BELLIN MEMORIAL HOSPITAL INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BELLIN MEMORIAL HOSPITAL INC (EIN 39-0884478)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-11
- IRS object ID
- 202122239349301302
- Schema version
- 2019v5.2
- 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 | 2021-08-11T11:10:17-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | 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 | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390884478 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BELL | BusinessNameControlTxt |
| Phone | 9204457260 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 23400 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54305 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES DIETSCHE | PersonNm |
| Person Title | EVP-CFO | PersonTitleTxt |
| Phone | 9204457260 | PhoneNum |
| Signature | 2021-08-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2021-08-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES DIETSCHE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 23400 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54305 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $607,967,223 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BELLIN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1908 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | BELLIN MEMORIAL HOSPITAL, INC. (BMH) PROVIDES HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BMH, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, BMH PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR ARE UNINSURED OR UNDERINSURED. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID, ARE ALSO CONSIDERED PART OF THE BELLIN HEALTH BENEFITS PROVIDED TO THE COMMUNITY SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN COST. | ActivityOrMissionDesc |
| Voting Members Governing Body | 23 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 4416 | TotalEmployeeCnt |
| Total Volunteers | 354 | TotalVolunteersCnt |
| Total Gross UBI | $2,586,284 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,108,019 | PYContributionsGrantsAmt |
| CY Contributions Grants | $13,409,509 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $559,196,425 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $566,552,003 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,928,446 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,326,522 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,883,002 | PYOtherRevenueAmt |
| CY Other Revenue | $15,268,701 | CYOtherRevenueAmt |
| PY Total Revenue | $580,115,892 | PYTotalRevenueAmt |
| CY Total Revenue | $606,556,735 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $779,584 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $686,264 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $301,014,013 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $322,933,154 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $230,442,314 | PYOtherExpensesAmt |
| CY Other Expenses | $235,799,424 | CYOtherExpensesAmt |
| PY Total Expenses | $532,235,911 | PYTotalExpensesAmt |
| CY Total Expenses | $559,418,842 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $47,879,981 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $47,137,893 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $689,223,217 | TotalAssetsBOYAmt |
| Total Assets EOY | $753,402,442 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $229,534,525 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $247,167,372 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $459,688,692 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $506,235,070 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | BELLIN HEALTH IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR IMPROVING THE HEALTH AND WELLBEING OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN, AND ALL OTHERS WE SERVE. WE CARRY OUT THIS RESPONSIBILITY THROUGH INDIVIDUALIZED CARE EXCELLENCE, COMMUNITY HEALTH IMPROVEMENT, AND EQUITABLE HEALTHCARE FINANCING PLANS ALL DESIGNED TO POSITIVELY IMPACT HEALTH AND WELLBEING. WE ARE STEADFAST IN OUR COMMITMENT TO PROVIDING COMPASSIONATE, SAFE, AND COORDINATED CARE THAT IS ACCESSIBLE AND AFFORDABLE FOR EVERYONE. WE BUILD TRUSTED RELATIONSHIPS AND ADVANCE TRUE COLLABORATION, FUELING OUR DESIRE TO CONSTANTLY IMPROVE AND INNOVATE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $469,795,576 | ExpenseAmt |
| Grant | $686,264 | GrantAmt |
| Revenue | $577,206,208 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2020 35,357 INPATIENT DAYS WERE PROVIDED (32,396 ADULTS AND PEDIATRICS), AS COMPARED TO 33,562 (30,736 ADULTS AND PEDIATRICS) IN FISCAL YEAR 2019. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2020 AND 2019 WERE 232,070 AND 254,357, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 939,032 (AS COMPARED TO 920,862 IN 2019) PHYSICIAN CLINIC VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS. | Desc |
| Total Program Service Expenses | $469,795,576 | 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 | Yes (1) | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | 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 | 339 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 4416 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | Yes (1) | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 23 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | JAMES DIETSCHE EPV-CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204457260 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 744 S WEBSTER AVE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| DAVID STAMPFL MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $1,532,485 | $0 | $41,515 | |||
| GEORGE KERWIN - TERMED | ||||||||
| FORMER CEO | 50.00 | $1,531,063 | $0 | $36,139 | Yes (X) | |||
| PATRICK MCKENZIE MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $1,193,851 | $0 | $39,629 | |||
| JAMES SPEARS MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $1,165,488 | $0 | $32,716 | |||
| ROBERT ANDERSON MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $1,137,269 | $0 | $38,353 | |||
| TIMOTHY ROARTY MD | ||||||||
| PHYSICIAN | 40.00 | Yes (X) | $1,036,728 | $0 | $34,986 | |||
| CHRISTINE WOLESKE | ||||||||
| PRESIDENT/CEO | 50.00 | $1,028,581 | $0 | $170,215 | Yes (X) | Yes (X) | ||
| STEVEN GERNDT MD | ||||||||
| BOARD MEMBER/PRESIDENT MEDICAL STAFF | 50.00 | $729,797 | $0 | $31,287 | Yes (X) | |||
| JENNIFER LYNCH MD | ||||||||
| BOARD MEMBER/PRESIDENT BELLIN SPECIALTY GROUP | 50.00 | $743,950 | $0 | $14,571 | Yes (X) | |||
| JAMES DIETSCHE | ||||||||
| EVP-CFO | 50.00 | $518,817 | $0 | $81,453 | Yes (X) | |||
| ROBERT MEAD MD | ||||||||
| BOARD MEMBER/PAST PRESIDENT MED | 50.00 | $319,156 | $0 | $38,188 | Yes (X) | |||
| WILLIAM WITTMAN MD | ||||||||
| BOARD MEMBER/BMG PHYSIAN | 50.00 | $240,610 | $0 | $30,404 | Yes (X) | |||
| SABINA SINGH MD | ||||||||
| BOARD MEMBER/PRESIDENT BEL | 50.00 | $247,845 | $0 | $20,622 | Yes (X) | |||
| MARK RINGWELSKI MD - TERMED | ||||||||
| BOARD MEMBER/PRESIDENT BEL | 50.00 | $135,126 | $0 | $16,581 | Yes (X) | |||
| PAUL CASEY MD - TERMED | ||||||||
| BOARD MEMBER/PRESIDENT MED | 50.00 | $27,961 | $0 | $0 | Yes (X) | |||
| TERRY FULWILER | ||||||||
| BOARD CHAIR | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JOHN DYKEMA | ||||||||
| VICE-CHAIR | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| MARK MCMULLEN | ||||||||
