2017-05-10T14:02:50-05:00 2016-06-30 990 2015-07-01 390806324 Door County Memorial Hospital DOOR 9207435566 323 South 18th Avenue Sturgeon Bay WI 54235 Bill Hinner CFO Reg Health System,WI North 2017-05-09 2015 2021-01-29 14:40:06Z Ministry Door County Medical Center Gerald Worrick 323 South 18th Avenue Sturgeon Bay WI 54235 80968730 false 0928 X www.ministryhealth.org/dcmh/home.nws X 1944 WI To improve the health and well-being of all people in the communities we serve. 16 13 726 130 0 0 224901 882164 77061808 78975945 -72603 325699 534631 552339 77748737 80736147 12000 601850 0 0 44487849 47060985 0 0 0 24371962 27710781 68871811 75373616 8876926 5362531 92782314 94049534 19215283 16360510 73567031 77689024 Our 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. false false 50769246 601850 79096944 DOOR COUNTY MEMORIAL HOSPITAL ("THE HOSPITAL") IS A FULLY ACCREDITED, ACUTE-CARE HOSPITAL AND OUTPATIENT MEDICAL CENTER, WITH 25 LICENSED BEDS. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES AND SPECIALTIES, INCLUDING HOME HEALTH, A SKILLED NURSING FACILITY FOR LONG-TERM CARE AND REHABILITATION SERVICES, A REHAB SERVICES DEPARTMENT AND 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. 50769246 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true true false false false false false true false false false false false false false false false true true true false false true 109 0 true 726 true false false false false false false false false false false X 16 13 false false false false true true true true true false false true true true true true true false false false WI X Craig Aittama 7153465161 5700 Lands End Way 2nd Floor Stevens Point WI 54482 BARTH GUILETTE VICE CHAIR 1.0 0 X X 0 0 0 JOSEPH MCMAHON TREASURER 1.0 0 X X 0 0 0 PATRICK O'HERN CHAIRMAN 1.0 0 X X 0 0 0 CATHY WIESE SECRETARY 1.0 0 X X 0 0 0 GERALD WORRICK CORP PRESIDENT - CEO 40.0 1.0 X X 0 361891 32820 CORWIN DAHL BOARD MEMBER 1.0 0 X 0 0 0 RICHARD HOGAN MD BOARD MEMBER 40.0 0 X 0 0 0 WILLIAM MUNDY BOARD MEMBER 1.0 0 X 0 0 0 ERIC PAULSEN BOARD MEMBER 1.0 0 X 0 0 0 SALLY PFEIFER MEMBER AT LARGE 1.0 0 X 0 0 0 JEFF RABAS BOARD MEMBER 1.0 0 X 0 0 0 KELTON REITZ MD BOARD MEMBER 40.0 0 X 0 0 0 GRACE ROSSMAN BOARD MEMBER 1.0 0 X 0 0 0 DAVID WARD BOARD MEMBER 1.0 0 X 0 0 0 JAMES SARKIS BOARD MEMBER 1.0 0 X 0 0 0 SCOTT WEDERQUIST BOARD MEMBER 1.0 0 X 0 0 0 NICHOLAS DESIEN MINISTRY HEALTH CARE CEO (END 12/31/15) 1.0 54.3 X 0 2799737 271786 JEFFREY FRANCIS MINISTRY HEALTH CARE CAFO (END 9/9/15) 1.0 53.8 X 0 652678 51385 DANIEL NEUFELDER SVP, HOSPITAL OPERATIONS & PRESIDENT, AHS 0.5 63.4 X 0 2171860 190168 MICHAEL S BRUNO MD PHYSICIAN 40.0 0 X 497396 0 36964 DANIEL J TOMASZEWSKI MD PHYSICIAN 40.0 0 X 877302 0 36878 MARC P BINARD MD PHYSICIAN 40.0 0 X 512901 0 17902 STEVEN S DAVIS MD PHYSICIAN 40.0 0 X 533131 0 37545 DR JAMES F HEISE PHYSICIAN 40.0 0 X 504024 0 35447 2924754 5986165 710895 55 false true true CDW Government 300 N Milwaukee Avenue Vernon Hills IL 60061 IT Services 400585 Synthes 1302 Wrights Lane East West Chester PA 19380 Medical Devices 174898 Navin Haffty & Associates LLC 200 Cordwainer Drive Suite 100 Norwell MA 02061 Software Consulting 158801 NewPoint Healthcare Advisors LLC 200 Quebec St Suite 300-111 Denver CO 80230 Professional Services 140428 4 X 17000 0 0 660000 48230 156934 882164 Net Patient Revenue 622110 77650783 77650783 0 0 Oncology Clinic Rev. 621110 299414 299414 0 0 Occupational Health 622000 242847 242847 0 0 340B Pharmacy Rev. 622110 116226 116226 0 0 Wash Island Subsidy 621110 135000 135000 0 0 531675 531675 0 0 78975945 325699 0 0 325699 0 0 0 0 0 0 0 0 417221 0 232583 0 184638 0 184638 0 0 184638 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria Sales 722514 246702 0 0 246702 Lifeline Equipment 900099 120999 120999 0 0 0 0 0 0 0 0 0 0 367701 80736147 79096944 0 757039 601850 601850 0 0 0 0 0 0 0 0 0 0 0 0 0 0 36558566 27211765 9346801 0 1770333 1348146 422187 0 6419412 4815101 1604311 