2021-08-11T11:10:17-05:00 2020-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-10-01 390884478 BELLIN MEMORIAL HOSPITAL INC BELL 9204457260 PO BOX 23400 GREEN BAY WI 54305 JAMES DIETSCHE EVP-CFO 9204457260 2021-08-10 1 TERRI REXRODE CPA MST P00096513 9206620016 2021-08-10 2019 2022-09-23 18:48:47Z JAMES DIETSCHE PO BOX 23400 GREEN BAY WI 54305 607967223 0 X WWW.BELLIN.ORG X 1908 WI 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. 23 15 4416 354 2586284 0 1108019 13409509 559196425 566552003 10928446 11326522 8883002 15268701 580115892 606556735 779584 686264 0 0 301014013 322933154 0 0 0 230442314 235799424 532235911 559418842 47879981 47137893 689223217 753402442 229534525 247167372 459688692 506235070 X 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. 0 0 469795576 686264 577206208 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. 469795576 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 339 0 4416 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 23 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JAMES DIETSCHE EPV-CFO 9204457260 744 S WEBSTER AVE GREEN BAY WI 54301 DAVID STAMPFL MD PHYSICIAN 40.00 X 1532485 0 41515 GEORGE KERWIN - TERMED FORMER CEO 50.00 X 1531063 0 36139 PATRICK MCKENZIE MD PHYSICIAN 40.00 X 1193851 0 39629 JAMES SPEARS MD PHYSICIAN 40.00 X 1165488 0 32716 ROBERT ANDERSON MD PHYSICIAN 40.00 X 1137269 0 38353 TIMOTHY ROARTY MD PHYSICIAN 40.00 X 1036728 0 34986 CHRISTINE WOLESKE PRESIDENT/CEO 50.00 X X 1028581 0 170215 STEVEN GERNDT MD BOARD MEMBER/PRESIDENT MEDICAL STAFF 50.00 X 729797 0 31287 JENNIFER LYNCH MD BOARD MEMBER/PRESIDENT BELLIN SPECIALTY GROUP 50.00 X 743950 0 14571 JAMES DIETSCHE EVP-CFO 50.00 X 518817 0 81453 ROBERT MEAD MD BOARD MEMBER/PAST PRESIDENT MED 50.00 X 319156 0 38188 WILLIAM WITTMAN MD BOARD MEMBER/BMG PHYSIAN 50.00 X 240610 0 30404 SABINA SINGH MD BOARD MEMBER/PRESIDENT BEL 50.00 X 247845 0 20622 MARK RINGWELSKI MD - TERMED BOARD MEMBER/PRESIDENT BEL 50.00 X 135126 0 16581 PAUL CASEY MD - TERMED BOARD MEMBER/PRESIDENT MED 50.00 X 27961 0 0 TERRY FULWILER BOARD CHAIR 0.50 X X 0 0 0 JOHN DYKEMA VICE-CHAIR 0.50 X X 0 0 0 MARK MCMULLEN BOARD SECRETARY 0.50 X X 0 0 0 ELL LEE DDS TREASURER 0.50 X X 0 0 0 NANCY ARMBRUST BOARD MEMBER 0.50 X 0 0 0 G CORT CONDON BOARD MEMBER 0.50 X 0 0 0 DANIEL GULLING - TERMED BOARD MEMBER 0.50 X 0 0 0 FRED SCHMIDT MD BOARD MEMBER 0.50 X 0 0 0 DANIEL ARIENS BOARD MEMBER 0.50 X 0 0 0 JOHN JONES BOARD MEMBER 0.50 X 0 0 0 SUSAN FINCO BOARD MEMBER 0.50 X 0 0 0 MICHAEL HADDAD BOARD MEMBER 0.50 X 0 0 0 ROBERT CLAUSEN BOARD MEMBER 0.50 X 0 0 0 KARL SCHMIDT BOARD MEMBER 0.50 X 0 0 0 BARB GILLING BOARD MEMBER 0.50 X 0 0 0 BILL BOHN BOARD MEMBER 0.50 X 0 0 0 JAMIE SPITZER BOARD MEMBER 0.50 X 0 0 0 SAIED ASSEF MD BOARD MEMBER/PHYSICIAN DIRECTOR 50.00 X 0 0 0 11588727 0 626659 432 1 1 0 APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 3604369 MAYO COLLABORATIVE SERVICES 200 1ST ST SW ROCHESTER MN 55905 LAB SERVICES 2634822 NORDIC CONSULTING PARTNERS 2601 BELTLINE