| BOARD SECRETARY | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| ELL LEE DDS | ||||||||
| TREASURER | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| NANCY ARMBRUST | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| G CORT CONDON | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| DANIEL GULLING - TERMED | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| FRED SCHMIDT MD | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| DANIEL ARIENS | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| JOHN JONES | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| SUSAN FINCO | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| MICHAEL HADDAD | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| ROBERT CLAUSEN | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| KARL SCHMIDT | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| BARB GILLING | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| BILL BOHN | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| JAMIE SPITZER | ||||||||
| BOARD MEMBER | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| SAIED ASSEF MD | ||||||||
| BOARD MEMBER/PHYSICIAN DIRECTOR | 50.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $11,588,727 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $626,659 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 432 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 |
|---|---|---|---|---|---|
| APOGEE MEDICAL MANAGEMENT | |||||
| 15059 N SCOTTSDALE RD STE 600 | SCOTTSDALE | AZ | 85254 | CONTRACTED PHYSICIAN/MANAGEMENT SERVICES | $3,604,369 |
| MAYO COLLABORATIVE SERVICES | |||||
| 200 1ST ST SW | ROCHESTER | MN | 55905 | LAB SERVICES | $2,634,822 |
| NORDIC CONSULTING PARTNERS | |||||
| 2601 BELTLINE HWY STE 600 | MADISON | WI | 53713 | IT STAFFING AND CONSULTING SERVICES | $2,093,021 |
| IEI GENERAL CONTRACTORS | |||||
| 1725 MIDWAY ROAD | DE PERE | WI | 54115 | CONSTRUCTION SERVICES | $2,040,435 |
| AMERIEBO LLC | |||||
| 1851 S ALVERNO ROAD | MANITOWOC | WI | 54220 | BILLING/COLLECTION SERVICES | $1,901,119 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 73 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $698,410 | RelatedOrganizationsAmt |
| Government Grants | $12,468,643 | GovernmentGrantsAmt |
| All Other Contributions | $242,456 | AllOtherContributionsAmt |
| Total Contributions | $13,409,509 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621500 | $553,185,212 | $551,013,828 | $2,171,384 |
| CONTRACTED SERVICES | 621110 | $3,580,537 | $3,580,537 | |
| ACO INCENTIVE | 621110 | $3,443,214 | $3,443,214 | |
| RENT FROM AFFILIATES | 621110 | $2,783,492 | $2,783,492 | |
| MISCELLANEOUS | 621110 | $1,748,601 | $1,748,601 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,810,947 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,519 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $414,900 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,351,528 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $566,552,003 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,797,343 | TotalRevenueColumnAmt |
| Exclusion | $6,797,343 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,834,182 | RealAmt |
| Personal | $47,897 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,157,498 | RealAmt |
| Personal | $47,897 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $676,684 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $676,684 | TotalRevenueColumnAmt |
| Exclusion | $676,684 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,711,521 | SecuritiesAmt |
| Other | $22,751 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $205,093 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,711,521 | SecuritiesAmt |
| Other | -$182,342 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,529,179 | TotalRevenueColumnAmt |
| Exclusion | $4,529,179 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| BOSC K-1 INCOME | 900099 | $6,953,503 | $6,953,503 |
| EHR INCENTIVE | 621110 | $4,051,060 | $4,051,060 |
| LOSS FROM HEALTHCARE AFFILIATES | 900099 | $3,587,454 | $3,587,454 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $14,592,017 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $606,556,735 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $577,206,208 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,586,284 | UnrelatedBusinessRevenueAmt |
| Exclusion | $13,354,734 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $686,264 | TotalAmt |
| Program Services | $686,264 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,216,156 | TotalAmt |
| Program Services | $2,568,136 | ProgramServicesAmt |
| Management And General | $1,648,020 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,271,848 | TotalAmt |
| Program Services | $222,678,433 | ProgramServicesAmt |
| Management And General | $33,593,415 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,079,238 | TotalAmt |
| Program Services | $9,553,375 | ProgramServicesAmt |
| Management And General | $1,525,863 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,306,440 | TotalAmt |
| Program Services | $30,312,495 | ProgramServicesAmt |
| Management And General | $4,993,945 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,059,472 | TotalAmt |
| Program Services | $13,963,263 | ProgramServicesAmt |
| Management And General | $2,096,209 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $893,334 | TotalAmt |
| Program Services | $893,334 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $857,677 | TotalAmt |
| Management And General | $857,677 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,108,650 | TotalAmt |
| Management And General | $1,108,650 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $438,414 | TotalAmt |
| Management And General | $438,414 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,631,857 | TotalAmt |
| Program Services | $32,955,896 | ProgramServicesAmt |
| Management And General | $6,675,961 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,213,235 | TotalAmt |
| Program Services | $21,946 | ProgramServicesAmt |
| Management And General | $6,191,289 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,552,993 | TotalAmt |
| Program Services | $3,398,103 | ProgramServicesAmt |
| Management And General | $4,154,890 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,796,884 | TotalAmt |
| Program Services | $4,337,267 | ProgramServicesAmt |
| Management And General | $4,459,617 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,977,901 | TotalAmt |
| Program Services | $10,379,586 | ProgramServicesAmt |
| Management And General | $598,315 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $992,284 | TotalAmt |
| Program Services | $705,737 | ProgramServicesAmt |
| Management And General | $286,547 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,466,042 | TotalAmt |
| Program Services | $600,171 | ProgramServicesAmt |
| Management And General | $865,871 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,667,315 | TotalAmt |
| Program Services | $704,474 | ProgramServicesAmt |
| Management And General | $5,962,841 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,090,621 | TotalAmt |
| Program Services | $16,874,502 | ProgramServicesAmt |
| Management And General | $7,216,119 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,077,969 | TotalAmt |
| Program Services | $404,118 | ProgramServicesAmt |
| Management And General | $673,851 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $85,892,244 | $85,538,546 | $353,698 |