0 2312674 695364 1617310 0 31836 31836 0 0 400766 0 400766 0 20957 0 20957 0 7050 0 7050 0 0 0 0 0 0 0 3691994 2994680 697314 0 694547 0 694547 0 4952620 3951925 1000695 0 1269342 144363 1124979 0 0 0 0 0 1301257 1245356 55901 0 183096 92097 90999 0 0 0 0 0 579114 318481 260633 0 234689 234689 0 0 0 0 0 0 4011586 1350565 2661021 0 238119 208250 29869 0 Purchased Services 4820522 1853662 2966860 0 Medical Supplies 2613817 2613817 0 0 Dues and Licenses 264627 157159 107468 0 Food Supplies 535404 535404 0 0 1859438 364736 1494702 0 75373616 50769246 24604370 0 0 0 0 0 2978 3278 12033689 12822979 0 50558 11070039 12452383 108053 142490 0 0 0 194161 995910 916418 1785399 2026877 33353893 7470126 24803339 25883767 0 0 0 0 0 725282 41982907 38831341 92782314 94049534 6458248 5853398 0 0 0 0 9613899 8111969 0 0 0 2084651 1504651 0 0 1058485 890492 19215283 16360510 X 72486968 77210429 1080063 478595 0 0 0 0 0 0 0 0 73567031 77689024 92782314 94049534 5362531 -1240538 0 0 0 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7050 7050 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying 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 ACTIVITY Lobbying 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. 4203539 4203539 17588858 2254133 15334725 0 0 0 0 10260644 5119201 5141443 0 1300852 96792 1204060 25883767 Other Receivables 547098 Foundation Receivables 478595 Interest in Investments Held by Ascension Health Alliance 36134488 Due From Third Party Payers 1362845 Physician Receivable 308315 38831341 0 Intercompany Debt with Ministry Health Care, Inc. 345147 due to Third Party Payors 545345 890492 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote From 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. true true X true X 250 true X true true false true true 0 747956 0 747956 0.0099 0 7559820 5346367 2213453 0.0294 0 0.0 0 0 8307776 5346367 2961409 0.0393 18 2100 1042449 123259 919190 0.0122 7 226 217582 0 217582 0.0029 2 3751 1091515 124517 966998 0.0128 0 0 0 0 0 0.0 8 1058 529981 0 529981 0.0070 35 7135 2881527 247776 2633751 0.0349 35 7135 11189303 5594143 5595160 0.0742 0 0 0 0 0 0.0 0 0 0 0 0 0.0 2 0 1450 0 1450 0.0000 2 0 1218 0 1218 0.0000 1 0 18891 0 18891 0.0003 1 346 33422 0 33422 0.0004 1 0 8513 0 8513 0.0001 2 30 152842 0 152842 0.0020 0 0 0 0 0 0.0 9 376 216336 0 216336 0.0029 false 2035798 0 35380035 37986145 -2606110 X true true 1 1 Door County Memorial Hospital 323 South 18th Avenue Sturgeon Bay WI 54235 www.ministryhealth.org/dcmh/home.nws 1064 X X X X Door County Memorial Hospital 1 false false true X X X X X X X X X 15 true false true true X http://dcmedical.org/Hospital-Information/About/Community-Health-Needs X true 15 true http://dcmedical.org/Hospital-Information/About/Community-Health-Needs false false true X 250.0 400.0 X X X X X true true X X X true X HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/FINANCIAL_ASSISTANCE_PROGRAM_RC08.PDF X HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/MHC_FINANCIALAID_APPLICATION_REV4.PDF X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 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 , 1 Facility , 1 - door county memorial hospital. Door County Public Health Department Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 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. 4 North Shore Medical Clinic 323 South 18th Avenue Sturgeon Bay WI 54235 OP Phys Clinic North Shore Medical Clinic 3711 Highway 42 Fish Creek WI 54212 OP Phys Clinic North Shore Medical Clinic 815 Jefferson Street Algoma WI 54201 OP Phys Clinic North Shore Medical Clinic 910 Main Road Washington Island WI 54201 OP Phys Clinic Schedule H, Part I, Line 6a Community benefit report prepared by related organization Door County Memorial Hospital is inlcuded in Ministry Healthcare Schedule H, Part II Community Building Activities Door County Medical Center participates in community coalitions and other collaborative efforts with the