HWY STE 600 MADISON WI 53713 IT STAFFING AND CONSULTING SERVICES 2093021 IEI GENERAL CONTRACTORS 1725 MIDWAY ROAD DE PERE WI 54115 CONSTRUCTION SERVICES 2040435 AMERIEBO LLC 1851 S ALVERNO ROAD MANITOWOC WI 54220 BILLING/COLLECTION SERVICES 1901119 73 698410 12468643 242456 13409509 NET PATIENT SERVICE REVENUE 621500 553185212 551013828 2171384 CONTRACTED SERVICES 621110 3580537 3580537 ACO INCENTIVE 621110 3443214 3443214 RENT FROM AFFILIATES 621110 2783492 2783492 MISCELLANEOUS 621110 1748601 1748601 1810947 44519 414900 1351528 566552003 6797343 6797343 1834182 47897 1157498 47897 676684 0 676684 676684 4711521 22751 0 205093 4711521 -182342 4529179 4529179 BOSC K-1 INCOME 900099 6953503 6953503 EHR INCENTIVE 621110 4051060 4051060 LOSS FROM HEALTHCARE AFFILIATES 900099 3587454 3587454 14592017 606556735 577206208 2586284 13354734 686264 686264 4216156 2568136 1648020 256271848 222678433 33593415 11079238 9553375 1525863 35306440 30312495 4993945 16059472 13963263 2096209 893334 893334 857677 857677 1108650 1108650 438414 438414 39631857 32955896 6675961 6213235 21946 6191289 7552993 3398103 4154890 8796884 4337267 4459617 10977901 10379586 598315 992284 705737 286547 1466042 600171 865871 6667315 704474 5962841 24090621 16874502 7216119 1077969 404118 673851 SUPPLIES 85892244 85538546 353698 EQUIPMENT RENT/MAINT 13894886 10996272 2898614 BAD DEBTS 12601213 12601213 DUES/SUBSCRIPTIONS 10165897 7734279 2431618 2480008 1888166 591842 559418842 469795576 89623266 0 17077 17230 148955240 187655201 72720587 75475297 33986977 29113453 5768606 7679094 6695875 3280278 435613114 234790878 191342693 200822236 196879307 211699500 11491085 15068245 3124985 2159664 18240785 20432244 689223217 753402442 60884767 82203489 70851 38042 100322788 94366285 68256119 70559556 229534525 247167372 X 454903413 501241175 4785279 4993895 459688692 506235070 689223217 753402442 X 47137893 4219541 -4811056 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21104 21104 0 PART II-B, LINE 1: AHA AND WHA DUES 2778946 5651 46602 18012 2813187 2697255 63290 27788 9387 2778946 2689035 50 32052 23882 2697255 2637679 7394 56750 12788 2689035 2283113 319500 45890 10824 2637679 0.00000 0.92140 0.07860 1 1 1 10243211 10243211 192081035 77249055 114831980 3159914 2170408 989506 216236723 155371415 60865308 13892231 13892231 200822236 DEFERRED COMPENSATION 14455735 NONCONTROLLING INTEREST OF CONSOLIDATED AFFILIATE 1411295 CAPITAL LEASE OBLIGATIONS 45899322 INTEREST RATE SWAP VALUATION 8793204 70559556 603058364 4219541 -16901973 -12682432 615740796 438414 -9622475 -9184061 606556735 556318363 10351850 10351850 545966513 438414 13013915 13452329 559418842 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. 