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DOOR COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
DOOR COUNTY MEMORIAL HOSPITAL (EIN 39-0806324)
Tax period
2015-07-01 to 2016-06-30
Filed
2017-05-10
IRS object ID
201721309349302622
Schema version
2015v3.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2017-05-10T14:02:50-05:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390806324EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Door County Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDOORBusinessNameControlTxt
Phone9207435566PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 South 18th AvenueAddressLine1Txt
CitySturgeon BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54235ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBill HinnerPersonNm
Person TitleCFO Reg Health System,WI NorthPersonTitleTxt
Signature2017-05-09SignatureDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Ministry Door County Medical CenterBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Gerald WorrickBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 South 18th AvenueAddressLine1Txt
CitySturgeon BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54235ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$80,968,730GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.ministryhealth.org/dcmh/home.nwsWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1944FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTo improve the health and well-being of all people in the communities we serve.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee726TotalEmployeeCnt
Total Volunteers130TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$224,901PYContributionsGrantsAmt
CY Contributions Grants$882,164CYContributionsGrantsAmt
PY Program Service Revenue$77,061,808PYProgramServiceRevenueAmt
CY Program Service Revenue$78,975,945CYProgramServiceRevenueAmt
PY Investment Income-$72,603PYInvestmentIncomeAmt
CY Investment Income$325,699CYInvestmentIncomeAmt
PY Other Revenue$534,631PYOtherRevenueAmt
CY Other Revenue$552,339CYOtherRevenueAmt
PY Total Revenue$77,748,737PYTotalRevenueAmt
CY Total Revenue$80,736,147CYTotalRevenueAmt
PY Grants And Similar Paid$12,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$601,850CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$44,487,849PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$47,060,985CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$24,371,962PYOtherExpensesAmt
CY Other Expenses$27,710,781CYOtherExpensesAmt
PY Total Expenses$68,871,811PYTotalExpensesAmt
CY Total Expenses$75,373,616CYTotalExpensesAmt
PY Revenues Less Expenses$8,876,926PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$5,362,531CYRevenuesLessExpensesAmt
Total Assets BOY$92,782,314TotalAssetsBOYAmt
Total Assets EOY$94,049,534TotalAssetsEOYAmt
Total Liabilities BOY$19,215,283TotalLiabilitiesBOYAmt
Total Liabilities EOY$16,360,510TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$73,567,031NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$77,689,024NetAssetsOrFundBalancesEOYAmt
MissionOur mission as a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$50,769,246ExpenseAmt
Grant$601,850GrantAmt
Revenue$79,096,944RevenueAmt
DescDOOR COUNTY MEMORIAL HOSPITAL ("THE HOSPITAL") IS A FULLY ACCREDITED, ACUTE-CARE HOSPITAL AND OUTPATIENT MEDICAL CENTER, WITH 25 LICENSED BEDS. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES AND SPECIALTIES, INCLUDING HOME HEALTH, A SKILLED NURSING FACILITY FOR LONG-TERM CARE AND REHABILITATION SERVICES, A REHAB SERVICES DEPARTMENT AND MINISTRY NORTH SHORE MEDICAL CLINIC. DURING FISCAL 2016, THE HOSPITAL COUNTED 3,985 INPATIENT DAYS, INCLUDING SWING BED. THE HOSPITAL'S OUTPATIENT FACILITIES, WHICH INCLUDE ITS REHABILITATION AGENCY AND 30 BED EXTENDED CARE FACILITY SERVED 103,479 VISITS, AND THE NORTH SHORE MEDICAL CLINIC, INCLUDING ITS URGENT CARE FACILITY, RECEIVED 67,642 VISITS. SEE SCHEDULE H FOR FURTHER DETAILS REGARDING THE COMMUNITY BENEFITS DOOR COUNTY MEMORIAL HOSPITAL PROVIDES.Desc
Total Program Service Expenses$50,769,246TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document109IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee726EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Craig AittamaBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7153465161PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15700 Lands End Way 2nd FloorAddressLine1Txt
CityStevens PointCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54482ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
BARTH GUILETTE
VICE CHAIR1.00Yes (X)Yes (X)$0$0$0
JOSEPH MCMAHON
TREASURER1.00Yes (X)Yes (X)$0$0$0
PATRICK O'HERN
CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
CATHY WIESE
SECRETARY1.00Yes (X)Yes (X)$0$0$0
GERALD WORRICK
CORP PRESIDENT - CEO40.01.0Yes (X)Yes (X)$0$361,891$32,820
CORWIN DAHL
BOARD MEMBER1.00Yes (X)$0$0$0
RICHARD HOGAN MD
BOARD MEMBER40.00Yes (X)$0$0$0
WILLIAM MUNDY
BOARD MEMBER1.00Yes (X)$0$0$0
ERIC PAULSEN
BOARD MEMBER1.00Yes (X)$0$0$0
SALLY PFEIFER
MEMBER AT LARGE1.00Yes (X)$0$0$0
JEFF RABAS
BOARD MEMBER1.00Yes (X)$0$0$0
KELTON REITZ MD
BOARD MEMBER40.00Yes (X)$0$0$0
GRACE ROSSMAN
BOARD MEMBER1.00Yes (X)$0$0$0
DAVID WARD
BOARD MEMBER1.00Yes (X)$0$0$0
JAMES SARKIS
BOARD MEMBER1.00Yes (X)$0$0$0
SCOTT WEDERQUIST
BOARD MEMBER1.00Yes (X)$0$0$0
NICHOLAS DESIEN
MINISTRY HEALTH CARE CEO (END 12/31/15)1.054.3Yes (X)$0$2,799,737$271,786
JEFFREY FRANCIS
MINISTRY HEALTH CARE CAFO (END 9/9/15)1.053.8Yes (X)$0$652,678$51,385
DANIEL NEUFELDER
SVP, HOSPITAL OPERATIONS & PRESIDENT, AHS0.563.4Yes (X)$0$2,171,860$190,168
MICHAEL S BRUNO MD
PHYSICIAN40.00$497,396$0$36,964Yes (X)
DANIEL J TOMASZEWSKI MD
PHYSICIAN40.00$877,302$0$36,878Yes (X)
MARC P BINARD MD
PHYSICIAN40.00$512,901$0$17,902Yes (X)
STEVEN S DAVIS MD
PHYSICIAN40.00$533,131$0$37,545Yes (X)
DR JAMES F HEISE
PHYSICIAN40.00$504,024$0$35,447Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,924,754TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,986,165TotReportableCompRltdOrgAmt
Total Other Compensation$710,895TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K55IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsYes (true)CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CDW Government
300 N Milwaukee AvenueVernon HillsIL60061IT Services$400,585
Synthes
1302 Wrights Lane EastWest ChesterPA19380Medical Devices$174,898
Navin Haffty & Associates LLC
200 Cordwainer Drive Suite 100NorwellMA02061Software Consulting$158,801
NewPoint Healthcare Advisors LLC
200 Quebec St Suite 300-111DenverCO80230Professional Services$140,428
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
Federated Campaigns$17,000FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$0FundraisingAmt
Related Organizations$660,000RelatedOrganizationsAmt
Government Grants$48,230GovernmentGrantsAmt
All Other Contributions$156,934AllOtherContributionsAmt
Total Contributions$882,164TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Net Patient Revenue622110$77,650,783$77,650,783$0$0
Oncology Clinic Rev.621110$299,414$299,414$0$0
Occupational Health622000$242,847$242,847$0$0
340B Pharmacy Rev.622110$116,226$116,226$0$0
Wash Island Subsidy621110$135,000$135,000$0$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$531,675TotalRevenueColumnAmt
Related Or Exempt Func Income$531,675RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$78,975,945TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$325,699TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$325,699ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$417,221RealAmt
