COALITIONS AND OTHER COLLABORATIVE EFFORTS WITH THE COMMUNITY WHOSE PURPOSE IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE INCLUDE HABITAT FOR HUMANITY, WISCONSIN COMMUNITY HEALTH PROGRAM, SOUTHERN DOOR AUDITORIUM COMMITTEE, DOOR COUNTY ELDER AND ADULT-AT-RISK INTERDISCIPLINARY TEAM, DOOR COUNTY COMMUNITY PARTNERSHIP FOR CHILDREN AND FAMILIES, MENTAL HEALTH FOCUS GROUP ANDDOOR COUNTY UNITED WAY. BY WORKING TOGETHER WITH OTHER ORGANIZATIONS IN THE COMMUNITY, WE EXPECT TO HAVE A GREATER IMPACT ON HEALTH. ACCORDING TO THE COUNTY HEALTH RANKINGS SITE, WITH A SHARED VISION AND COMMITMENT TO IMPROVED HEALTH, WORKING TOGETHER CAN YIELD BETTER RESULTS THAN WORKING ALONE. LEADERSHIP FROM DOOR COUNTY MEDICAL CENTER ALSO ATTEND LEADERSHIP DOOR COUNTY. FUTURE COMMUNITY LEADERS WHO ARE KNOWLEDGEABLE ABOUT BOTH THE ASSETS AND CHALLENGES OUR COMMUNITY HAS WILL HELP US TO POSITIVELY ADDRESS THE HEALTH ISSUES OF THE FUTURE. THE MEDICAL CENTER ALSO IS A COMMUNITY SHARPS DISPOSAL SITE. BY SAFELY REMOVING SHARPS FROM THE ENVIRONMENT, WE MAKE THE COMMUNITY SAFER IN TERMS OF INJURY AND INFECTION. IN ADDITION, DOOR COUNTY MEDICAL CENTER PROVIDES JOB SHADOWING FOR AREA YOUTH. ACCORDING TO THE COUNTY HEALTH RANKINGS, EMPLOYMENT PROVIDES INCOME AND, OFTEN, BENEFITS THAT CAN SUPPORT HEALTHY LIFESTYLE CHOICES. UNEMPLOYMENT AND UNDER EMPLOYMENT LIMIT THESE CHOICES, AND NEGATIVELY AFFECT BOTH QUALITY OF LIFE AND HEALTH OVERALL. |
| PART III, LINE 2: | ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. ATTEMPTS TO RESOLVE THESE OUTSTANDING BALANCES CAN INCLUDE, BUT ARE NOT LIMITED TO STATEMENTS BEING SENT, PHONE CALLS AND LETTERS BEING SENT. ACCOUNT FOLLOW UP PROTOCOL IS BASED ON PERSONAL PAY BALANCE SIZE OWED. |
| PART III, LINE 3: | DOOR COUNTY MEMORIAL HOSPITAL HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. |
| PART III, LINE 4: | THE BAD DEBT EXPENSE INCLUDED ON FORM 990 (PART IX, LINE 25, COLUMN A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,613,862. |
| PART III, LINE 8: | HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SERVICES TO THOSE PATIENTS. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT IS STEP DOWN. |
| PART III, LINE 9B: | DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS MADE AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICES SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS. |
| PART VI, LINE 2: | OTHER THAN THE CHNA PROCESS, WHICH OCCURS EVERY THREE YEARS IN COLLABORATION WITH THE DOOR COUNTY PUBLIC HEALTH DEPARTMENT, THE ORGANIZATION USES MARKET RESEARCH TO GAUGE HEALTH CARE NEEDS. THE ORGANIZATION CONDUCTS FACEBOOK SURVEYS THAT ASSESS NEEDS IN OUR MARKET/COMMUNITY AND RECEIVED INPUT ON HEALTH CARE NEEDS THAT WILL BE USED IN THE NEXT CHNA. |
| PART VI, LINE 3: | THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE CHARITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE. PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASSISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. |
| PART VI, LINE 4: | WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THIS IS A WORK IN PROGRESS. DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") PROVIDED SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT, WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. THE CITY OF STURGEON BAY IS LOCATED IN DOOR COUNTY. THE POPULATION OF DOOR COUNTY, AS OF THE 2019 CENSUS DATA, IS 27,472. THE POPULATION CONSISTED OF 95% WHITE, 3% HISPANIC, 1% AFRICAN AMERICAN, AND 1% ASIAN. OF THE 27,472 POPULATION, 51% WERE FEMALE AND 49% MALE. THE AGE POPULATION IS WIDELY SPREAD. 16% WERE UNDER 18 AND 30% WERE 65+. THE LARGEST INDUSTRIES IN DOOR COUNTY ARE MANUFACTURING 18%, RETAIL 12%, HEALTHCARE 12%, AND HOSPITALITY 11%. ROUGHLY 10% OF THE POPULATION WERE BELOW THE POVERTY LINE. |