| EQUIPMENT RENT/MAINT | $13,894,886 | $10,996,272 | $2,898,614 |
| BAD DEBTS | $12,601,213 | $12,601,213 | |
| DUES/SUBSCRIPTIONS | $10,165,897 | $7,734,279 | $2,431,618 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,480,008 | TotalAmt |
| Program Services | $1,888,166 | ProgramServicesAmt |
| Management And General | $591,842 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $559,418,842 | TotalAmt |
| Program Services | $469,795,576 | ProgramServicesAmt |
| Management And General | $89,623,266 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,077 | BOYAmt |
| EOY | $17,230 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,955,240 | BOYAmt |
| EOY | $187,655,201 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,720,587 | BOYAmt |
| EOY | $75,475,297 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,986,977 | BOYAmt |
| EOY | $29,113,453 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,768,606 | BOYAmt |
| EOY | $7,679,094 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,695,875 | BOYAmt |
| EOY | $3,280,278 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $435,613,114 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $234,790,878 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,342,693 | BOYAmt |
| EOY | $200,822,236 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $196,879,307 | BOYAmt |
| EOY | $211,699,500 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,491,085 | BOYAmt |
| EOY | $15,068,245 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,124,985 | BOYAmt |
| EOY | $2,159,664 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,240,785 | BOYAmt |
| EOY | $20,432,244 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $689,223,217 | BOYAmt |
| EOY | $753,402,442 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,884,767 | BOYAmt |
| EOY | $82,203,489 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $70,851 | BOYAmt |
| EOY | $38,042 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,322,788 | BOYAmt |
| EOY | $94,366,285 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,256,119 | BOYAmt |
| EOY | $70,559,556 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,534,525 | BOYAmt |
| EOY | $247,167,372 | 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 | $454,903,413 | BOYAmt |
| EOY | $501,241,175 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,785,279 | BOYAmt |
| EOY | $4,993,895 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $459,688,692 | BOYAmt |
| EOY | $506,235,070 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $689,223,217 | BOYAmt |
| EOY | $753,402,442 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $47,137,893 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $4,219,541 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$4,811,056 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 | $21,104 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $21,104 | 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 | AHA AND WHA DUES | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,778,946 | BeginningYearBalanceAmt |
| Contributions | $5,651 | ContributionsAmt |
| Investment Earnings Or Losses | $46,602 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $18,012 | OtherExpendituresAmt |
| End Year Balance | $2,813,187 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,697,255 | BeginningYearBalanceAmt |
| Contributions | $63,290 | ContributionsAmt |
| Investment Earnings Or Losses | $27,788 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $9,387 | OtherExpendituresAmt |
| End Year Balance | $2,778,946 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,689,035 | BeginningYearBalanceAmt |
| Contributions | $50 | ContributionsAmt |
| Investment Earnings Or Losses | $32,052 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $23,882 | OtherExpendituresAmt |
| End Year Balance | $2,697,255 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,637,679 | BeginningYearBalanceAmt |
| Contributions | $7,394 | ContributionsAmt |
| Investment Earnings Or Losses | $56,750 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $12,788 | OtherExpendituresAmt |
| End Year Balance | $2,689,035 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,283,113 | BeginningYearBalanceAmt |
| Contributions | $319,500 | ContributionsAmt |
| Investment Earnings Or Losses | $45,890 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $10,824 | OtherExpendituresAmt |
| End Year Balance | $2,637,679 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.92140 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.07860 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,243,211 | OtherCostOrOtherBasisAmt |
| Book Value | $10,243,211 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $192,081,035 | OtherCostOrOtherBasisAmt |
| Depreciation | $77,249,055 | DepreciationAmt |
| Book Value | $114,831,980 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,159,914 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,170,408 | DepreciationAmt |
| Book Value | $989,506 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $216,236,723 | OtherCostOrOtherBasisAmt |
| Depreciation | $155,371,415 | DepreciationAmt |
| Book Value | $60,865,308 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,892,231 | OtherCostOrOtherBasisAmt |
| Book Value | $13,892,231 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $200,822,236 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION | $14,455,735 |
| NONCONTROLLING INTEREST OF CONSOLIDATED AFFILIATE | $1,411,295 |
| CAPITAL LEASE OBLIGATIONS | $45,899,322 |
| INTEREST RATE SWAP VALUATION | $8,793,204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $70,559,556 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $603,058,364 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $4,219,541 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$16,901,973 | OtherRevenueAmt |
| Revenue Not Reported | -$12,682,432 | RevenueNotReportedAmt |
| Revenue Subtotal | $615,740,796 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $438,414 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$9,622,475 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$9,184,061 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $606,556,735 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $556,318,363 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $10,351,850 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $10,351,850 | ExpensesNotReportedAmt |
| Expenses Subtotal | $545,966,513 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $438,414 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $13,013,915 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $13,452,329 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $559,418,842 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR HEALTH CARE SERVICES AND EMPLOYEE TRAINING AND DEVELOPMENT. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | GAIN ON SWAP AGREEMENT -1,171,684. NON-CONTROLLING INTEREST -3,129,076. PROVISION FOR BAD DEBTS -12,601,213. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | TRANSFER FROM FOUNDATION 698,410. HOSPITAL SUPPLIES 30,965. RENTAL EXPENSES -1,205,395. RENT FROM AFFILIATES 2,783,492. BOSC EXPENSES -11,929,947. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 1,205,395. RENT FROM AFFILIATES -2,783,492. BOSC EXPENSES 11,929,947. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | REALLOCATION OF SUPPLIES EXPENSE TO 990T 30,965. EXPENSES PAID FOR BY FOUNDATION TRANSFERS 381,737. PROVISION FOR BAD DEBTS 12,601,213. |