community whose purpose is to improve the health of the community. These include Habitat for Humanity, Wisconsin Community Health Program, Southern Door Auditorium committee, Door county Elder and Adult-at-risk Interdisciplinary team, Door County Community Partnership for Children and Families, Mental Health Focus group 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 amount Accounts are written off to bad debt after all internal collection efforts have been exhausted. Attempts to resolve these outstanding balances can include, but are not limited to statements being sent, phone calls and letters being sent. Account follow up protocol is based on personal pay balance size owed. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Door County Memorial Hospital has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From 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 costs Ascension 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 assistance Door County Memorial Hospital ("DCMH") has a debt collection policy which sets forth collection practices for patients who are known to qualify or may qualify for financial assistance under the charity care program. Sufficient financial counseling support is made available to patients so they can easily access patient financial service representatives and have their questions answered, and gain an understanding of the reasons why they owe a balance. Accounts are designated as charity care in the business offices so no additional time is spent on collection efforts. 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 assessment The 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 assistance The Organization goes to great lengths in order to inform and educate patients/persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs and under the Organization's Charity Care Policy. The Charity Care Policy and application is posted on the Organization's website. Admissions and other key areas contain summary information of the Charity Care Policy. As part of the intake/discharge process, patients are provided with a copy of the policy and other information for financial assistance. If during the course of the patient registration process, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to the Organization's Community Care program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of Community Care Financial Assistance can be initiated by any member of the hospital's workforce, including medical staff members, who become aware of the patient's potential need for Community Care Financial Assistance. The Charity Care Policy was also translated into dialects prevalent in the community in order to reach out to those that may speak another language. Patient registration staff and financial counselors are provided with scripts to follow when interacting with patients. As part of the charity care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs. Schedule H, Part VI, Line 4 Community information While there is growing agreement in the United States about what constitutes a non-profit hospital's "community benefit", this is a work in progress. Door County Memorial Hospital ("DCMH") provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. Our Hospital, like most rural hospitals, was created and is maintained in order to provide care locally - care that without our Hospital, would not be available locally. The City of Sturgeon Bay is located in Door County. The population of Door County, as of the 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 health The local board for Door County Memorial Hospital is made up of community members that live in our primary service area. Door County Memorial Hospital partners with the local YMCA on various events promoting health and well-being in the community. Door County Memorial Hospital extends medical privileges to all qualified physicians in the community. Door County Memorial Hospital participates in