Personal$0PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$232,583RealAmt
Personal$0PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$184,638RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$184,638TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$184,638ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$0ContriRptFundraisingEventAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Cafeteria Sales722514$246,702$0$0$246,702
Lifeline Equipment900099$120,999$120,999$0$0
$0$0$0$0

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$367,701OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$80,736,147TotalRevenueColumnAmt
Related Or Exempt Func Income$79,096,944RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$757,039ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$601,850TotalAmt
Program Services$601,850ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$36,558,566TotalAmt
Program Services$27,211,765ProgramServicesAmt
Management And General$9,346,801ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,770,333TotalAmt
Program Services$1,348,146ProgramServicesAmt
Management And General$422,187ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$6,419,412TotalAmt
Program Services$4,815,101ProgramServicesAmt
Management And General$1,604,311ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,312,674TotalAmt
Program Services$695,364ProgramServicesAmt
Management And General$1,617,310ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$31,836TotalAmt
Program Services$31,836ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$400,766TotalAmt
Program Services$0ProgramServicesAmt
Management And General$400,766ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,957TotalAmt
Program Services$0ProgramServicesAmt
Management And General$20,957ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$7,050TotalAmt
Program Services$0ProgramServicesAmt
Management And General$7,050ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt
Fundraising$0FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,691,994TotalAmt
Program Services$2,994,680ProgramServicesAmt
Management And General$697,314ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$694,547TotalAmt
Program Services$0ProgramServicesAmt
Management And General$694,547ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,952,620TotalAmt
Program Services$3,951,925ProgramServicesAmt
Management And General$1,000,695ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,269,342TotalAmt
Program Services$144,363ProgramServicesAmt
Management And General$1,124,979ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,301,257TotalAmt
Program Services$1,245,356ProgramServicesAmt
Management And General$55,901ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$183,096TotalAmt
Program Services$92,097ProgramServicesAmt
Management And General$90,999ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$579,114TotalAmt
Program Services$318,481ProgramServicesAmt
Management And General$260,633ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$234,689TotalAmt
Program Services$234,689ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,011,586TotalAmt
Program Services$1,350,565ProgramServicesAmt
Management And General$2,661,021ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$238,119TotalAmt
Program Services$208,250ProgramServicesAmt
Management And General$29,869ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
Purchased Services$4,820,522$1,853,662$2,966,860$0
Medical Supplies$2,613,817$2,613,817$0$0
Dues and Licenses$264,627$157,159$107,468$0
Food Supplies$535,404$535,404$0$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,859,438TotalAmt
Program Services$364,736ProgramServicesAmt
Management And General$1,494,702ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$75,373,616TotalAmt
Program Services$50,769,246ProgramServicesAmt
Management And General$24,604,370ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Joint Costs TotalJointCostsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,978BOYAmt
EOY$3,278EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$12,033,689BOYAmt
EOY$12,822,979EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$50,558EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,070,039BOYAmt
EOY$12,452,383EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$108,053BOYAmt
EOY$142,490EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$194,161EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$995,910BOYAmt
EOY$916,418EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,785,399BOYAmt
EOY$2,026,877EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$33,353,893LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,470,126LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,803,339BOYAmt
EOY$25,883,767EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$725,282EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$41,982,907BOYAmt
EOY$38,831,341EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$92,782,314BOYAmt
EOY$94,049,534EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,458,248BOYAmt
EOY$5,853,398EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,613,899BOYAmt
EOY$8,111,969EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,084,651BOYAmt
EOY$1,504,651EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,058,485BOYAmt
EOY$890,492EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$19,215,283BOYAmt
EOY$16,360,510EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$72,486,968BOYAmt
EOY$77,210,429EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,080,063BOYAmt
EOY$478,595EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$73,567,031BOYAmt
EOY$77,689,024EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$92,782,314BOYAmt
EOY$94,049,534EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$5,362,531ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,240,538NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$0DonatedServicesAndUseFcltsAmt
Investment Expense$0InvestmentExpenseAmt
Prior Period Adjustments$0PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$7,050OtherActivitiesAmt
Total Lobbying Expenditures$7,050TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYLobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Door County Memorial Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYLobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Door County Memorial Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,203,539OtherCostOrOtherBasisAmt
Book Value$4,203,539BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,588,858OtherCostOrOtherBasisAmt
Depreciation$2,254,133DepreciationAmt
Book Value$15,334,725BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$0BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,260,644OtherCostOrOtherBasisAmt
Depreciation$5,119,201DepreciationAmt
Book Value$5,141,443BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$0InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$1,300,852OtherCostOrOtherBasisAmt
Depreciation$96,792DepreciationAmt
Book Value$1,204,060BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$25,883,767TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (5 entries)

DescDescBook ValueBookValueAmt
Other Receivables$547,098
Foundation Receivables$478,595