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 | 220.000000000000 | 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 | $4,948,754 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,948,754 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00910 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,294,532 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $29,231,892 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $31,062,640 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $65,243,286 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $29,231,892 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $36,011,394 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06590 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,917,955 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,917,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00900 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,570,135 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,570,135 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,632,548 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,632,548 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,120,638 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,120,638 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $76,363,924 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $29,231,892 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $47,132,032 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08630 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $128,302 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $128,302 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $128,302 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $128,302 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,058,585 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $144,698,894 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $167,625,793 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$22,926,899 | 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 |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 BELLIN ORTHOPEDIC SURGERY CENTER LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | ORTHOPEDIC SURGERY CENTER | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.55000 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.45000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | BELLIN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 744 S WEBSTER AVE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54305 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BELLIN.ORG | WebsiteAddressTxt |
| State License | 147 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN 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 | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION B, LINE 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION B, LINE 7D | 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 | 220.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BUSOF.001_-_FINANCIAL_ASSISTANCE.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/COMMUNITY_CARE_APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/PLAIN_LANGUAGE_SUMMARY_-_FINANCIAL_AS | 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 |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BELLIN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THIS YEAR'S ASSESSMENT BUILT ON COLLABORATION, ACTIVELY SEEKING INPUT FROM A BROAD CROSS SECTION OF COMMUNITY STAKEHOLDERS WITH THE GOAL OF REACHING CONSENSUS ON PRIORITIES TO MUTUALLY FOCUS HUMAN, MATERIAL AND FINANCIAL RESOURCES ON. BELOW IS A LISTING OF PARTICIPANTS IN A CHNA SUMMIT IN WHICH HEALTH PRIORITIES WERE DETERMINED.-CITY OF GREEN BAY - PARKS & RECREATION-NORTHEASTERN WISCONSIN TECHNICAL COLLEGE-CITY OF DE PERE - HEALTH DEPARTMENT-BELLIN HEALTH-BROWN COUNTY PUBLIC HEALTH-ASHWAUBENON SCHOOLS-INTERN SCHOOL SOCIAL WORKER (HSSD)-WILLOW CREEK BEHAVIORAL HEALTH-HSHS ST VINCENT HOSPITAL/ ST MARY'S HOSPITAL-LIVE 54218-BELLIN PSYCHIATRIC CENTER-BROWN COUNTY BOARD-WIC-FAMILY & CHILDCARE RESOURCES OF NEW-AGING AND DISABILITY RESOURCE CENTER-BROWN COUNTY BOARD OF HEALTH-WI DHS DIVISION OF PUBLIC HEALTH-HOWARD SUAMICO SCHOOLS-CONNECTIONS FOR MENTAL WELLNESS-PULASKI COMMUNITY SCHOOLS-ST NORBERT COLLEGE-HSHS LIBERTAS TREATMENT CENTER-SHERMAN COUNSELING-UW EXTENSIONS-AIDS RESOURCE CENTER OF WISCONSIN (ARCW)-FOUNDATIONS-BOCE/ETC.-AURORA BEHAVIORAL HEALTH - UWGB-UNITED WAY - BROWN COUNTY-EX PRISONER OPPORTUNITIES-INTEGRATED COMMUNITY SOLUTIONS-OCONTO COUNTY PUBLIC HEALTH-RETIRED LAW ENFORCEMENT - DE PERE-BELLIN COLLEGE-BROWN COUNTY - CTC-UW GREEN BAY-ONEIDA NATION-BROWN COUNTY CHILD AND ADOLESCENT BEHAVIORAL HEALTH-PREVEA HEALTH-BROWN COUNTY HEALTH & HUMAN SERVICES-NEW COMMUNITY CLINIC-NEW COMMUNITY CLINIC & BROWN COUNTY BOARD OF HEALTH-GREEN BAY AREA PUBLIC SCHOOLS-CITY OF GREEN BAY - MAYOR-AURORA BAYCARE MEDICAL CENTER (ABMC)-ORAL HEALTH PARTNERSHIP-COMMUNITY VOLUNTEER-CITY OF DE PERE-JOSHUA - BC MENTAL HEALTH TASK FORCE - CONNECTIONS FOR MENTAL WELLNESS-DIOCESE OF GB CATHOLIC CHARITIES-BAY AREA COMMUNITY COUNCIL (BACC)-DARJUNE/EXPOTO ENSURE THAT THE NEEDS OF THESE GROUPS WERE ADEQUATELY REPRESENTED, WE INCLUDED REPRESENTATIVES FROM BROWN COUNTY HEALTH AND HUMAN SERVICES (PUBLIC HEALTH, AGING & DISABILITY RESOURCE CENTER, AND CHILD & FAMILY SERVICES); VARIOUS BROWN COUNTY DEPARTMENTS INCLUDING HEAD START, PROBATION & PAROLE, VICTIM/WITNESS SERVICES, VETERANS SERVICES; LOVE, INC.; BROWN COUNTY INTERFAITH ORGANIZATION; LOCAL SCHOOL DISTRICTS; BROWN COUNTY INTERFAITH; PARTNERS FOR COMMUNITY DEVELOPMENT; FAMILY RESOURCE CENTER OF BROWN COUNTY; SAFE HARBOR. THESE ORGANIZATIONS SERVE THE UNDER-RESOURCED IN OUR COMMUNITY, INCLUDING LOW-INCOME SENIORS, CHILDREN LIVING IN POVERTY, FAMILIES WHO STRUGGLE WITH SHELTER AND FOOD INSECURITY; VETERANS AND VICTIMS OF DOMESTIC VIOLENCE. |
| BELLIN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: AURORA BAYCARE MEDICAL CENTER (GREEN BAY) AND ST. MARY'S AND ST. VINCENT HOSPITALS (HSHS, GREEN BAY) |
| BELLIN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: BROWN COUNTY HEALTH DEPARTMENT, CITY OF DE PERE HEALTH DEPARTMENT, AND BROWN COUNTY UNITED WAY. |
| BELLIN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BROWN_COUNTY-FY2018_CHNA_EDITS_04_10_FULL URL FOR PART V, SECTION B, LINE 10A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BROWN_COUNTY_FY2018_IMPLEMENTATION_PL |