1 1 X 1 X 220.000000000000 1 X 1 1 1 0 1 1 4948754 4948754 0.00910 60294532 29231892 31062640 0.05680 65243286 29231892 36011394 0.06590 4917955 4917955 0.00900 4570135 4570135 0.00840 1632548 1632548 0.00300 11120638 11120638 0.02040 76363924 29231892 47132032 0.08630 128302 128302 0.00020 128302 128302 0.00020 1 5058585 144698894 167625793 -22926899 X 1 1 1 BELLIN ORTHOPEDIC SURGERY CENTER LLC ORTHOPEDIC SURGERY CENTER 0.55000 0.45000 1 1 BELLIN MEMORIAL HOSPITAL 744 S WEBSTER AVE GREEN BAY WI 54305 WWW.BELLIN.ORG 147 X X X BELLIN MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 17 1 1 1 1 X SEE PART V, SECTION B, LINE 7D X X 1 17 1 SEE PART V, SECTION B, LINE 7D 0 1 X 220.000000000000 400.000000000000 X X X 1 1 X X X X 1 X HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BUSOF.001_-_FINANCIAL_ASSISTANCE.PDF X HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/COMMUNITY_CARE_APPLICATION.PDF X HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/PLAIN_LANGUAGE_SUMMARY_-_FINANCIAL_AS X X X X X X 1 X 0 X X X X 1 X 0 0 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. 35 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 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 1 ALTRUSA HOUSE 1116 E MASON ST GREEN BAY WI 54301 391593989 501(C)3 25000 COMMUNITY SPONSORSHIP BAY LAKES COUNCIL PO BOX 267 APPLETON WI 54912 391184320 501(C)3 5000 DONATION CEREBRAL PALSY INC 2801 S WEBSTER AVE GREEN BAY WI 54301 390901265 501(C)3 23000 CAPITAL CAMPAIGN - BUILDING EXPANSION CURATIVE CONNECTIONS 2900 CURRY LN GREEN BAY WI 54311 390806435 501(C)3 20000 DONATION DOCTORS IN RECITAL INC N9349 ABITZ LN DYCKESVILLE WI 54217 391516026 501(C)3 7500 DONATION DOWNTOWN GREEN BAY CHARITIES 130 E WALNUT ST GREEN BAY WI 54301 391858389 501(C)3 7500 FARMERS MARKET ENCOMPASS EARLY EDUCATION & CARE 2589 S WEBSTER AVE GREEN BAY WI 54301 390824004 501(C)3 35000 DONATION FAMILY SERVICES 300 CROOKS ST GREEN BAY WI 54305 390827320 501(C)3 46200 DONATION FOUNDATIONS HEALTH & WHOLENESS 1061 W MASON ST GREEN BAY WI 54303 391047205 501(C)3 5000 DONATION GREATER GREEN BAY COMMUNITY FOUNDATION 310 W WALNUT ST SUITE 350 GREEN BAY WI 54303 391699966 501(C)3 51000 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 27500 DONATION GREEN BAY PUBLIC SCHOOLS PO BOX 23387 GREEN BAY WI 543053387 396002329 GOVT - PUBLIC SCHOOL 50000 HEALTH & WELLNESS PROGRAM HOWARD SUAMICO SCHOOL DISTRICT 2706 LINEVILLE RD GREEN BAY WI 543137151 396031599 GOVT - PUBLIC SCHOOL 50000 ATHLETIC PROGRAMS - FIELD SURFACE KIWANIS SKI CLUB PO BOX 475 IRON MOUNTAIN MI 49801 383254313 501(C)3 25000 DONATION LUXEMBURG-CASCO SCHOOL DISTRICT 318 N MAIN ST LUXEMBURG WI 54217 391087534 GOVT - PUBLIC SCHOOL 5000 DONATION MARCH OF DIMES 677 BAETEN RD STE 100 GREEN BAY WI 54304 131846366 501(C)3 5000 DONATION MARINETTE MENOMINEE AREA COMMUNITY FOUNDATION 1101 11TH AVE MENOMINEE WI 49858 383264725 501(C)3 5000 DONATION NEW COMMUNITY CLINIC 622 BODART STREET GREEN BAY WI 54301 391200636 501(C)3 50000 SUPPORT FREE COMMUNITY HEALTH CLINIC UNIVERSITY OF WI - GREEN BAY 2420 NICOLET DR GREEN BAY WI 54311 391805963 GOVT- STATE AGENCY 25000 MARK REINKE, MD MEMORIAL SCHOLARSHIP UNIVERSITY OF WI - OSHKOSH 842 ALGOMA BLVD OSHKOSH WI 54901 391805963 GOVT- STATE AGENCY 85000 SUPPORT ORGANIZATION'S ACTIVITIES WRIGHTSTOWN SCHOOL