Interest in Investments Held by Ascension Health Alliance$36,134,488
Due From Third Party Payers$1,362,845
Physician Receivable$308,315
FieldValueIRS element (for citing)
Total Book Value Other Assets$38,831,341TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
Intercompany Debt with Ministry Health Care, Inc.$345,147
due to Third Party Payors$545,345
FieldValueIRS element (for citing)
Total Liability$890,492TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteFormAndLineReferenceDesc
ExplanationFrom the consolidated audited financial statements of Ministry Health Care, Inc., which includes the activity of Door County Memorial Hospital: The Health Ministry accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of tax position taken or expected to be taken in a tax return.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served0PersonsServedCnt
Total Community Benefit Expns$747,956TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$747,956NetCommunityBenefitExpnsAmt
Total Expense0.0099TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served0PersonsServedCnt
Total Community Benefit Expns$7,559,820TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,346,367DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,213,453NetCommunityBenefitExpnsAmt
Total Expense0.0294TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$8,307,776TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,346,367DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,961,409NetCommunityBenefitExpnsAmt
Total Expense0.0393TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs18ActivitiesOrProgramsCnt
Persons Served2100PersonsServedCnt
Total Community Benefit Expns$1,042,449TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$123,259DirectOffsettingRevenueAmt
Net Community Benefit Expns$919,190NetCommunityBenefitExpnsAmt
Total Expense0.0122TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs7ActivitiesOrProgramsCnt
Persons Served226PersonsServedCnt
Total Community Benefit Expns$217,582TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$217,582NetCommunityBenefitExpnsAmt
Total Expense0.0029TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served3751PersonsServedCnt
Total Community Benefit Expns$1,091,515TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$124,517DirectOffsettingRevenueAmt
Net Community Benefit Expns$966,998NetCommunityBenefitExpnsAmt
Total Expense0.0128TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs8ActivitiesOrProgramsCnt
Persons Served1058PersonsServedCnt
Total Community Benefit Expns$529,981TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$529,981NetCommunityBenefitExpnsAmt
Total Expense0.0070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs35ActivitiesOrProgramsCnt
Persons Served7135PersonsServedCnt
Total Community Benefit Expns$2,881,527TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$247,776DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,633,751NetCommunityBenefitExpnsAmt
Total Expense0.0349TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs35ActivitiesOrProgramsCnt
Persons Served7135PersonsServedCnt
Total Community Benefit Expns$11,189,303TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,594,143DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,595,160NetCommunityBenefitExpnsAmt
Total Expense0.0742TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$1,450TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,450NetCommunityBenefitExpnsAmt
Total Expense0.0000TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$1,218TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,218NetCommunityBenefitExpnsAmt
Total Expense0.0000TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$18,891TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$18,891NetCommunityBenefitExpnsAmt
Total Expense0.0003TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served346PersonsServedCnt
Total Community Benefit Expns$33,422TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$33,422NetCommunityBenefitExpnsAmt
Total Expense0.0004TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$8,513TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,513NetCommunityBenefitExpnsAmt
Total Expense0.0001TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served30PersonsServedCnt
Total Community Benefit Expns$152,842TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$152,842NetCommunityBenefitExpnsAmt
Total Expense0.0020TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs9ActivitiesOrProgramsCnt
Persons Served376PersonsServedCnt
Total Community Benefit Expns$216,336TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$216,336NetCommunityBenefitExpnsAmt
Total Expense0.0029TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$2,035,798BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$35,380,035ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$37,986,145CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$2,606,110MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Door County Memorial HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1323 South 18th AvenueAddressLine1Txt
CitySturgeon BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54235ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.ministryhealth.org/dcmh/home.nwsWebsiteAddressTxt
State License1064StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Door County Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://dcmedical.org/Hospital-Information/About/Community-Health-NeedsOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttp://dcmedical.org/Hospital-Information/About/Community-Health-NeedsStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.0FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.0FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/FINANCIAL_ASSISTANCE_PROGRAM_RC08.PDFFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/MHC_FINANCIALAID_APPLICATION_REV4.PDFFAPAppAvailableOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Medicare RatesYes (X)MedicareRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1Facility , 1 - door county memorial hospital. Door County Medical Center's CHNA process sought input from community members, including members of medically underserved, low-income and minority populations and from organizations that serve those populations. In January 2016, a community stakeholder meeting was held. Door County Medical Center intentionally invited organizations that represent members of medically underserved, low-income and minority populations. The stakeholder meeting attendees participated in a facilitated discussion about the community health data, progress on the previous priority areas, and any emerging needs. The list of organizations participating in the January 2016 stakeholder meeting is below. * Door County Department of Public Health Staff* * Ministry Door County Medical Center * United Way of Door County* * Door County Public Library * Ministry Dental Clinic* * UW-Extension, Door County * UW-Green Bay * Door County Public Schools* * Boys and Girls Club of Door County* * Door County YMCA * Senior Resource Center* * Ministry Home Care * Sturgeon Bay Fire Department * Northeast Wisconsin Technical College (NWTC) * Door County Board of Health * Bellin College * Good Samaritan- Scandia Village * Lakeshore CAP Food Pantry* * Door County Sheriff's Department* *Denotes organizations or programs representing medically underserved, low-income, and/or minority populations.