Medicare, Medicaid, and other government sponsored programs. Schedule H, Part VI, Line 6 Affiliated health care system MINISTRY 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 report WI Door County Memorial Hospital Foundation 1843 Michigan Street Sturgeon Bay WI 54235 391649104 501(c)(3) 601469 Pledges Reported by Foundation due to Door County Memorial Hospital Foundation raises money to support DCMH projects 1 0 true true false false false false false false false GERALD WORRICK CORP PRESIDENT - CEO 0 268527 0 68336 0 25028 0 9275 0 23545 0 394711 0 0 NICHOLAS DESIEN MINISTRY HEALTH CARE CEO (END 12/31/15) 0 1298254 0 1454145 0 47338 0 242978 0 28808 0 3071523 0 0 JEFFREY FRANCIS MINISTRY HEALTH CARE CAFO (END 9/9/15) 0 382625 0 40711 0 229342 0 27845 0 23540 0 704063 0 0 DANIEL NEUFELDER SVP, HOSPITAL OPERATIONS & PRESIDENT, AHS 0 1009083 0 1146884 0 15893 0 162663 0 27505 0 2362028 0 0 MICHAEL S BRUNO MD PHYSICIAN 497396 0 0 0 0 0 15900 0 21064 0 534360 0 0 0 DANIEL J TOMASZEWSKI MD PHYSICIAN 877302 0 0 0 0 0 15473 0 21405 0 914180 0 0 0 MARC P BINARD MD PHYSICIAN 512901 0 0 0 0 0 0 0 17902 0 530803 0 0 0 STEVEN S DAVIS MD PHYSICIAN 533131 0 0 0 0 0 15900 0 21645 0 570676 0 0 0 DR JAMES F HEISE PHYSICIAN 504024 0 0 0 0 0 15900 0 19547 0 539471 0 0 0 Schedule J, Part I, Line 3 EXPLANATION MINISTRY 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 payment The 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 plan Eligible 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. A Wisconsin Health & Education Facilities Authority 391337855 2014-08-15 10000000 Refund debt issued 10/21/2009 false false false A 1888031 0 10000000 0 0 0 0 0 0 0 10000000 0 true false true true A false false true true false 0.0 0.0 0.0 false false true A false true false false true false false false true A true DR TOMASZEWSKI HIGHEST COMPENSATED EMPLOYEE EMPLOYEE RETENTION LOAN X 150000 29149 false true true BRIAN MATYSIAK HIGHEST COMPENSATED EMPLOYEE RETENTION LOAN X 85000 61952 false true true DR MARC BINNARD HIGHEST COMPENSATED EMPLOYEE EMPLOYEE RETENTION X 50000 26389 false true true DR JAMES HEISE HIGHEST COMPENSATED EMPLOYEE EDUCATION LOAN X 25000 25000 false true true 142490 Form 990, Part VI, Line 15 ADDITIONAL INFORMATION IN 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 stockholders Door 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 body Door 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 stockholders All 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 body Management, 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 policy The Organization regularly and consistently monitors and enforces compliance with the Conflict of Interest Policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals 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 public The 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 Revenue Other 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: ; ASCENSION HEALTH ALLIANCE PO BOX 45998 STLOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ASCENSION HEALTH PO BOX 45998 STLOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false MINISTRY HEALTH CARE INC 10925 W LAKE PARK DR STE 100 MILWAUKEE WI 53224 391490371 PARENT CORPORATION WI 501(c)(3 Type II ASCENSION HEALTH false AFFINITY HEALTH SYSTEM 1570 MIDWAY PLACE MENASHA WI 54952 391568866 SUPPORT RELATED HEALTHCARE ORGANIZATIONS IL 501(c)(3 Type II MINISTRY HEALTH CARE INC true AGAPE COMMUNITY CENTER OF MILWAUKEE INC 6100 NORTH 42ND STREET MILWAUKEE WI 53209 391461846 COMMUNITY CENTER WI 501(c)(3 7 MINISTRY HEALTH CARE INC true CALUMET MEDICAL CENTER INC 614 MEMORIAL DRIVE CHILTON WI 53014 390905385 HOSPITAL WI 501(c)(3 3 AFFINITY HEALTH SYSTEM true CATALPA HEALTH INC N4642 COUNTY N APPLETON WI 54914 454681563 MENTAL HEALTH FACILITY WI 501(c)(3 3 ST ELIZABETH HOSPITAL INC true SAINT MICHAEL'S FOUNDATION OF STEVENS POINT INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 391657410 