| BELLIN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2018 THROUGH 2020. THE NEEDS IDENTIFIED ARE: MENTAL HEALTH, PHYSICAL ACTIVITY, OBESITY, AND NUTRITION, AND HEALTH INEQUALITY. BELLIN REPRESENTATIVES LEAD THE INITIATIVES. A SUMMARY OF HOW BELLIN HAS BEEN ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA IS AS FOLLOWS:MENTAL HEALTH: LONG-TERM PERFORMANCE INDICATORS: BY JULY 2020, THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS PER 30 DAYS, AS REPORTED BY COUNTY RESIDENTS, WILL DECREASE FROM 3.4 TO 3.2. STRATEGY ONE: SCREENING TOOL ASSESSMENT AND BEST PRACTICE IDENTIFICATION BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT AND MENTAL HEALTH TASK FORCE TO: -ASSIST IN COMPLETING AN INVENTORY OF CURRENT BEHAVIORAL HEALTH SCREENING TOOLS USED ACROSS SETTINGS. -ASSIST IN COMPLETING AN INVENTORY OF CURRENT SUICIDE RISK SCREENING TOOLS USED ACROSS SETTINGS (CONSIDER COLLABORATION WITH THE BROWN COUNTY COALITION FOR SUICIDE PREVENTION ON THIS ACTIVITY). -IDENTIFY BEST PRACTICE BEHAVIORAL HEALTH SCREENING TOOLS AND DEVELOP RECOMMENDATIONS FOR TOOLS USED IN VARIOUS COMMUNITY SETTINGS. -IDENTIFY BEST PRACTICE SUICIDE RISK SCREENING TOOLS AND DEVELOP RECOMMENDATIONS FOR TOOLS USED IN VARIOUS COMMUNITY SETTINGS. STRATEGY TWO: ""NO WRONG DOOR"" ACCESS PLATFORM FOR MENTAL HEALTH TREATMENT AND PROVIDERS BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT AND MENTAL HEALTH TASK FORCE TO: -IMPLEMENT TRILOGY NETWORK OF CARE IN COLLABORATION WITH NEW CONNECTIONS -WORK WITH PRIMARY CARE PROVIDERS TO IDENTIFY EDUCATION NEEDS AND STRENGTHEN PRIMARY CARE AS THE ENTRY POINT TO ""RIGHT CARE, RIGHT PERSON, RIGHT TIME"" MENTAL HEALTH TREATMENT. -INVESTIGATE AND IMPLEMENT A ""NO WRONG DOOR"" REFERRAL PROCESS BETWEEN COMMUNITY AGENCIES TO GUARANTEE THE RIGHT ACCESS AT THE RIGHT TIME. STRATEGY THREE: DEVELOP A NETWORK OF PEER SUPPORT, INCREASING AVAILABILITY OF IMMEDIATE RESOURCES TO COMMUNITY BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT AND MENTAL HEALTH TASK FORCE TO: -COMPLETE AN INVENTORY OF CURRENT MENTAL HEALTH PEER SUPPORT RESOURCES AVAILABLE IN THE COMMUNITY. -IDENTIFY EDUCATIONAL/TRAINING PROGRAMS AVAILABLE TO THOSE INTERESTED IN PROVIDING PEER SUPPORT IN THE COMMUNITY (E.G. QPR, MENTAL HEALTH FIRST AID, ETC.). -DEVELOP A PEER SUPPORT NETWORK, IMPLEMENT SERVICES AND PROVIDE RESOURCE CONTACTS TO COMMUNITY ORGANIZATIONS AND AGENCIES. PHYSICAL ACTIVITY, OBESITY, AND NUTRITION:LONG-TERM PERFORMANCE INDICATORS: BY 2020, INCREASE NUMBER OF INDIVIDUALS WITH A HEALTHY WEIGHT BY THREE PERCENT, AS EVIDENCED BY AN INCREASE IN THE NUMBER OF COMMUNITY MEMBERS WITH A BMI UNDER 30. (BASELINE MEASURE: 72 PERCENT AT HEALTHY WEIGHT, BASED ON COUNTY HEALTH RANKINGS 2017- 2013 DATA).STRATEGY ONE: FOOD AS MEDICINE BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT TO IMPROVE EQUITABLE ACCESS TO HEALTHY FOOD, AND INCREASE THE PROPORTION OF BROWN COUNTY RESIDENTS WHO CONSUME THE RECOMMENDED NUMBER OF SERVINGS OF FRUITS AND VEGETABLES BY AT LEAST TWO PERCENT (SHORT TERM) AND FOUR PERCENT (LONG TERM) BY: -ESTABLISHING RELATIONSHIPS WITH VARIOUS COMMUNITY GROUPS AND OFFERING ASSISTANCE TO FACILITATE CHANGE OR MAINTENANCE FOR PROGRAMS THAT FOCUS ON CONSUMPTION OF HEALTHY FOODS -MONITORING HEALTHY FOOD DONATIONS AT SCOUTING FOR FOODS DRIVE -MAINTAINING AND PROMOTING FOOD DRIVE 5 TOOLKIT -MONITORING AND ENCOURAGING FOOD PANTRY INFRASTRUCTURE THAT PROMOTES HEALTHY FOOD CHOICES -INSTITUTE A PLATFORM OF HEALTHY SNACKS IN THE SCHOOL SYSTEM BY ELIMINATING CANDY, HIGH FAT SNACKS AND SODA FROM VENDING MACHINES AND CAFETERIAS -TRACKING THE RATIO OF ELIGIBILITY FOR EBT PROGRAM TO THOSE WHO USE THE DOUBLE YOUR BUCKS PROGRAM AT THE FARMER'S MARKET -BEN'S WISH PROGRAM THAT ASSISTS LOCAL COMMUNITIES IN FIGHTING FOOD INSECURITY ISSUES THROUGH FOOD DRIVE COLLECTION, WEEKEND BACKPACK PROGRAM AND EDUCATIONAL ACTIVITIES. STRATEGY TWO: MOVEMENT AS MEDICINE BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT TO DECREASE PHYSICAL INACTIVITY (SHORT-TERM BY TWO PERCENT, LONG-TERM BY FOUR PERCENT) THROUGH EMPOWERING COMMUNITY MEMBERS TO USE ACTIVE MEANS OF TRANSPORT/MOVEMENT BY PARTNERING WITH THE GREATER GREEN BAY ACTIVE COMMUNITY ALLIANCE. ENCOURAGE BROWN COUNTY RESIDENTS TO UTILIZE COMMUNITY RESOURCES (E.G. WALKING/BIKING TRAILS, FITNESS CENTERS, ETC) AND FACILITATE CAMPAIGN(S) THAT PROMOTE(S) HEALTHY LIFESTYLES THROUGH SAFE AND AFFORDABLE MODES OF PHYSICAL ACTIVITY (AS MEASURED BY A DECREASE IN PHYSICAL INACTIVITY) BY STRUCTURING THE WORK AROUND THE THREE ES (ENGINEERING, EDUCATION, ENFORCEMENT). TOGETHER, WE WILL ACCOMPLISH THIS BY: -INVENTORYING EXISTING INITIATIVES THAT ARE IN ALIGNMENT WITH THIS OBJECTIVE. -PARTNERING WITH THE GREATER GREEN BAY ACTIVE COMMUNITY ALLIANCE TO CREATE A MORE ACTIVE AND CONNECTED COMMUNITY. -DEVELOPING AN EDUCATIONAL STRATEGY USING THE THREE ES IN PARTNERSHIP WITH THE GREATER GREEN BAY ACTIVE COMMUNITY ALLIANCE. -MONITORING UTILIZATION TRENDS OF ACTIVE DESIGN AND INFRASTRUCTURE TO IDENTIFY GAPS AND OPPORTUNITIES TO IMPROVE. STRATEGY THREE: CULTURE CHANGE: BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT TO LINK LIFE STUDY DATA, CHIP AND THE GROW PROJECT TOGETHER TO COLLABORATE ON COMMUNITY INITIATIVES. TOGETHER WE WILL CREATE A COMMUNITY DRIVEN BY MULTI-SECTORED PARTNERSHIPS SUPPORTIVE OF CULTURAL WELL-BEING THAT IMPROVES THE HEALTH OF BROWN COUNTY BY: -CONVENING MEETINGS WITH LEADERSHIP FROM LIFE STUDY, CHIP AND THE GROW PROJECT. -TESTING A COMMUNITY EDUCATION PLATFORM SUPPORTING THE CONNECTION BETWEEN NUTRITION, MOVEMENT AND HEALTH STATUS. -ENGAGING AND EMPOWERING THE GROWTH AND DEVELOPMENT OF RELATIONSHIPS BETWEEN AGENCIES IN THE FOOD-RELATED AND WELL-BEING SECTORS. -ADOPTING HEALTHFUL HOSPITAL FOOD AMERICAN MEDICAL ASSOCIATION RESOLUTION 406.HEALTH EQUALITY:IN ADDITION TO THE THREE COMMUNITY TEAMS, BELLIN IS HAS AN INTERNAL TEAM FOCUSED ON ADDRESSING HEALTH EQUITY. PRIMARY DRIVERS IN THIS WORK INCLUDE: LEADERSHIP AND ADVOCACY AS HEALTHCARE LEADERS FOR HEALTH EQUITY, ORGANIZATION FOCUS TO ADDRESS OPPORTUNITIES FOR HEALTH CARE EQUITY AND PARTNERSHIPS WITH THE KEY STAKEHOLDERS AND COMMUNITIES. ONE OF THE KEY PROJECT THAT THIS TEAM WILL FOCUS ON US THE COLLECTION AND USE OF REAL (RACE, ETHNICITY AND LANGUAGE) DATA. SOME ADDITIONAL PROJECTS THAT THE TEAM HAS PRIORITIZED FALL UNDER THE SECONDARY DRIVERS OF DEVELOPING A RECRUITMENT AND RETENTION STRATEGY TO EVOLVE THE WORKFORCE TO REFLECT THE COMMUNITY WE LIVE IN, AND THE QUALITATIVE AND QUANTITATIVE UNDERSTANDING OF THE POPULATIONS WE SERVE BY ADDRESSING THE SOCIAL DETERMINATES OF HEALTH. NEXT STEPS THE IMPLEMENTATION PLAN OUTLINES A THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PROCESS. ANNUALLY, THE HOSPITAL WILL: -REVIEW THE IMPLEMENTATION PLAN AND UPDATE STRATEGIES FOR THE FOLLOWING FISCAL YEAR -SET AND TRACK ANNUAL PERFORMANCE INDICATORS FOR EACH IMPLEMENTATION STRATEGY -TRACK PROGRESS TOWARD MID TERM PERFORMANCE INDICATORS -REPORT PROGRESS TOWARD THE PERFORMANCE INDICATORS TO THE HOSPITAL BOARD, COMMUNITY BENEFIT ADVISORY COMMITTEE" |
| BELLIN MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY INCLUDES FACTORS AS: HOMELESS, DECEASED WITH NO KNOWN ESTATE, APPROVED COURT BANKRUPTCY, PAYMENT ASSISTANCE RANK ORDER SCORE, ELIGIBLE FOR STATE OF WI FOOD SHARE PROGRAM. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 35 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (35 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - THE CANCER TEAM OF BELLIN HEALTH | ||||
| 1580 COMMANCHE AVE | GREEN BAY | WI | 54313 | PROVIDER CLINIC SITE |
| 2 - FAMILY MEDICAL CENTER ASHWAUBENON | ||||
| 1630 COMMANCHE AVE | GREEN BAY | WI | 54313 | PROVIDER CLINIC SITE |
| 3 - BELLIN HEALTH NEPHROLOGY | ||||
| 2020 RIVERSIDE DR SUITE 200 | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 4 - BELLIN HEALTH TITLETOWN SPORTS MEDICINE | ||||
| 1970 S RIDGE RD | GREEN BAY | WI | 54304 | PROVIDER CLINIC SITE |
| 5 - BELLIN HEALTH GENERATIONS | ||||
| 704 S WEBSTER AVE SUITE 300 | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 6 - CARDIOLOGY ASSOCIATES OF BELLIN HEALTH | ||||
| 744 S WEBSTER AVE | GREEN BAY | WI | 54301 | HOSPITAL BASED SITE |
| 7 - BELLIN HEALTH SURGICAL ASSOCIATES | ||||
| 720 S VAN BUREN ST SUITE 201 | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 8 - BELLIN HEALTH IRON MOUNTAIN | ||||