Schedule H, Part V, Section B, Line 6b Facility , 1Facility , 1 - door county memorial hospital. Door County Public Health Department
Schedule H, Part V, Section B, Line 11 Facility , 1Facility , 1 - door county memorial hospital. Using the CHNA completed in June 2013, the hospital developed, adopted, and worked on executing a three-year Implementation Strategy to address priority community health needs. In Fiscal Year 2016 (Tax Year 2015), the hospital implemented the following plan to address the priority needs: 1. Food, Nutrition and Exercise: Create awareness around the importance of adequate, appropriate and safe food and. * Encouraged restaurants' use of visual indicators of healthy options. * Supported in-school sampling of fruits and vegetables. 2. Mental Health and Well-Being: Create awareness of and access to mental health services in the community. * Participated in the Door County Mental Health Focus Group Committee. * Revised and redistributed the Mental Health Resource Guide to area residents. Electronic versions were made available to public on public websites. * Increased the number of mental health awareness events. 3. Oral Health: Increase access to oral health care or prevention for Door County residents and increase awareness of, or education about, oral health issues in Door County. * Conducted fluoride varnish clinics for children. * Initiated a program to provide dental care to underserved adults in the community. * Provided oral health educational presentations. Using the CHNA completed in June 2016, the hospital developed and adopted FY17-FY19 (tax years 2016-2018) Implementation Strategy. The following summarizes the strategies the hospital will implement during that time period to address the priority needs. Mental Health * Increase mental health awareness and education by conducting at least two annual mental health awareness events/activities/educational sessions. * Increase access to behavioral and mental health services through primary care screening and referral. * Create and distribute a mental health resource guide. * Promote local QPR (Question, Persuade, Refer) training. QPR is a research-based suicide prevention program that trains lay people on how to recognize the warning signs of a suicide crisis and how to question, persuade and refer someone for help. Oral Health * Increase access to dental care through the Door County Dental Clinic by continuing to provide a full range of dental services for low-income residents who have limited ability to purchase dental care services. * Assess opportunities for increased oral health-related programming in schools. * Increase awareness of oral health issues through public service announcements. Adequate, Appropriate and Safe Food and Nutrition * Incorporate visual indicators of healthy food at local eating establishments. * Increase healthy nutritional choices in schools. * Increase access to fresh produce and whole foods for low-income individuals by sponsoring a voucher program at the local farmer's market, enabling FoodShare recipients to double each FoodShare dollar. Healthy Growth & Development * Conduct research to identify key issues in the early childhood population and top family needs, and then develop an action plan. * Provide parenting information and support. The description below includes the needs not being addressed as well as the reason why the needs are not being addressed. In addition to the four health issues selected as top priorities, stakeholders identified two other significant health issues in Door County. These issues will be addressed by other organizations in the community. While these issues will not be addressed by Door County Medical Center as priority health needs, we will provide support to those community efforts whenever possible. Alcohol and Drug Use: The stakeholders identified alcohol misuse and drug use, particularly heroin and other opiates, as emerging issues in the community. Wisconsin has seen a 260 percent increase in opiate overdose death among 12-24 year olds in the past decade, with prescription opioids playing a role in more deaths than heroin and cocaine combined. Ministry will engage in increased educational efforts around this issue. The Door County AODA Coalition, of which Ministry is a part, and local law enforcement departments will be addressing these issues. Chronic Disease Prevention: Stakeholders identified chronic preventable disease as another health issue, in particular heart health, obesity and diabetes. Because diet plays a significant role in these conditions, this health issue is being addressed through the priority need of adequate, appropriate and safe food and nutrition. In addition, MDCMC's continued support of silent sporting events, athletic events, the Door County YMCA, youth sports, outdoor activities, nature preserves and other outdoor resources provides increased opportunities for exercise, which contributes to addressing this need.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
North Shore Medical Clinic
323 South 18th AvenueSturgeon BayWI54235OP Phys Clinic
North Shore Medical Clinic
3711 Highway 42Fish CreekWI54212OP Phys Clinic
North Shore Medical Clinic
815 Jefferson StreetAlgomaWI54201OP Phys Clinic
North Shore Medical Clinic
910 Main RoadWashington IslandWI54201OP Phys Clinic

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part I, Line 6a Community benefit report prepared by related organizationDoor County Memorial Hospital is inlcuded in Ministry Healthcare
Schedule H, Part II Community Building ActivitiesDoor County Medical Center participates in community coalitions and other collaborative efforts with the community whose purpose is to improve the health of the community. These include Habitat for Humanity, Wisconsin Community Health Program, Southern Door Auditorium committee, Door county Elder and Adult-at-risk Interdisciplinary team, Door County Community Partnership for Children and Families, Mental Health Focus group and Door County United Way. By working together with other organizations in the community, we expect to have a greater impact on health. According to the County Health Rankings site, with a shared vision and commitment to improved health, working together can yield better results than working alone. Leadership from Door County Medical Center also attend Leadership Door County. Future community leaders who are knowledgeable about both the assets and challenges our community has will help us to positively address the health issues of the future. The Medical Center also is a community Sharps disposal site. By safely removing sharps from the environment, we make the community safer in terms of injury and infection. In addition, Door County Medical Center provides job shadowing for area youth. According to the County Health Rankings, employment provides income and, often, benefits that can support healthy lifestyle choices. Unemployment and under employment limit these choices, and negatively affect both quality of life and health overall.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountAccounts are written off to bad debt after all internal collection efforts have been exhausted. Attempts to resolve these outstanding balances can include, but are not limited to statements being sent, phone calls and letters being sent. Account follow up protocol is based on personal pay balance size owed.