CHARITABLE FOUNDATION WI 501(c)(3 Type I SAINT MICHAEL'S HOSPITAL OF STEVENS POINT true DR KATE NEWCOMB CONVALESCENT CENTER INC PO BOX 829 WOODRUFF WI 54568 391357365 NURSING/ASSISTED LIVING SERVICES WI 501(c)(3 9 HOWARD YOUNG HEALTH CARE INC true EAGLE RIVER MEMORIAL HOSPTIAL INCORPORATED 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501(c)(3 3 THE HOWARD YOUNG MEDICAL CENTER INC true FOUNDATION OF SAINT CLARE'S HOSPITAL OF WESTON INC 3400 MINISTRY PARKWAY WESTON WI 54476 753193633 CHARITABLE FOUNDATION WI 501(c)(3 Type I MINISTRY HEALTH CARE INC true FOUNDATION OF SAINT JOSEPH'S HOSPITAL OF MARSHFIELD 611 SAINT JOSEPH AVENUE MARSHFIELD WI 54449 391684957 CHARITABLE FOUNDATION WI 501(c)(3 Type I SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC true GOOD SAMARITAN HEALTH CENTER OF MERRILL WISCONSIN INC 601 SOUTH CENTER AVENUE MERRILL WI 54452 390808503 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true GOOD SAMARITAN HEALTH CENTER FOUNDATION OF MERRILL WISCONSIN INC 601 SOUTH CENTER AVENUE MERRILL WI 54452 391627755 CHARITABLE FOUNDATION WI 501(c)(3 Type I GOOD SAMARITAN HEALTH CENTER OF MERRILL true HOWARD YOUNG FOUNDATION INC 240 MAPLE STREET WOODRUFF WI 54568 391521169 CHARITABLE FOUNDATION WI 501(c)(3 7 HOWARD YOUNG HEALTH CARE INC true HOWARD YOUNG HEALTH CARE INC 240 MAPLE STREET WOODRUFF WI 54568 391499115 HOME OFFICE WI 501(c)(3 Type II MINISTRY HEALTH CARE INC true THE HOWARD YOUNG MEDICAL CENTER INC 240 MAPLE STREET WOODRUFF WI 54568 390873606 HOSPITAL WI 501(c)(3 3 HOWARD YOUNG HEALTH CARE INC true MERCY HEALTH FOUNDATION INC PO BOX 3370 OSHKOSH WI 54903 237140261 CHARITABLE FOUNDATION WI 501(c)(3 9 AFFINITY HEALTH SYSTEM true MERCY MEDICAL CENTER OF OSHKOSH INC 500 S OAKWOOD ROAD OSHKOSH WI 54904 390806268 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true MINISTRY MEDICAL GROUP INC 824 ILLINOIS AVENUE STEVENS POINT WI 54481 391965593 CLINICS WI 501(c)(3 Type III-FI MINISTRY HEALTH CARE INC true MINISTRY WEIGHT MANAGEMENT INC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391829015 HEALTH SERVICES WI 501(c)(3 3 SACRED HEART - ST MARY'S HOSPITALS INC true OUR LADY OF VICTORY HOSPITAL 1120 PINE STREET STANLEY WI 54768 390807065 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true SACRED HEART-ST MARY'S HOSPITALS INC PO BOX 347 STEVENS POINT WI 54481 391390638 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true SAINT CLARE'S HOSPITAL OF WESTON INC 3400 MINISTRY PARKWAY WESTON WI 54476 721531917 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true SAINT ELIZABETH'S HOSPITAL OF WABASHA INC 1200 GRANT BLVD WEST WABASHA MN 55981 410693877 HOSPITAL MN 501(c)(3 3 MINISTRY HEALTH CARE INC true SAINT ELIZABETH'S HOSPITAL FOUNDATION INC 1506 S ONEIDA STREET APPLETON WI 54915 391256677 CHARITABLE FOUNDATION WI 501(c)(3 7 AFFINITY HEALTH SYSTEM true ST ELIZABETH HOSPITAL INC 1506 S ONEIDA STREET APPLETON WI 54915 390816818 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC 611 SAINT JOSEPH AVENUE MARSHFIELD WI 54449 391847631 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true SAINT MICHAEL'S HOSPITAL OF STEVENS POINT INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 390808443 HOSPITAL WI 501(c)(3 3 MINISTRY HEALTH CARE INC true NETWORK HEALTH SYSTEM INC 1570 APPLETON RD MENASHA WI 54952 391127163 CLINICAL HEALTHCARE SERVICES WI 501(c)(3 3 AFFINITY HEALTH SYSTEM true TWIN MED LLP PO BOX 8005 MENASHA WI 54952 391180341 RENTAL PROPERTY WI NA N/A 0 NETWORK HEALTH PLAN INC 1570 MIDWAY PLACE MENASHA WI 54952 391442058 INSURANCE WI NA C Corporation false MINISTRY HOLDINGS INC 1570 MIDWAY PLACE MENASHA WI 54952 422966177 INSURANCE HOLDING COMPANY WI NA C Corporation false NETWORK HEALTH INSURANCE CORPORATION 1570 MIDWAY PLACE MENASHA WI 54952 392020474 INSURANCE WI NA C Corporation false false false true false false false false false false false false false false false true true false true false MERCY MEDICAL CENTER OF OSHKOSH INC M 120000 FMV