DISTRICT PO BOX 128 WRIGHTSTOWN WI 541800128 391016208 GOVT - PUBLIC SCHOOL 10000 DONATION YWCA GREATER GREEN BAY 230 S MADISON ST GREEN BAY WI 54301 390806277 501(C)3 23700 DONATION DOOR COUNTY ECONOMIC 185 E WALNUT ST STURGEON BAY WI 54235 391621905 501(C)3 5000 DONATION HOWE COMMUNITY RESOURCE CENTER 526 S MONROE AVE GREEN BAY WI 54301 391910410 501(C)3 5000 DONATION NEVILLE PUBLIC MUSEUM PO BOX 325 GREEN BAY WI 54305 930756332 MUSEUM 10000 DONATION UNIVERSITY OF WI - MADISON 1220 LINDEN DR MADISON WI 53706 391805963 501(C)3 5000 DONATION 25 1 PART I, LINE 2: 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. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 DAVID STAMPFL MD PHYSICIAN 893206 0 638505 0 774 0 17746 0 23769 0 1574000 0 0 0 GEORGE KERWIN - TERMED FORMER CEO 6923 0 1354000 0 170140 0 36139 0 0 0 1567202 0 0 0 PATRICK MCKENZIE MD PHYSICIAN 1192583 0 80 0 1188 0 15785 0 23844 0 1233480 0 0 0 JAMES SPEARS MD PHYSICIAN 717094 0 447206 0 1188 0 13640 0 19076 0 1198204 0 0 0 ROBERT ANDERSON MD PHYSICIAN 776516 0 359565 0 1188 0 18734 0 19619 0 1175622 0 0 0 TIMOTHY ROARTY MD PHYSICIAN 493710 0 542244 0 774 0 11217 0 23769 0 1071714 0 0 0 CHRISTINE WOLESKE PRESIDENT/CEO 570739 0 422692 0 35150 0 151742 0 18473 0 1198796 0 0 0 STEVEN GERNDT MD BOARD MEMBER/PRESIDENT MEDICAL STAFF 396768 0 332255 0 774 0 13711 0 17576 0 761084 0 0 0 JENNIFER LYNCH MD BOARD MEMBER/PRESIDENT BELLIN SPECIA 549994 0 193686 0 270 0 13291 0 1280 0 758521 0 0 0 JAMES DIETSCHE EVP-CFO 428323 0 90080 0 414 0 57862 0 23591 0 600270 0 0 0 ROBERT MEAD MD BOARD MEMBER/PAST PRESIDENT MED 196511 0 121457 0 1188 0 16697 0 21491 0 357344 0 0 0 WILLIAM WITTMAN MD BOARD MEMBER/BMG PHYSIAN 218625 0 19699 0 2286 0 10330 0 20074 0 271014 0 0 0 SABINA SINGH MD BOARD MEMBER/PRESIDENT BEL 185767 0 61664 0 414 0 12053 0 8569 0 268467 0 0 0 MARK RINGWELSKI MD - TERMED BOARD MEMBER/PRESIDENT BEL 95218 0 39497 0 411 0 9582 0 6999 0 151707 0 0 0 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. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DLH7 2015-04-09 44994006 REFUND AND LEGALLY DEFEASE 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2011-11-23 12944000 REFINANCING OF 2001 BONDS 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-08-29 35000000 FUNDING OF NICU EXPANSION PROJECT AND VARIOUS RENOVATION AND EQUIPMENT PURCH 0 0 0 D WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-08-29 8000000 FUNDING OF IT INFRASTRUCTURE 0 0 0 A 2685000 44994006 528236 44465770 2009 0 1 1 1 B 1290000 12944000 79844 2001 1 0 1 1 C 41624205 25949079 314452 15360674 0 0 0 1 D 8351848 1950999 74748 6326101 0 0 0 1 A 0 1 1 1 0 0.01000 0.01000 1 0 1 B 0 1 1 1 0 0.01000 0.01000 1 0 1 C 0 1 1 1 0 0.01000 0.01000 1 0 1 D 0 1 1 1 0 0.01000 0.01000 1 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 SUSAN FINCO OWNER OF LEONARD & FINCO COMMUNICATIONS 187353 PROVISION OF MARKETING SERVICES 0 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. 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