Schedule H, Part III, Line 3 Bad Debt Expense MethodologyDoor County Memorial Hospital has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnoteFrom the footnote of the consolidated financial statements of Ministry Health Care, Inc., which includes the activity of Door County Memorial Hospital: The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Ministry follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Ministry's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costsAscension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistanceDoor County Memorial Hospital ("DCMH") has a debt collection policy which sets forth collection practices for patients who are known to qualify or may qualify for financial assistance under the charity care program. Sufficient financial counseling support is made available to patients so they can easily access patient financial service representatives and have their questions answered, and gain an understanding of the reasons why they owe a balance. Accounts are designated as charity care in the business offices so no additional time is spent on collection efforts.
Schedule H, Part V, Section B, Line 16a FAP website- Door County Memorial Hospital: Line 16a URL: HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/FINANCIAL_ASSISTANCE_PROGRAM_RC08.PDF;
Schedule H, Part V, Section B, Line 16b FAP Application website- Door County Memorial Hospital: Line 16b URL: HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/MHC_FINANCIALAID_APPLICATION_REV4.PDF;
Schedule H, Part VI, Line 2 Needs assessmentThe Organization performs community needs assessments as needed. Planning workgroups consisting of community partners are formed to define the community and its needs through review of healthy people initiatives, census documents, and local government health and welfare agencies. Considering other community resources/assets, data collection methods are used to identify particular problems or subgroups and areas known to have high poverty rates and to be underserved. The data is analyzed and priorities are set based on trending information which may target a specific need. When a need is identified, the Hospital develops a plan to implement a program either through community collaboration or individually. Outcomes from the programs are measured and considered in subsequent community needs assessments. Community benefit plans are presented to senior leadership and board members to ensure the findings are incorporated into the Organization's strategy and policy development. For example, senior leaders are required to provide direct service hours to the poor as part of their performance goals.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistanceThe Organization goes to great lengths in order to inform and educate patients/persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs and under the Organization's Charity Care Policy. The Charity Care Policy and application is posted on the Organization's website. Admissions and other key areas contain summary information of the Charity Care Policy. As part of the intake/discharge process, patients are provided with a copy of the policy and other information for financial assistance. If during the course of the patient registration process, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to the Organization's Community Care program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of Community Care Financial Assistance can be initiated by any member of the hospital's workforce, including medical staff members, who become aware of the patient's potential need for Community Care Financial Assistance. The Charity Care Policy was also translated into dialects prevalent in the community in order to reach out to those that may speak another language. Patient registration staff and financial counselors are provided with scripts to follow when interacting with patients. As part of the charity care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs.
Schedule H, Part VI, Line 4 Community informationWhile there is growing agreement in the United States about what constitutes a non-profit hospital's "community benefit", this is a work in progress. Door County Memorial Hospital ("DCMH") provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. Our Hospital, like most rural hospitals, was created and is maintained in order to provide care locally - care that without our Hospital, would not be available locally. The City of Sturgeon Bay is located in Door County. The population of Door County, as of the 2015 census data, is 24,038. The population consisted of 97% White, 2% Hispanic, 1% African American, and 1% Asian. Of the 24,038 population, 51% were female and 49% male. The age population is widely spread. 17% were under 18 and 24% were 65+. The largest industry in Door County is educational, health and social services (18.8%). Arts, entertainment and recreation (16.1%) and manufacturing (14.0%) are the next largest industries in Door County. Roughly 6.2% of families and 11.4% of the population were below the poverty line. That includes 20.7% of those under 18 years old and 7.9% of those 65 and older.
Schedule H, Part VI, Line 5 Promotion of community healthThe local board for Door County Memorial Hospital is made up of community members that live in our primary service area. Door County Memorial Hospital partners with the local YMCA on various events promoting health and well-being in the community. Door County Memorial Hospital extends medical privileges to all qualified physicians in the community. Door County Memorial Hospital participates in Medicare, Medicaid, and other government sponsored programs.