| 440 WOODWARD AVE | IRON MOUNTAIN | MI | 49801 | PROVIDER CLINIC SITE |
| 9 - FAMILY MEDICAL CENTER DE PERE EAST | ||||
| 555 REDBIRD CIRCLE | DE PERE | WI | 54115 | PROVIDER CLINIC SITE |
| 10 - FAMILY MEDICAL CENTER BELLEVUE | ||||
| 3263 EATON RD | GREEN BAY | WI | 543116830 | PROVIDER CLINIC SITE |
| 11 - GASTROENTEROLOGY ASSOCIATES OF GREEN BAY | ||||
| 725 S WEBSTER AVE | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 12 - FAMILY MEDICAL CENTER HOWARD | ||||
| 2714 RIVERVIEW | GREEN BAY | WI | 54313 | PROVIDER CLINIC SITE |
| 13 - NEUROLOGY CONSULTANTS OF BELLIN HEALTH | ||||
| 725 S WEBSTER AVE | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 14 - FAMILY MEDICAL CENTER GREEN BAY | ||||
| 704 S WEBSTER AVE | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 15 - BELLIN HEALTH CARDIOVASCULAR & THORACIC | ||||
| 720 S VAN BUREN ST SUITE 303 | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 16 - BELLIN HEALTH ESCANABA | ||||
| 610 S LINCOLN ROAD | ESCANABA | MI | 49829 | PROVIDER CLINIC SITE |
| 17 - FAMILY MEDICAL CENTER DE PERE WEST | ||||
| 1800 LAWRENCE DR | DE PERE | WI | 54115 | PROVIDER CLINIC SITE |
| 18 - BELLIN HEALTH OCONTO FALLS | ||||
| 107 E HIGHLAND DR | OCONTO FALLS | WI | 54154 | PROVIDER CLINIC SITE |
| 19 - FAMILY MEDICAL CENTER KEWAUNEE | ||||
| 575 - 4TH STREET | KEWAUNEE | WI | 54216 | PROVIDER CLINIC SITE |
| 20 - FAMILY MEDICAL CENTER ALGOMA | ||||
| 831 PARKER AVE | ALGOMA | WI | 54201 | PROVIDER CLINIC SITE |
| 21 - FAMILY MEDICAL CENTER BRILLION | ||||
| 964 W RYAN ST SUITE B | BRILLION | WI | 54110 | PROVIDER CLINIC SITE |
| 22 - BELLIN HEALTH ASTHMA & ALLERGY | ||||
| 519 S MONROE AVENUE | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 23 - BELLIN HEALTH ASTHMA & ALLERGY - NEENAH | ||||
| 1524 COMMERCIAL ST STE 2N | NEENAH | WI | 54957 | PROVIDER CLINIC SITE |
| 24 - FAMILY MEDICAL CENTER MANITOWOC | ||||
| 3415 CUSTER ST SUITE D | MANITOWOC | WI | 54221 | PROVIDER CLINIC SITE |
| 25 - BELLIN HEALTH ENDOCRINOLOGY | ||||
| 704 S WEBSTER AVE SUITE 501 | GREEN BAY | WI | 54301 | PROVIDER CLINIC SITE |
| 26 - FAMILY MEDICAL CENTER DENMARK | ||||
| 595 COUNTY ROAD R | DENMARK | WI | 54208 | PROVIDER CLINIC SITE |
| 27 - FAMILY MEDICAL CENTER PULASKI | ||||
| 723 S WISCONSIN ST | PULASKI | WI | 541620109 | PROVIDER CLINIC SITE |
| 28 - FAMILY MEDICAL CENTER SEYMOUR | ||||
| 405 COMMERCIAL ST | SEYMOUR | WI | 54165 | PROVIDER CLINIC SITE |
| 29 - FAMILY MEDICAL CENTER WRIGHTSTOWN | ||||
| 555 QUALITY CT | WRIGHTSTOWN | WI | 54180 | PROVIDER CLINIC SITE |
| 30 - FAMILY MEDICAL CENTER LUXEMBURG | ||||
| 140 B SCHOOL CREEK TRAIL | LUXEMBURG | WI | 54217 | PROVIDER CLINIC SITE |
| 31 - FAMILY MEDICAL CENTER STURGEON BAY | ||||
| 311 N 3RD AVE | STURGEON BAY | WI | 54235 | PROVIDER CLINIC SITE |
| 32 - FAMILY MEDICAL CENTER SURING | ||||
| 307 MANOR DR | SURING | WI | 54174 | PROVIDER CLINIC SITE |
| 33 - FAMILY MEDICAL CENTER BONDUEL | ||||
| 401 W MILL ST | BONDUEL | WI | 54107 | PROVIDER CLINIC SITE |
| 34 - BELLIN HEALTH FASTCARE - GREEN BAY EAST | ||||
| 1976 LIME KILN RD | GREEN BAY | WI | 54311 | CONVENIENT CARE CENTER |
| 35 - BELLIN HEALTH FASTCARE - GREEN BAY WEST | ||||
| 2015 SHAWANO AVE | GREEN BAY | WI | 54303 | CONVENIENT CARE CENTER |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | BELLIN MEMORIAL HOSPITAL IN INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. |
| PART I, LINE 7: | AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE OF $12,601,213 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY BUILDING ACTIVITIES FOCUS ON SOCIAL CONDITIONS THAT CONTRIBUTE TO HEALTH PROBLEMS, SUCH AS HOMELESSNESS, POVERTY, AND OTHER LIVING CONDITIONS AFFECTING THE QUALITY OF LIFE. THESE RANGE FROM DEVELOPING COMMUNITY LEADERS, DISASTER READINESS, AND SUPPORT OF LOCAL ECONOMIC DEVELOPMENT, TO HEALTH IMPROVEMENT ADVOCACY. BELLIN MEMORIAL HOSPITAL IS ACTIVE IN THE GREEN BAY PUBLIC SCHOOLS WITH OUR THRIVE PROGRAM THAT ASSISTS IN SETTING AND MEETING HEALTH AND WELLNESS GOALS FOR STUDENTS IN THIS SCHOOL SYSTEM. BELLIN ALSO HOLDS AN ANNUAL BELLIN RUN/WALK 10K EVENT EACH YEAR WITH OVER 13,000 PARTICIPANTS OF ALL AGES LEARNING FIRST HAND THE VALUE OF EXERCISE IN DAILY LIFE. |
| PART III, LINE 2: | THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS. |
| PART III, LINE 3: | THE HOSPITAL UTILIZES HFMA #15 THEREFORE NONE OF THE BAD DEBT WOULD BE DEEMED CHARITY CARE. |
| PART III, LINE 4: | THE ATTACHED FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES DESCRIBES THE HOSPITAL'S POLICY ON PAGE 16 OF THE FINANCIAL STATEMENTS. CONSISTENT WITH BELLIN HEALTH SYSTEMS' MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, BELLIN HEALTH SYSTEMS HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS BELLIN HEALTH SYSTEMS EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. BELLIN HEALTH SYSTEMS' POLICY IS TO PROVIDE A 35% DISCOUNT FROM ESTABLISHED CHARGES TO UNINSURED PATIENTS. THIS POLICY DID NOT CHANGE IN 2020 AND 2019. |
| PART III, LINE 8: | THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RUL 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, FOR-PROFIT HOSPITALS HAVE CARVED OUT HIGH-MARGIN SERVICES (I.E. ONCOLOGY, ORTHO, ETC) LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS MEANS THAT THE SHORTFALL IS NOT NECESSARILY FROM INEFFICIENT OPERATIONS. MEDICARE CAN BE THE LARGEST PAYOR AND HOSPITALS HAVE NO ABILITY TO DENY COVERAGE. THIS, IN TURN, IS A PROMOTION OF ACCESS TO HEALTHCARE SERVICES (A COMMUNITY BENEFIT). ALSO, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. |
| PART III, LINE 9B: | FOR PATIENTS WHO CANNOT MEET THE EXPECTATIONS OF THE DEBT COLLECTION POLICY, THE ORGANIZATION OFFERS FINANCIAL ASSITANCE. THE ORGANIZATION WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE DETERMING WHETHER A GUARANTOR IS ELIGILBE FOR ASSISTANCE UNTER THE FINANCIAL ASSISTANCE POLICY. ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM AS PART OF THE REGISTRATION PROCESS IN ADDITION, ALL STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE AVAILABILITY. |
| PART VI, LINE 2: | IN FY2020, BELLIN MEMORIAL HOSPITAL CONTINUALLY ASSESSED THE HEALTHCARE NEEDS OF OUR COMMUNITIES, WITH A MAJOR AREA OF FOCUS ON COVID-19. THROUGH OUR PARTNERSHIP WITH PUBLIC HEALTH AND THE BEYOND HEALTH COMMUNITY COLLABORATIVE, EFFORTS WERE AIMED AT CREATING AND IMPLEMENTING COVID-19 INTERVENTIONS TO ADDRESS ACCESS TO HEALTHCARE, TESTING, AND PREVENTION MEASURES. INTENTIONAL EFFORTS WERE MADE BY BELLIN HEALTH TO UNDERSTAND AND ADDRESS THE BURDEN OF COVID-19 IN BROWN COUNTY SPECIFIC TO GROUPS IMPACTED BY INEQUITY AND HEALTH DISPARITIES IN THE COMMUNITY. INTERVENTIONS INCLUDED ONSITE TESTING AT LOCAL MEAT PACKING PLANTS, TO ADDRESS THE NEEDS OF ESSENTIAL WORKERS. ADDITIONAL COMMUNITY ASSESSMENT AND OUTREACH INCLUDED SAFE-AT-WORK AND SAFE-AT-SCHOOL ASSESSMENTS TO SUPPORT SAFE RETURN TO WORK AND SCHOOL EFFORTS IN PARTNERSHIP WITH EMPLOYERS AND SCHOOLS. LOCAL EMPLOYERS WERE SURVEYED THROUGHOUT FY2020 TO ASSESS AND ADDRESS HEALTHCARE NEEDS. COMMUNITY UPDATES AND EDUCATION WERE PROVIDED THROUGH VIRTUAL TOWNHALL SESSIONS. ADDITIONALLY, MONTHLY VIRTUAL SESSIONS WERE HELD TO ADDRESS MENTAL HEALTH TOPICS. DURING THIS TIME, BELLIN HEALTH TEAM MEMBERS CONTRIBUTED TO THE NEXT CHNA, WHILE CHIP WORKGROUPS MET VIRTUALLY TO WORK TOWARD SET GOALS. |
| PART VI, LINE 3: | FINANCIAL COUNSELORS ADVISE PATIENTS OF ASSISTANCE PROGRAMS. A SERVICE CALLED HRS ERASE IS USED TO REVIEW SELF PAY ACCOUNTS FOR POSSIBLE COVERAGE THROUGH GOVERNMENT PROGRAMS. |