| PART VI, LINE 5: | THE LOCAL BOARD FOR DOOR COUNTY MEMORIAL HOSPITAL IS MADE UP OF COMMUNITY MEMBERS THAT LIVE IN OUR PRIMARY SERVICE AREA. DOOR COUNTY MEMORIAL HOSPITAL PARTNERS WITH THE LOCAL YMCA ON VARIOUS EVENTS PROMOTING HEALTH AND WELL-BEING IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, AND OTHER GOVERNMENT SPONSORED PROGRAMS. |
| PART VI, LINE 6: | THE DIRECT OFFSETTING REVENUE FOR MEDICAID INCLUDES $1,845,650 OF PRIOR YEAR COST REPORT SETTLEMENTS. WITHOUT THE PRIOR YEAR SETTLEMENTS, THE DIRECT OFFSETTING REVENUE ON LINE 7B WOULD BE $8,777,585 AND THE PERCENTAGE RESULT ON LINE 7K COL (F) WOULD BE 4.5%. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| NWTC EDUCATIONAL FOUNDATION | ||||||||
| PO BOX 19042 | GREEN BAY | WI | 54307 | 237069405 | 501(C)(3) | $25,000 | $0 | GENERAL SUPPORT |
| DOOR COUNTY ECONOMIC DEVELOPMENT | ||||||||
| 185 E WALNUT STREET | STURGEON BAY | WI | 54235 | 391621905 | 501(C)(3) | $7,500 | $0 | DOOR COUNTY ECONOMIC DEVELOPMENT |
| MONEY MANAGEMENT | ||||||||
| 57 NORTH 12TH AVE | STURGEON BAY | WI | 54235 | 391814584 | 501(C)(3) | $5,000 | $0 | NURSING & HEALTH CARE PROGRAMS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | POLICY STAT ID: 6244784 POLICY STATEMENT: IT IS THE POLICY OF DOOR COUNTY MEDICAL CENTER THAT ANY GRANT OR OTHER ASSISTANCE OF $5,000 OR MORE FROM DOOR COUNTY MEDICAL CENTER WILL REQUIRE ADMINISTRATIVE APPROVAL. THE CONTRIBUTIONS ADDRESSED IN THIS POLICY ARE CONSIDERED GRANT DONATIONS AND ARE NOT SPONSORSHIPS OR MARKETING EVENTS. PROCEDURE: A REQUEST FOR DONATIONS OF $5,000 OR MORE WILL NEED TO BE WRITTEN IN LETTER FORMAT ADDRESSED TO THE DOOR COUNTY MEDICAL CENTER ADMINISTRATIVE TEAM. THE CHECK REQUEST TO BE PROCESSED BY ACCOUNTS PAYABLE SHOULD BE SIGNED BY THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL. THE ADMINISTRATIVE TEAM WILL DISCUSS AND APPROVE OR REJECT THE REQUEST DURING ITS WEEKLY TEAM MEETING. DEPARTMENT DIRECTORS DO NOT HAVE THE AUTHORITY TO APPROVE ANY DONATION REQUEST. WHEN A REQUEST IS APPROVED BY THE ADMINISTRATIVE TEAM, A "GRANT AGREEMENT" FORM (COPY ATTACHED) WILL BE ISSUED AND WILL BE SIGNED BY THE ORGANIZATION RECEIVING THE CONTRIBUTION. THE ADMINISTRATIVE TEAM, WHEN MAKING DECISIONS ON REQUESTS FOR DONATIONS, MUST DETERMINE THAT THERE IS A DIRECT BENEFIT TO THE WELFARE OF DCMC OR TO THE PATIENTS AND COMMUNITY IT SERVES. AT THE COMPLETION OF THE GRANT PERIOD NOTED ON THE "GRANT AGREEMENT" FORM, THE ORGANIZATION THAT RECEIVED THE CONTRIBUTION WILL NEED TO COMPLETE A "GRANT FINAL REPORT" FORM. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR DANIEL TOMASZEWSKI | ||||||||||||||
| PHYSICIAN | $1,156,885 | $0 | $0 | $0 | $24,193 | $0 | $11,600 | $0 | $22,579 | $0 | $1,215,257 | $0 | $0 | $0 |
| DR MARK JORDAN | ||||||||||||||
| PHYSICIAN | $613,165 | $0 | $0 | $0 | $64,635 | $0 | $17,400 | $0 | $24,095 | $0 | $719,295 | $0 | $0 | $0 |
| DR MARC BINARD | ||||||||||||||
| PHYSICIAN | $323,947 | $0 | $0 | $0 | $313,830 | $0 | $17,400 | $0 | $25,065 | $0 | $680,242 | $0 | $0 | $0 |
| DR JAMES HEISE | ||||||||||||||
| PHYSICIAN | $351,917 | $0 | $0 | $0 | $175,043 | $0 | $17,400 | $0 | $23,763 | $0 | $568,123 | $0 | $0 | $0 |
| DR JOSEPH REBHAN | ||||||||||||||
| PHYSICIAN | $276,935 | $0 | $238,149 | $0 | $10,431 | $0 | $17,400 | $0 | $21,120 | $0 | $564,035 | $0 | $0 | $0 |
| DR DORENE DEMPSTER | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $362,945 | $0 | $0 | $0 | $8,034 | $0 | $17,400 | $0 | $27,030 | $0 | $415,409 | $0 | $0 | $0 |
| DR RICHARD HOGAN | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $343,371 | $0 | $0 | $0 | $18,756 | $0 | $17,400 | $0 | $24,154 | $0 | $403,681 | $0 | $0 | $0 |
| BRIAN STEPHENS | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $301,506 | $0 | $0 | $0 | $4,286 | $0 | $17,400 | $0 | $21,795 | $0 | $344,987 | $0 | $0 | $0 |
| DR PAUL BOARD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $191,092 | $0 | $0 | $0 | $78,147 | $0 | $16,744 | $0 | $26,499 | $0 | $312,482 | $0 | $0 | $0 |