Schedule H, Part VI, Line 6 Affiliated health care systemMINISTRY HEALTH CARE, INC. (MINISTRY OR THE HEALTH MINISTRY) IS A MEMBER OF ASCENSION HEALTH. IN DECEMBER 2011, ASCENSION HEALTH ALLIANCE, DOING BUSINESS AS ASCENSION, BECAME THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTH CARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. IN ADDITION TO SERVING AS THE SOLE CORPORATE MEMBER OF ASCENSION HEALTH, ASCENSION SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS OTHER SUBSIDIARIES. ASCENSION, ITS SUBSIDIARIES, AND THE HEALTH MINISTRIES ARE REFERRED TO COLLECTIVELY FROM TIME TO TIME HEREAFTER AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE, THE CONGREGATION OF ST. JOSEPH, THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET, THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE, AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI-US/CARIBBEAN PROVINCE. THE HEALTH MINISTRY IS A WISCONSIN NON-STOCK, TAX-EXEMPT CORPORATION THAT MANAGES, PROMOTES, AND SUPPORTS HEALTH CARE AND RELATED MINISTRIES IN WISCONSIN AND MINNESOTA. THE HEALTH MINISTRY PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF WISCONSIN AND MINNESOTA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. THE HEALTH MINISTRY IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF THE HEALTH MINISTRY ARE RELATED TO PROVIDING HEALTH CARE SERVICES. EFFECTIVE NOVEMBER 1, 2014, THE HEALTH MINISTRY SOLD 50% OF ITS OWNERSHIP IN NETWORK HEALTH, INC. TO AN UNRELATED HEALTH SYSTEM. ON FEBRUARY 1, 2015, THE HEALTH MINISTRY TRANSFERRED ITS OWNERSHIP IN MINISTRY HOME CARE, INC. TO ASCENSION HEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING AFFILIATES LOCATED PRIMARILY IN WISCONSIN, IN WHICH MINISTRY HAS A CONTROLLING INTEREST AND/OR IS THE SOLE SPONSOR. AFFINITY HEALTH SYSTEM, INC. (AFFINITY): CALUMET MEDICAL CENTER, INC. (CMC): AFFINITY MEDICAL GROUP (AMG) TWIN MED, LLC MERCY MEDICAL CENTER, INC. MERCY HEALTH FOUNDATION ST. ELIZABETH HOSPITAL CATALPA HEALTH: ST. ELIZABETH FOUNDATION AGAPE COMMUNITY CENTER OF MILWAUKEE, INC. DOOR COUNTY MEMORIAL HOSPITAL (DOOR COUNTY) GOOD SAMARITAN HEALTH CENTER OF MERRILL GOOD SAMARITAN HEALTH CENTER FOUNDATION HOWARD YOUNG HEALTH CARE, INC. (HOWARD YOUNG): DR. KATE NEWCOMB CONVALESCENT CENTER HOWARD YOUNG MEDICAL CENTER, INC. DR. HOWARD YOUNG FOUNDATION EAGLE RIVER MEMORIAL HOSPITAL, INC. MINISTRY MEDICAL GROUP, INC. MINISTRY HOLDINGS, INC. (THROUGH NOVEMBER 1, 2014): NETWORK HEALTH (NH) (THROUGH NOVEMBER 1, 2014) NETWORK HEALTH INSURANCE CORPORATION (NHIC) (THRU NOVEMBER 1, 2014) OUR LADY OF VICTORY HOSPITAL SACRED HEART HOSPITAL-ST. MARY'S HOSPITAL, INC. ST. CLARE'S HOSPITAL OF WESTON, INC. FOUNDATION OF ST. CLARE'S HOSPITAL OF WESTON, INC. ST. ELIZABETH'S HOSPITAL OF WABASHA, INC. ST. JOSEPH'S HOSPITAL OF MARSHFIELD, INC. FOUNDATION OF ST. JOSEPH'S HOSPITAL OF MARSHFIELD, INC. ST. MICHAEL'S HOSPITAL OF STEVENS POINT, INC. ST. MICHAEL'S FOUNDATION OF STEVENS POINT, INC. THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE THAT SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND TO OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND FOR COMMUNITY BENEFIT PROGRAMS: 1. TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. 2. UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS. 3. COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND THE OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. 4. COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY OR IN THE COST OF OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OF OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA AND IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF TOTAL OPERATING EXPENSES TO BILLED CHARGES FOR PATIENT CARE. THE AMOUNT OF TRADITIONAL CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, WAS APPROXIMATELY $10,700 AND $12,600 FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY. THE AMOUNT OF UNPAID COST OF PUBLIC PROGRAMS, COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS, AND COST OF COMMUNITY BENEFIT PROGRAMS ARE REPORTED IN THE ACCOMPANYING SUPPLEMENTARY INFORMATION.
Schedule H, Part VI, Line 7 State filing of community benefit reportWI

Schedule I IRS990ScheduleI

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Door County Memorial Hospital FoundationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11843 Michigan StreetAddressLine1Txt
CitySturgeon BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54235ZIPCd
FieldValueIRS element (for citing)
Recipient EIN391649104RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$601,469CashGrantAmt
Valuation Method UsedPledges Reported by Foundation due to Door County Memorial HospitalValuationMethodUsedDesc
Purpose Of GrantFoundation raises money to support DCMH projectsPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GERALD WORRICK
CORP PRESIDENT - CEO$0$268,527$0$68,336$0$25,028$0$9,275$0$23,545$0$394,711$0$0
NICHOLAS DESIEN
MINISTRY HEALTH CARE CEO (END 12/31/15)$0$1,298,254$0$1,454,145$0$47,338$0$242,978$0$28,808$0$3,071,523$0$0
JEFFREY FRANCIS
MINISTRY HEALTH CARE CAFO (END 9/9/15)$0$382,625$0$40,711$0$229,342$0$27,845$0$23,540$0$704,063$0$0
DANIEL NEUFELDER
SVP, HOSPITAL OPERATIONS & PRESIDENT, AHS$0$1,009,083$0$1,146,884$0$15,893$0$162,663$0$27,505$0$2,362,028$0$0