| PART VI, LINE 4: | BELLIN MEMORIAL HOSPITAL SERVES NORTHEAST WISCONSIN AND UPPER MICHIGAN. OUR CURRENT PAYOR SUPPLEMENTAL INFORMATION MIX IS 46.2% MEDICARE AND 9.4% MEDICAID. |
| PART VI, LINE 5: | A MAJORITY OF BELLIN MEMORIAL HOSPITALS GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN BELLIN MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEROF. IN ADDITION, BELLIN MEMORIAL HOSPITAL EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. BELLIN MEMORIAL HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, EDUCATION, AND FACILITIES. |
| PART VI, LINE 6: | BELLIN HEALTH IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. DIRECTLY, AND IN PARTNERSHIP WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE GUIDE INDIVIDUALS AND FAMILIES IN THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. WE ARE COMMITTED TO PROVIDING SAFE, RELIABLE, COST-EFFECTIVE TOTAL HEALTH SOLUTIONS WITH RESPECT AND COMPASSION. OUR INNOVATIVE WORK WILL IMPACT HEALTHCARE DELIVERY IN OUR REGION AS WELL AS THROUGHOUT THE WORLD. |
| 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 (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| ALTRUSA HOUSE | |||||||
| 1116 E MASON ST | GREEN BAY | WI | 54301 | 391593989 | 501(C)3 | $25,000 | COMMUNITY SPONSORSHIP |
| BAY LAKES COUNCIL | |||||||
| PO BOX 267 | APPLETON | WI | 54912 | 391184320 | 501(C)3 | $5,000 | DONATION |
| CEREBRAL PALSY INC | |||||||
| 2801 S WEBSTER AVE | GREEN BAY | WI | 54301 | 390901265 | 501(C)3 | $23,000 | CAPITAL CAMPAIGN - BUILDING EXPANSION |
| CURATIVE CONNECTIONS | |||||||
| 2900 CURRY LN | GREEN BAY | WI | 54311 | 390806435 | 501(C)3 | $20,000 | DONATION |
| DOCTORS IN RECITAL INC | |||||||
| N9349 ABITZ LN | DYCKESVILLE | WI | 54217 | 391516026 | 501(C)3 | $7,500 | DONATION |
| DOWNTOWN GREEN BAY CHARITIES | |||||||
| 130 E WALNUT ST | GREEN BAY | WI | 54301 | 391858389 | 501(C)3 | $7,500 | FARMERS MARKET |
| ENCOMPASS EARLY EDUCATION & CARE | |||||||
| 2589 S WEBSTER AVE | GREEN BAY | WI | 54301 | 390824004 | 501(C)3 | $35,000 | DONATION |
| FAMILY SERVICES | |||||||
| 300 CROOKS ST | GREEN BAY | WI | 54305 | 390827320 | 501(C)3 | $46,200 | DONATION |
| FOUNDATIONS HEALTH & WHOLENESS | |||||||
| 1061 W MASON ST | GREEN BAY | WI | 54303 | 391047205 | 501(C)3 | $5,000 | DONATION |
| GREATER GREEN BAY COMMUNITY FOUNDATION | |||||||
| 310 W WALNUT ST SUITE 350 | GREEN BAY | WI | 54303 | 391699966 | 501(C)3 | $51,000 | GREEN BAY NEIGHBORHOOD LEADERSHIP COUNCIL, ACHIEVE BROWN COUNTY |
| GREEN BAY AREA CHAMBER OF COMMERCE | |||||||
| 300 N BROADWAY ST STE 3A | GREEN BAY | WI | 54303 | 390318170 | 501(C)3 | $27,500 | DONATION |
| GREEN BAY PUBLIC SCHOOLS | |||||||
| PO BOX 23387 | GREEN BAY | WI | 543053387 | 396002329 | GOVT - PUBLIC SCHOOL | $50,000 | HEALTH & WELLNESS PROGRAM |
| HOWARD SUAMICO SCHOOL DISTRICT | |||||||
| 2706 LINEVILLE RD | GREEN BAY | WI | 543137151 | 396031599 | GOVT - PUBLIC SCHOOL | $50,000 | ATHLETIC PROGRAMS - FIELD SURFACE |
| KIWANIS SKI CLUB | |||||||
| PO BOX 475 | IRON MOUNTAIN | MI | 49801 | 383254313 | 501(C)3 | $25,000 | DONATION |
| LUXEMBURG-CASCO SCHOOL DISTRICT | |||||||
| 318 N MAIN ST | LUXEMBURG | WI | 54217 | 391087534 | GOVT - PUBLIC SCHOOL | $5,000 | DONATION |
| MARCH OF DIMES | |||||||
| 677 BAETEN RD STE 100 | GREEN BAY | WI | 54304 | 131846366 | 501(C)3 | $5,000 | DONATION |
| MARINETTE MENOMINEE AREA COMMUNITY FOUNDATION | |||||||
| 1101 11TH AVE | MENOMINEE | WI | 49858 | 383264725 | 501(C)3 | $5,000 | DONATION |
| NEW COMMUNITY CLINIC | |||||||
| 622 BODART STREET | GREEN BAY | WI | 54301 | 391200636 | 501(C)3 | $50,000 | SUPPORT FREE COMMUNITY HEALTH CLINIC |
| UNIVERSITY OF WI - GREEN BAY | |||||||
| 2420 NICOLET DR | GREEN BAY | WI | 54311 | 391805963 | GOVT- STATE AGENCY | $25,000 | MARK REINKE, MD MEMORIAL SCHOLARSHIP |
| UNIVERSITY OF WI - OSHKOSH | |||||||
| 842 ALGOMA BLVD | OSHKOSH | WI | 54901 | 391805963 | GOVT- STATE AGENCY | $85,000 | SUPPORT ORGANIZATION'S ACTIVITIES |
| WRIGHTSTOWN SCHOOL DISTRICT | |||||||
| PO BOX 128 | WRIGHTSTOWN | WI | 541800128 | 391016208 | GOVT - PUBLIC SCHOOL | $10,000 | DONATION |
| YWCA GREATER GREEN BAY | |||||||
| 230 S MADISON ST | GREEN BAY | WI | 54301 | 390806277 | 501(C)3 | $23,700 | DONATION |
| DOOR COUNTY ECONOMIC | |||||||
| 185 E WALNUT ST | STURGEON BAY | WI | 54235 | 391621905 | 501(C)3 | $5,000 | DONATION |
| HOWE COMMUNITY RESOURCE CENTER | |||||||
| 526 S MONROE AVE | GREEN BAY | WI | 54301 | 391910410 | 501(C)3 | $5,000 | DONATION |
| NEVILLE PUBLIC MUSEUM | |||||||
| PO BOX 325 | GREEN BAY | WI | 54305 | 930756332 | MUSEUM | $10,000 | DONATION |
| UNIVERSITY OF WI - MADISON | |||||||
| 1220 LINDEN DR | MADISON | WI | 53706 | 391805963 | 501(C)3 | $5,000 | DONATION |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 25 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION REQUIRES A COMPREHENSIVE REQUEST OF THE GRANTEE TO PROVIDE RATIONALE FOR THE REQUEST. REQUIRED INFORMATION TO BE PROVIDED BY THE GRANTEE INCLUDES, TAX-EXEMPT STATUS, IDENTIFICATION OF USE OF RESOURCES AND FOLLOW UP INFORMATION AS TO THE UTILIZATION OF THE RESOURCES. THE ORGANIZATION REVIEWS EACH GRANTEE REQUEST IN RELATIONSHIP TO THE MISSION OF THE ORGANIZATION AND COMMUNITY SUPPORT. ALL REQUESTS REQUIRE APPROVAL BY SENIOR LEADERSHIP OF THE ORGANIZATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| 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 |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (14 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID STAMPFL MD | ||||||||||||||
| PHYSICIAN | $893,206 | $0 | $638,505 | $0 | $774 | $0 | $17,746 | $0 | $23,769 | $0 | $1,574,000 | $0 | $0 | $0 |
| GEORGE KERWIN - TERMED | ||||||||||||||
| FORMER CEO | $6,923 | $0 | $1,354,000 | $0 | $170,140 | $0 | $36,139 | $0 | $0 | $0 | $1,567,202 | $0 | $0 | $0 |
| PATRICK MCKENZIE MD | ||||||||||||||
| PHYSICIAN | $1,192,583 | $0 | $80 | $0 | $1,188 | $0 | $15,785 | $0 | $23,844 | $0 | $1,233,480 | $0 | $0 | $0 |
| JAMES SPEARS MD | ||||||||||||||
| PHYSICIAN | $717,094 | $0 | $447,206 | $0 | $1,188 | $0 | $13,640 | $0 | $19,076 | $0 | $1,198,204 | $0 | $0 | $0 |
| ROBERT ANDERSON MD | ||||||||||||||
| PHYSICIAN | $776,516 | $0 | $359,565 | $0 | $1,188 | $0 | $18,734 | $0 | $19,619 | $0 | $1,175,622 | $0 | $0 | $0 |
| TIMOTHY ROARTY MD | ||||||||||||||
| PHYSICIAN | $493,710 | $0 | $542,244 | $0 | $774 | $0 | $11,217 | $0 | $23,769 | $0 | $1,071,714 | $0 | $0 | $0 |
| CHRISTINE WOLESKE | ||||||||||||||
| PRESIDENT/CEO | $570,739 | $0 | $422,692 | $0 | $35,150 | $0 | $151,742 | $0 | $18,473 | $0 | $1,198,796 | $0 | $0 | $0 |
| STEVEN GERNDT MD | ||||||||||||||
| BOARD MEMBER/PRESIDENT MEDICAL STAFF | $396,768 | $0 | $332,255 | $0 | $774 | $0 | $13,711 | $0 | $17,576 | $0 | $761,084 | $0 | $0 | $0 |
| JENNIFER LYNCH MD | ||||||||||||||
| BOARD MEMBER/PRESIDENT BELLIN SPECIA | $549,994 | $0 | $193,686 | $0 | $270 | $0 | $13,291 | $0 | $1,280 | $0 | $758,521 | $0 | $0 | $0 |
| JAMES DIETSCHE | ||||||||||||||
| EVP-CFO | $428,323 | $0 | $90,080 | $0 | $414 | $0 | $57,862 | $0 | $23,591 | $0 | $600,270 | $0 | $0 | $0 |
| ROBERT MEAD MD | ||||||||||||||
| BOARD MEMBER/PAST PRESIDENT MED | $196,511 | $0 | $121,457 | $0 | $1,188 | $0 | $16,697 | $0 | $21,491 | $0 | $357,344 | $0 | $0 | $0 |
| WILLIAM WITTMAN MD | ||||||||||||||
| BOARD MEMBER/BMG PHYSIAN | $218,625 | $0 | $19,699 | $0 | $2,286 | $0 | $10,330 | $0 | $20,074 | $0 | $271,014 | $0 | $0 | $0 |
| SABINA SINGH MD | ||||||||||||||