| ANDREW LALUZERNE | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $147,265 | $0 | $0 | $0 | $2,333 | $0 | $9,629 | $0 | $24,794 | $0 | $184,021 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | PHYSICIANS ARE ALLOWED UP TO $1,000 FOR SPOUSE TRAVEL TO CONFERENCES. SUPPORTING DOCUMENTATION OF THE EXPENSES IS MAINTAINED AND TRACKED BY THE PHYSICIANS. SPOUSE TRAVEL AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2014-08-15 | BondIssuedDt |
| Issue Price | $10,000,000 | IssuePriceAmt |
| Purpose | REFUND DEBT ISSUED 10/21/09 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $463,320 | RetiredAmt |
| Total Proceeds | $10,000,000 | TotalProceedsAmt |
| Other Spent Proceeds | $10,000,000 | OtherSpentProceedsAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| DR MARK JORDAN | |||||||
| EMPLOYED PHYSICIAN | EDUCATION LOAN | Yes (X) | $158,117 | $71,152 | 0 | Yes (1) | Yes (1) |
| DR MARK JORDAN | |||||||
| EMPLOYED PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $50,000 | $4,167 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $75,319 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THERE ARE TWO CLASSES OF MEMBERS. CLASS H MEMBERS ARE REPRESENTATIVES FROM HSHS. TWO CLASS H MEMBERS ARE REQUIRED PER THE PARTNERSHIP AGREEMENT WITH HSHS. CLASS D MEMBERS ARE REPRESENTATIVES FROM DOOR COUNTY MEDICAL CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | CLASS H DIRECTORS OF THE GOVERNING BODY OF DOOR COUNTY MEMORIAL HOSPITAL SHALL BE APPOINTED BY ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS PROVIDED THAT THE CLASS D DIRECTORS SHALL RECEIVE ADVANCE NOTICE OF AND THE RIGHT TO ATTEND AND PARTICIPATE IN DISCUSSION AT SVGB MEETINGS DURING WHICH SVGB DISCUSSES POTENTIAL CANDIDATES TO THE CLASS H DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | STARTING 11/1/16 DOOR COUNTY MEMORIAL HOSPITAL ENTERED INTO AN AFFILIATION AGREEMENT WITH HOSPITAL SISTERS HEALTH SYSTEM, HOSPITAL SISTERS SERVICES, INC. AND ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS. THERE ARE SOME DECISIONS THAT REQUIRE AFFIRMATIVE APPROVAL OF THE CLASS H DIRECTORS, VOTING A SINGLE VOTE AS A CLASS, AND THE AFFIRMATIVE APPROVAL OF THE CLASS D DIRECTORS, VOTING A SINGLE VOTE AS A CLASS. |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT AND CERTAIN OFFICERS WORK DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS' QUESTIONS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS OF THE GOVERNING BOARD OR COMMITTEE WILL DECIDE IF CONFLICTS ON INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTAND THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. |
| FORM 990, PART VI, SECTION B, LINE 15 | IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, WHICH IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO, WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF COMPENSATION, DOCUMENTATION OF THE DECISON WAS RECORDED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE DOOR COUNTY MEMORIAL HOSPITAL WEB PAGE IS AVAILABLE TO THE PUBLIC FOR INSPECTION WITH A GOOD DEAL OF INFORMATION REGARDING WHO DOOR COUNTY MEMORIAL HOSPITAL IS ALONG WITH OUR MISSION. THE ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT INCLUDED ON ANY WEB PAGE. HOWEVER, IF ANY INQUIRY IS MADE FOR ANY DOCUMENTS THEY ARE SHARED AS APPROPRIATE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS IN DOOR COUNTY HOSPITAL FOUNDATION 290,298. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|
| DOOR COUNTY MEDICAL CORPORATION | ||||||||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | 814221171 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | 0 | |
| DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 1843 MICHIGAN STREET | STURGEON BAY | WI | 54235 | 391649104 | CHARITABLE FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | DOOR COUNTRY MEDICAL CORPORATION |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC | ||
| C | $954,902 | ACTUAL |
| DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC | ||
| O | $411,921 | ACTUAL |