MICHAEL S BRUNO MD
PHYSICIAN$497,396$0$0$0$0$0$15,900$0$21,064$0$534,360$0$0$0
DANIEL J TOMASZEWSKI MD
PHYSICIAN$877,302$0$0$0$0$0$15,473$0$21,405$0$914,180$0$0$0
MARC P BINARD MD
PHYSICIAN$512,901$0$0$0$0$0$0$0$17,902$0$530,803$0$0$0
STEVEN S DAVIS MD
PHYSICIAN$533,131$0$0$0$0$0$15,900$0$21,645$0$570,676$0$0$0
DR JAMES F HEISE
PHYSICIAN$504,024$0$0$0$0$0$15,900$0$19,547$0$539,471$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3 EXPLANATIONMINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF DOOR COUNTY MEMORIAL HOSPITAL, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J, Part I, Line 4a Severance or change-of-control paymentThe following individual(s) received severance payments from the organization or a related organization: Jeffrey Francis - $225,000
Schedule J, Part I, Line 4b Supplemental nonqualified retirement planEligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment witht the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part ll, Column B in the year paid.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Wisconsin Health & Education Facilities AuthorityBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN391337855BondIssuerEIN
Bond Issued2014-08-15BondIssuedDt
Issue Price$10,000,000IssuePriceAmt
PurposeRefund debt issued 10/21/2009PurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$1,888,031RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$10,000,000TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$0IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$10,000,000OtherSpentProceedsAmt
Unspent$0UnspentAmt
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (true)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsYes (true)EngageBondCounselContractsInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.0PrivateBusUseByOthersPct
Private Bus Concerning UBI0.0PrivateBusConcerningUBIPct
Total Private Business Use0.0TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetYes (true)RebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (true)ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (4 entries)

Relationship With OrgRelationshipWithOrgTxtLoan PurposeLoanPurposeTxtLoan From OrganizationLoanFromOrganizationIndOriginal PrincipalOriginalPrincipalAmtBalance DueBalanceDueAmtDefaultDefaultIndBoard Or Committee ApprovalBoardOrCommitteeApprovalIndWritten AgreementWrittenAgreementInd
DR TOMASZEWSKI
HIGHEST COMPENSATED EMPLOYEEEMPLOYEE RETENTION LOANYes (X)$150,000$29,149falseYes (true)Yes (true)
BRIAN MATYSIAK
HIGHEST COMPENSATED EMPLOYEERETENTION LOANYes (X)$85,000$61,952falseYes (true)Yes (true)
DR MARC BINNARD
HIGHEST COMPENSATED EMPLOYEEEMPLOYEE RETENTIONYes (X)$50,000$26,389falseYes (true)Yes (true)
DR JAMES HEISE
HIGHEST COMPENSATED EMPLOYEEEDUCATION LOANYes (X)$25,000$25,000falseYes (true)Yes (true)
FieldValueIRS element (for citing)
Total Balance Due$142,490TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 15 ADDITIONAL INFORMATIONIN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, WHICH IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO, WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES.
Form 990, Part VI, Line 6 Classes of members or stockholdersDoor County Memorial Hospital has a single corporate member, Ministry Health Care, Inc.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyDoor County Memorial Hospital has a single corporate member, Ministry Health Care, Inc., who has the ability to elect members to the governing body of Door County Memorial Hospital.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholdersAll decisions that have a material impact to Door County Memorial Hospital financial information or corporation as a whole are subject to approval by its sole corporate member, Ministry Health Care, Inc.
Form 990, Part VI, Line 11b Review of form 990 by governing bodyManagement, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all board members are provided the Form 990 and management team members are available to answer any Board Members' questions.
Form 990, Part VI, Line 12c Conflict of interest policyThe Organization regularly and consistently monitors and enforces compliance with the Conflict of Interest Policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the Conflict of Interest Policy, has read and understands the policy, has agreed to comply with the policy, and understands that the Organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Line 19 Required documents available to the publicThe Ministry web page is available to the public for inspection with a good deal of information regarding who Ministry Health Care, Inc. is and the entities included along with our mission. The Articles of Incorporation, Bylaws, Conflict of Interest Policy and financial statements are not included on any web page. However, if any inquiry is made for any documents they are shared as appropriate.
Form 990, Part VIII, Line 2f Other Program Service RevenueOther Program Rev - Total Revenue: 99141, Related or Exempt Function Revenue: 99141, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Corp BSO Allocation - Total Revenue: 432534, Related or Exempt Function Revenue: 432534, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (30 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