| BOARD MEMBER/PRESIDENT BEL | $185,767 | $0 | $61,664 | $0 | $414 | $0 | $12,053 | $0 | $8,569 | $0 | $268,467 | $0 | $0 | $0 |
| MARK RINGWELSKI MD - TERMED | ||||||||||||||
| BOARD MEMBER/PRESIDENT BEL | $95,218 | $0 | $39,497 | $0 | $411 | $0 | $9,582 | $0 | $6,999 | $0 | $151,707 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | BELLIN MEMORIAL HOSPITAL PAYS FOR A PORTION OF MEMBERSHIP DUES AT A LOCAL COUNTRY CLUB FOR CHRISTINE WOLESKE IN ORDER TO HOLD VARIOUS EVENTS AT THE CLUB. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION. |
| PART I, LINE 4B | THE HOSPITAL HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. THE PARTICIPANTS ARE CHRIS WOLESKE AND JAMES DIETSCHE. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| A | 391337855 | 97712DLH7 | 2015-04-09 | $44,994,006 | REFUND AND LEGALLY DEFEASE | 0 | 0 | 0 |
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| B | 391337855 | 2011-11-23 | $12,944,000 | REFINANCING OF 2001 BONDS | 0 | 0 | 0 | |
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| C | 391337855 | 2019-08-29 | $35,000,000 | FUNDING OF NICU EXPANSION PROJECT AND VARIOUS RENOVATION AND EQUIPMENT PURCH | 0 | 0 | 0 | |
| WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| D | 391337855 | 2019-08-29 | $8,000,000 | FUNDING OF IT INFRASTRUCTURE | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | In Reserve FundInReserveFundAmt | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $2,685,000 | $44,994,006 | $528,236 | $44,465,770 | 2009 | 0 | Yes (1) | Yes (1) | Yes (1) | ||
| B | $1,290,000 | $12,944,000 | $79,844 | 2001 | Yes (1) | 0 | Yes (1) | Yes (1) | |||
| C | $41,624,205 | $314,452 | 0 | 0 | 0 | Yes (1) | $25,949,079 | $15,360,674 | |||
| D | $8,351,848 | $74,748 | 0 | 0 | 0 | Yes (1) | $1,950,999 | $6,326,101 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.01000 | 0.01000 | Yes (1) | 0 | Yes (1) |
| B | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.01000 | 0.01000 | Yes (1) | 0 | Yes (1) |
| C | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.01000 | 0.01000 | Yes (1) | 0 | Yes (1) |
| D | 0 | Yes (1) | Yes (1) | Yes (1) | 0 | 0.01000 | 0.01000 | Yes (1) | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd |
|---|---|---|---|---|---|---|---|---|---|
| A | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) | |||
| B | Yes (1) | 0 | 0 | 0 | 0 | Yes (1) | |||
| C | 0 | 0 | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
| D | Yes (1) |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUSAN FINCO | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | OWNER OF LEONARD & FINCO COMMUNICATIONS | RelationshipDescriptionTxt |
| Transaction | $187,353 | TransactionAmt |
| Transaction | PROVISION OF MARKETING SERVICES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | SABINA SINGH, MARK MCMULLEN, AND TERRY FULWILER HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC. HAS THE POWER TO APPOINT BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC., HAS THE POWER TO APPROVE MAJOR EXPENDITURES AND LONG-TERM BORROWINGS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED IN DETAIL BY SENIOR ADMINISTRATION AND IS PRESENTED TO THE EXECUTIVE COMMITTEE IN ITS ENTIRETY FOR A REVIEW OF THE DOCUMENT. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH YEAR A CONFLICT OF INTEREST REQUEST DOCUMENT IS PROVIDED TO EACH BOARD MEMBER. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. ALL EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AS PART OF ANNUAL MANDATORY EDUCATION. IF THERE IS A CONFLICT OF INTEREST, THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE WHICH IS A COMMITTEE OF THE BOARD OF DIRECTORS IS NOTIFIED. THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE ADDRESSES THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. CEO COMPENSATION: CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA TO THE RESULTS AND COMES UP WITH A RECOMMENDATION. THE CHAIR FACILITATES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. SENIOR LEADERS: COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN FOUNDATION -10,296. INTEREST RATE SWAP AGREEMENT -1,171,684. TRANSFER NET ASSETS TO BELLIN FOUNDATION -500,000. NON-CONTROLLING INTEREST IN CONSOLIDATED AFFILIATE -3,129,076. |
| FORM 990, PART XI, LINE 2B-2C | BELLIN MEMORIAL HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED AUDIT OF BELLIN HEALTH SYSTEMS, INC. THE BOARD OF DIRECTORS OF BELLIN HEALTH SYSTEMS, INC. ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54305 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C)(3) | LINE 12B, II | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING COLLEGE | WI | 501(C)(3) | LINE 2 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 391809171 | FOUNDATION | WI | 501(C)(3) | LINE 7 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN PSYCHIATRIC CENTER INC | |||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54305 | 391657627 | PPSYCHIATRIC HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| OCONTO HOSPITAL & MEDICAL CENTER INC | |||||||||||
| PO BOX 357 | OCONTO | WI | 54153 | 061745397 | HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN MEMORIAL HOSPITAL INC | Yes (1) | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54305 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| UNITY LIMITED PARTNERSHIP | |||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HOSPICE, PALLIATIVE & BEREAVEMENT SERVICES | WI | 501(C)(3) | LINE 10 | 0 | N/A | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN ORTHOPEDIC SURGERY CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2223 LIME KILN RD | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264677834 | EIN |
| Primary Activities | AMBULATORY ORTHOPEDIC SURGERY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $4,249,386 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,176,156 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.55000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BEL-REGIONAL HOME MEDICAL INC | |||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | Yes (1) |
| BELLIN INVESTMENTS INC | |||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 391564939 | OTHER | WI | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | 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 | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (17 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| J | $2,760,893 | ACTUAL |
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| O | $6,551,522 | ACTUAL |
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| D | $10,328,117 | ACTUAL |
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| S | $52,800,784 | ACTUAL |
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| L | $6,066,479 | ACTUAL |
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| D | $1,914,376 | ACTUAL |
| OCONTO HOSPITAL & MEDICAL CENTER | ||
| D | $26,300,000 | ACTUAL |
| BELLIN PSYCHIATRIC CENTER | ||
| J | $56,012 | ACTUAL |
| BELLIN PSYCHIATRIC CENTER | ||
| D | $10,519,143 | ACTUAL |
| BELLIN PSYCHIATRIC CENTER | ||
| D | $1,922,699 | ACTUAL |
| BELLIN PSYCHIATRIC CENTER | ||
| S | $15,500,000 | ACTUAL |
| BELLIN PSYCHIATRIC CENTER | ||
| Q | $2,165,579 | ACTUAL |
| BELLIN HEALTH FOUNDATION | ||
| C | $698,410 | ACTUAL |
| BELLIN HEALTH FOUNDATION | ||
| B | $500,000 | ACTUAL |
| BELLIN HEALTH FOUNDATION | ||
| S | $1,380,000 | ACTUAL |
| BELLIN HEALTH FOUNDATION | ||
| O | $397,315 | ACTUAL |
| BELLIN HEALTH FOUNDATION | ||
| Q | $784,275 | ACTUAL |