ASCENSION HEALTH ALLIANCE
PO BOX 45998STLOUISMO63145453358926NATIONAL HEALTH SYSTEMMO501(c)(3Type INAfalse
ASCENSION HEALTH
PO BOX 45998STLOUISMO63145311662309NATIONAL HEALTH SYSTEMMO501(c)(3Type IASCENSION HEALTH ALLIANCEfalse
MINISTRY HEALTH CARE INC
10925 W LAKE PARK DR STE 100MILWAUKEEWI53224391490371PARENT CORPORATIONWI501(c)(3Type IIASCENSION HEALTHfalse
AFFINITY HEALTH SYSTEM
1570 MIDWAY PLACEMENASHAWI54952391568866SUPPORT RELATED HEALTHCARE ORGANIZATIONSIL501(c)(3Type IIMINISTRY HEALTH CARE INCYes (true)
AGAPE COMMUNITY CENTER OF MILWAUKEE INC
6100 NORTH 42ND STREETMILWAUKEEWI53209391461846COMMUNITY CENTERWI501(c)(37MINISTRY HEALTH CARE INCYes (true)
CALUMET MEDICAL CENTER INC
614 MEMORIAL DRIVECHILTONWI53014390905385HOSPITALWI501(c)(33AFFINITY HEALTH SYSTEMYes (true)
CATALPA HEALTH INC
N4642 COUNTY NAPPLETONWI54914454681563MENTAL HEALTH FACILITYWI501(c)(33ST ELIZABETH HOSPITAL INCYes (true)
SAINT MICHAEL'S FOUNDATION OF STEVENS POINT INC
900 ILLINOIS AVENUESTEVENS POINTWI54481391657410CHARITABLE FOUNDATIONWI501(c)(3Type ISAINT MICHAEL'S HOSPITAL OF STEVENS POINTYes (true)
DR KATE NEWCOMB CONVALESCENT CENTER INC
PO BOX 829WOODRUFFWI54568391357365NURSING/ASSISTED LIVING SERVICESWI501(c)(39HOWARD YOUNG HEALTH CARE INCYes (true)
EAGLE RIVER MEMORIAL HOSPTIAL INCORPORATED
201 HOSPITAL ROADEAGLE RIVERWI54521390985690HOSPITALWI501(c)(33THE HOWARD YOUNG MEDICAL CENTER INCYes (true)
FOUNDATION OF SAINT CLARE'S HOSPITAL OF WESTON INC
3400 MINISTRY PARKWAYWESTONWI54476753193633CHARITABLE FOUNDATIONWI501(c)(3Type IMINISTRY HEALTH CARE INCYes (true)
FOUNDATION OF SAINT JOSEPH'S HOSPITAL OF MARSHFIELD
611 SAINT JOSEPH AVENUEMARSHFIELDWI54449391684957CHARITABLE FOUNDATIONWI501(c)(3Type ISAINT JOSEPH'S HOSPITAL OF MARSHFIELD INCYes (true)
GOOD SAMARITAN HEALTH CENTER OF MERRILL WISCONSIN INC
601 SOUTH CENTER AVENUEMERRILLWI54452390808503HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
GOOD SAMARITAN HEALTH CENTER FOUNDATION OF MERRILL WISCONSIN INC
601 SOUTH CENTER AVENUEMERRILLWI54452391627755CHARITABLE FOUNDATIONWI501(c)(3Type IGOOD SAMARITAN HEALTH CENTER OF MERRILLYes (true)
HOWARD YOUNG FOUNDATION INC
240 MAPLE STREETWOODRUFFWI54568391521169CHARITABLE FOUNDATIONWI501(c)(37HOWARD YOUNG HEALTH CARE INCYes (true)
HOWARD YOUNG HEALTH CARE INC
240 MAPLE STREETWOODRUFFWI54568391499115HOME OFFICEWI501(c)(3Type IIMINISTRY HEALTH CARE INCYes (true)
THE HOWARD YOUNG MEDICAL CENTER INC
240 MAPLE STREETWOODRUFFWI54568390873606HOSPITALWI501(c)(33HOWARD YOUNG HEALTH CARE INCYes (true)
MERCY HEALTH FOUNDATION INC
PO BOX 3370OSHKOSHWI54903237140261CHARITABLE FOUNDATIONWI501(c)(39AFFINITY HEALTH SYSTEMYes (true)
MERCY MEDICAL CENTER OF OSHKOSH INC
500 S OAKWOOD ROADOSHKOSHWI54904390806268HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
MINISTRY MEDICAL GROUP INC
824 ILLINOIS AVENUESTEVENS POINTWI54481391965593CLINICSWI501(c)(3Type III-FIMINISTRY HEALTH CARE INCYes (true)
MINISTRY WEIGHT MANAGEMENT INC
2251 NORTH SHORE DRIVERHINELANDERWI54501391829015HEALTH SERVICESWI501(c)(33SACRED HEART - ST MARY'S HOSPITALS INCYes (true)
OUR LADY OF VICTORY HOSPITAL
1120 PINE STREETSTANLEYWI54768390807065HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
SACRED HEART-ST MARY'S HOSPITALS INC
PO BOX 347STEVENS POINTWI54481391390638HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
SAINT CLARE'S HOSPITAL OF WESTON INC
3400 MINISTRY PARKWAYWESTONWI54476721531917HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
SAINT ELIZABETH'S HOSPITAL OF WABASHA INC
1200 GRANT BLVD WESTWABASHAMN55981410693877HOSPITALMN501(c)(33MINISTRY HEALTH CARE INCYes (true)
SAINT ELIZABETH'S HOSPITAL FOUNDATION INC
1506 S ONEIDA STREETAPPLETONWI54915391256677CHARITABLE FOUNDATIONWI501(c)(37AFFINITY HEALTH SYSTEMYes (true)
ST ELIZABETH HOSPITAL INC
1506 S ONEIDA STREETAPPLETONWI54915390816818HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC
611 SAINT JOSEPH AVENUEMARSHFIELDWI54449391847631HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
SAINT MICHAEL'S HOSPITAL OF STEVENS POINT INC
900 ILLINOIS AVENUESTEVENS POINTWI54481390808443HOSPITALWI501(c)(33MINISTRY HEALTH CARE INCYes (true)
NETWORK HEALTH SYSTEM INC
1570 APPLETON RDMENASHAWI54952391127163CLINICAL HEALTHCARE SERVICESWI501(c)(33AFFINITY HEALTH SYSTEMYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1TWIN MED LLPBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 8005AddressLine1Txt
CityMENASHACityNm
State AbbreviationWIStateAbbreviationCd
ZIP54952ZIPCd
FieldValueIRS element (for citing)
EIN391180341EIN
Primary ActivitiesRENTAL PROPERTYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeTypeTxt
Ownership0OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
NETWORK HEALTH PLAN INC
1570 MIDWAY PLACEMENASHAWI54952391442058INSURANCEWINAC Corporationfalse
MINISTRY HOLDINGS INC
1570 MIDWAY PLACEMENASHAWI54952422966177INSURANCE HOLDING COMPANYWINAC Corporationfalse
NETWORK HEALTH INSURANCE CORPORATION
1570 MIDWAY PLACEMENASHAWI54952392020474INSURANCEWINAC Corporationfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MERCY MEDICAL CENTER OF OSHKOSH INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeMTransactionTypeTxt
Involved$120,000InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt