AFFINITY HEALTH SYSTEM: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- AFFINITY HEALTH SYSTEM (EIN 39-1568866)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-11
- IRS object ID
- 201631329349304168
- Schema version
- 2014v6.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-11T18:01:13-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391568866 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Affinity Health System Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AFFI | BusinessNameControlTxt |
| Phone | 9207201300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1506 S ONEIDA STREET | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54915 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brian Regan | PersonNm |
| Person Title | Interim CFO | PersonTitleTxt |
| Signature | 2016-05-11 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONICA HILT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1506 S ONEIDA STREET | AddressLine1Txt |
| City | APPLETON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54915 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $35,143,946 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.affinityhealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | To further the healing ministry of Jesus by improving the health and well-being of all people. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 495 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $45,493 | PYContributionsGrantsAmt |
| CY Contributions Grants | $53,403 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,290,058 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,088,121 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$24,695 | PYInvestmentIncomeAmt |
| CY Investment Income | $788 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,523 | PYOtherRevenueAmt |
| CY Other Revenue | $1,634 | CYOtherRevenueAmt |
| PY Total Revenue | $31,319,379 | PYTotalRevenueAmt |
| CY Total Revenue | $35,143,946 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,122,669 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,830,611 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,188,033 | PYOtherExpensesAmt |
| CY Other Expenses | $8,310,913 | CYOtherExpensesAmt |
| PY Total Expenses | $31,310,702 | PYTotalExpensesAmt |
| CY Total Expenses | $35,141,524 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,677 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,422 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $43,141,407 | TotalAssetsBOYAmt |
| Total Assets EOY | $42,675,922 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,608,545 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,787,813 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,532,862 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,888,109 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The mission of Affinity Health System, Inc. is to live out the healing ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $25,687,979 | ExpenseAmt |
| Revenue | $35,088,121 | RevenueAmt |
| Desc | THE ENTITY BELIEVES IN MEETING THE HEALTHCARE NEEDS OF THE POOR, INDIGENT, AND UNDERSERVED. CARE IS PROVIDED TO THE PATIENTS WITHOUT REGARDS FOR ABILITY TO PAY. THE ENTITY PROVIDES ADMINISTRATIVE SUPPORT TO THREE HOSPITALS, AND 26 CLINIC LOCATIONS. THE ENTITY ALSO PROVIDES: FREE NEWSLETTERS FOCUSING ON WOMEN'S HEALTH ISSUES, CHILDREN'S HEALTH, AND SAFETY ISSUES HEALTH; INFORMATION SPOTS ON TELEVISION AND RADIO CLASSES ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PREGNANCY AND CHILD REARING. | Desc |
| Total Program Service Expenses | $25,687,979 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 495 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Craig Aittama | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7153465161 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5700 Lands End Way 2nd Floor | AddressLine1Txt |
| City | Stevens Point | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54482 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| STEPHEN C MORTON | ||||||||||
| BOARD CHAIRMAN | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| DANIEL NEUFELDER | ||||||||||
| BOARD VICE CHAIRMAN - SR VP OF HOSPITAL OPERATIONS | 0.40 | 62.90 | Yes (X) | Yes (X) | $0 | $1,071,649 | $17,365 | |||
| KATHRYN SIEMAN | ||||||||||
| TREASURER | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| WAYNE TREMBLY | ||||||||||
| SECRETARY | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| LANE EARNS | ||||||||||
| BOARD MEMBER | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| MARK W FAUSTICH MD | ||||||||||
| BOARD MEMBER | 0.40 | 40.70 | Yes (X) | $0 | $465,056 | $3,699 | ||||
| MARY HARP-JIRSCHELE | ||||||||||
| BOARD MEMBER | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| MONICA ANN HILT | ||||||||||
| PRESIDENT-AFINITY HEALTH SYSTEM | 0.20 | 44.70 | Yes (X) | $0 | $572,461 | $19,954 | ||||
| FREDERICK KLEIN MD | ||||||||||
| BOARD MEMBER | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| JOSEPH MCCORMICK MD | ||||||||||
| BOARD MEMBER | 0.40 | 1.10 | Yes (X) | $0 | $456,058 | $21,532 | ||||
| KEVIN RALOFSKY | ||||||||||
| BOARD MEMBER | 0.40 | 0.80 | Yes (X) | $0 | $0 | $0 | ||||
| STACEY SENSOR DO | ||||||||||
| BOARD MEMBER | 0.40 | 41.00 | Yes (X) | $0 | $526,309 | $23,275 | ||||
| SUDEEP SODHI MD | ||||||||||
| BOARD MEMBER | 0.40 | 40.70 | Yes (X) | $0 | $829,590 | $21,095 | ||||
| BARBARA J STRAND MD | ||||||||||
| BOARD MEMBER | 0.40 | 40.70 | Yes (X) | $0 | $369,312 | $7,343 | ||||
| MONICA VOMASTIC | ||||||||||
| BOARD MEMBER | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| MARLIN GREENFIELD | ||||||||||
| BOARD MEMBER | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| NICHOLAS DESIEN | ||||||||||
| MINISTRY HEALTH CARE CEO | 0.40 | 55.20 | Yes (X) | $0 | $2,134,343 | $18,803 | ||||
| JEFFREY FRANCIS | ||||||||||
| MINISTRY HEALTH CARE CAFO | 0.40 | 53.40 | Yes (X) | $0 | $1,021,840 | $19,803 | ||||
| TRAVIS ANDERSON | ||||||||||
| HOSPITAL PRESIDENT - STE APPLETON | 0.60 | 25.90 | $0 | $344,821 | $13,716 | Yes (X) | ||||
| MARK KEHRBERG MD | ||||||||||
| CHIEF MEDICAL OFFICER | 10.00 | 30.60 | $0 | $487,342 | $16,019 | Yes (X) | ||||
| GARY KUSNIERZ | ||||||||||
| VP PERFORMANCE EXCELLENCE | 40.00 | 0.30 | $0 | $267,288 | $19,648 | Yes (X) | ||||
| KAREN HIELSBERG | ||||||||||
| DIRECTOR PATIENT FINANCIAL SERVICES | 40.00 | 0 | $130,508 | $0 | $8,821 | Yes (X) | ||||
| WILLIAM BRAZEAU | ||||||||||
| BUSINESS INITIATIVES SYSTEM DIRECTOR | 40.00 | 0 | $115,844 | $0 | $18,994 | Yes (X) | ||||
| TROY DAY | ||||||||||
| SYSTEM DIRECTOR FINANCE SYSTEMS | 40.00 | 0 | $117,695 | $0 | $736 | Yes (X) | ||||
| CARRIE HANKES | ||||||||||
| MISSION INTEGRATION & SPIRITUAL CARE SYSTEM DIRECTOR | 40.00 | 0 | $150,563 | $0 | $19,800 | Yes (X) | ||||
| MIKE PERRY | ||||||||||
| DIRECTOR REGIONAL PERFORMANCE EXCELLENCE | 40.00 | 0 | $131,640 | $0 | $19,017 | Yes (X) | ||||
| JEFF BADGER | ||||||||||
| FORMER OFFICER | 0.00 | 0.00 | $0 | $659,840 | $13,832 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $646,250 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $9,205,908 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $283,451 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MEDICAL INFORMATION TECHNOLOGY | |||||
| MEDIRECH CIRCLE | WESTWOOD | MA | 02090 | I.S SERVICES | $772,144 |
| CDW GOVERNMENT | |||||
| 75 REMITTANCE DRIVE | CHICAGO | IL | 606751515 | I.S SERVICES | $332,891 |
| GE MEDICAL SYSTEMS | |||||
| 5517 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | I.S SERVICES | $129,720 |
| J & D Leasing | |||||
| 2821 South Carpenter Street | Appleton | WI | 54915 | Lease Space | $124,800 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $33,697 | RelatedOrganizationsAmt |
| Government Grants | $19,706 | GovernmentGrantsAmt |
| Total Contributions | $53,403 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Services to Affiliates | 561000 | $34,700,146 | $34,700,146 |
| Lifespan Classes | 561000 | $41,983 | $41,983 |
| Misc. Operating Rev. | 561000 | $345,992 | $345,992 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,088,121 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $788 | TotalRevenueColumnAmt |
| Exclusion | $788 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Non Operating Revenue | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,634 | TotalRevenueColumnAmt |
| Exclusion | $1,634 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,634 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,143,946 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,088,121 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,422 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,821,680 | TotalAmt |
| Program Services | $13,579,624 | ProgramServicesAmt |
| Management And General | $6,242,056 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $765,718 | TotalAmt |
| Program Services | $524,593 | ProgramServicesAmt |
| Management And General | $241,125 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,726,820 | TotalAmt |
| Program Services | $3,238,344 | ProgramServicesAmt |
| Management And General | $1,488,476 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,516,393 | TotalAmt |
| Program Services | $1,038,881 | ProgramServicesAmt |
| Management And General | $477,512 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $224,535 | TotalAmt |
| Program Services | $105,462 | ProgramServicesAmt |
| Management And General | $119,073 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,943 | TotalAmt |
| Program Services | $68,943 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$31,050 | TotalAmt |
| Program Services | -$33,672 | ProgramServicesAmt |
| Management And General | $2,622 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,755 | TotalAmt |
| Program Services | $173,717 | ProgramServicesAmt |
| Management And General | $57,038 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,301,831 | TotalAmt |
| Program Services | $6,301,831 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Purchased Services | $506,838 | $284,285 | $222,553 |
| Food | $34,197 | $10,828 | $23,369 |
| Dues | $5,471 | $4,596 | $875 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $969,393 | TotalAmt |
| Program Services | $390,547 | ProgramServicesAmt |
| Management And General | $578,846 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,141,524 | TotalAmt |
| Program Services | $25,687,979 | ProgramServicesAmt |
| Management And General | $9,453,545 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100 | BOYAmt |
| EOY | $100 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,681,681 | BOYAmt |
| EOY | $13,241,968 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,001,984 | BOYAmt |
| EOY | $10,605,639 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $838,386 | BOYAmt |
| EOY | $904,236 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,935,839 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,684,698 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,871,844 | BOYAmt |
| EOY | $8,251,141 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,444,119 | BOYAmt |
| EOY | $8,341,221 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,303,293 | BOYAmt |
| EOY | $1,331,617 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,141,407 | BOYAmt |
| EOY | $42,675,922 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,912,780 | BOYAmt |
| EOY | $22,607,577 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,695,765 | BOYAmt |
| EOY | $5,180,236 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,608,545 | BOYAmt |
| EOY | $27,787,813 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,532,862 | BOYAmt |
| EOY | $14,888,109 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,532,862 | BOYAmt |
| EOY | $14,888,109 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,141,407 | BOYAmt |
| EOY | $42,675,922 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,422 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,647,175 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 6 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (6 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| MERCY MEDICAL CENTER OF OSHKOSH INC | ||||
| 390806268 | 3 | Yes (true) | $0 | $0 |
| MERCY HEALTH FOUNDATION INC | ||||
| 237140261 | 9 | Yes (true) | $0 | $0 |
| ST ELIZABETH HOSPITAL INC | ||||
| 390816818 | 3 | Yes (true) | $0 | $0 |
| ST ELIZABETH HOSPITAL FOUNDATION INC | ||||
| 391256677 | 7 | Yes (true) | $0 | $0 |
| NETWORK HEALTH SYSTEM INC | ||||
| 391127163 | 3 | Yes (true) | $0 | $0 |
| CALUMET MEDICAL CENTER INC | ||||
| 390905385 | 3 | Yes (true) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 6 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | false | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule A, Part I, Line 11h(vii) MONETARY SUPPORT PROVIDED TO SUPPORTED ORGANIZATIONS | AFFINITY HEALTH SYSTEM, INC. SUPPORTS THE PROVISION OF HEALTHCARE SERVICES AT THE CORPORATIONS TO WHICH IT IS A MEMBER THROUGH THE PROVISION OF CENTRALIZED ADMINISTRATIVE SUPPORT INCLUDING REVENUE CYCLE, ADMINISTRATIVE COSTS, COMPLIANCE/CORPORATE INTEGRITY, TELECOMMUNICATIONS, BUSINESS SERVICES, HUMAN RESOURCES AND MARKETING. COSTS OF CERTAIN OF THESE DEPARTMENTS ARE CHARGED TO THE MEMBERS THROUGH A MANAGEMENT FEE. TRANSACTIONS WITH EACH MEMBER ARE DELINEATED ON SCHEDULE R. |
| Schedule A, Part IV, Section C, Line 1 Majority director detail | The Ascension Sponsor (the Canonical sponsor which was formed by the founding religious sponsors and which has been conferred public juridic personality by decree of The Congregation for Institutes of Consecrated Life and Societies of Apostolic Life of the Roman Catholic Church) determines the philosophy, mission, vision, values and expectations of the System, and appoints the board for Ascension, who delegates that appointment power within the System, with the Ascension Sponsor retaining ultimate control over governance matters. |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,635,881 | OtherCostOrOtherBasisAmt |
| Depreciation | $434,722 | DepreciationAmt |
| Book Value | $1,201,159 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,299,958 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,249,976 | DepreciationAmt |
| Book Value | $7,049,982 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,251,141 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Pension Liability | $3,802,912 |
| 457B Plan Liability | $1,377,324 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,180,236 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | From the consolidated audited financial statements of Ministry Health Care, Inc. which includes the activity of Affinity Health System, Inc.: 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 a tax position taken or expected to be taken in a tax return. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANIEL NEUFELDER | ||||||||||||||
| BOARD VICE CHAIRMAN - SR VP OF HOSPITAL OPERATIONS | $0 | $791,344 | $0 | $259,379 | $0 | $20,926 | $0 | $0 | $0 | $17,365 | $0 | $1,089,014 | $0 | $0 |
| MARK W FAUSTICH MD | ||||||||||||||
| BOARD MEMBER | $0 | $440,913 | $0 | $0 | $0 | $24,143 | $0 | $0 | $0 | $3,699 | $0 | $468,754 | $0 | $0 |
| MONICA ANN HILT | ||||||||||||||
| PRESIDENT-AFINITY HEALTH SYSTEM | $0 | $331,953 | $0 | $118,639 | $0 | $121,869 | $0 | $0 | $0 | $19,954 | $0 | $592,415 | $0 | $0 |
| JOSEPH MCCORMICK MD | ||||||||||||||
| BOARD MEMBER | $0 | $424,443 | $0 | $1,000 | $0 | $30,615 | $0 | $0 | $0 | $21,532 | $0 | $477,590 | $0 | $0 |
| STACEY SENSOR DO | ||||||||||||||
| BOARD MEMBER | $0 | $526,309 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $23,275 | $0 | $549,584 | $0 | $0 |
| SUDEEP SODHI MD | ||||||||||||||
| BOARD MEMBER | $0 | $817,681 | $0 | $0 | $0 | $11,909 | $0 | $0 | $0 | $21,095 | $0 | $850,685 | $0 | $0 |
| BARBARA J STRAND MD | ||||||||||||||
| BOARD MEMBER | $0 | $258,827 | $0 | $84,720 | $0 | $25,765 | $0 | $0 | $0 | $7,343 | $0 | $376,654 | $0 | $0 |
| JEFF BADGER | ||||||||||||||
| FORMER OFFICER | $0 | $264,031 | $0 | $374,899 | $0 | $20,910 | $0 | $0 | $0 | $13,832 | $0 | $673,672 | $0 | $0 |
| NICHOLAS DESIEN | ||||||||||||||
| MINISTRY HEALTH CARE CEO | $0 | $1,009,502 | $0 | $1,079,643 | $0 | $45,198 | $0 | $0 | $0 | $18,803 | $0 | $2,153,146 | $0 | $0 |
| JEFFREY FRANCIS | ||||||||||||||
| MINISTRY HEALTH CARE CAFO | $0 | $438,327 | $0 | $141,768 | $0 | $441,745 | $0 | $0 | $0 | $19,803 | $0 | $1,041,644 | $0 | $0 |
| TRAVIS ANDERSON | ||||||||||||||
| HOSPITAL PRESIDENT - STE APPLETON | $0 | $176,807 | $0 | $136,945 | $0 | $31,068 | $0 | $0 | $0 | $13,716 | $0 | $358,537 | $0 | $0 |
| MARK KEHRBERG MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $113,129 | $0 | $344,147 | $0 | $30,066 | $0 | $0 | $0 | $16,019 | $0 | $503,361 | $0 | $0 |
| GARY KUSNIERZ | ||||||||||||||
| VP PERFORMANCE EXCELLENCE | $0 | $166,167 | $0 | $56,826 | $0 | $44,295 | $0 | $0 | $0 | $19,648 | $0 | $286,936 | $0 | $0 |
| CARRIE HANKES | ||||||||||||||
| MISSION INTEGRATION & SPIRITUAL CARE SYSTEM DIRECTOR | $143,062 | $0 | $2,800 | $0 | $4,701 | $0 | $0 | $0 | $19,800 | $0 | $170,363 | $0 | $0 | $0 |
| MIKE PERRY | ||||||||||||||
| DIRECTOR REGIONAL PERFORMANCE EXCELLENCE | $130,729 | $0 | $2,800 | $0 | -$1,889 | $0 | $0 | $0 | $19,017 | $0 | $150,657 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 EXPLANATION | MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF AFFINITY HEALTH SYSTEM, INC., 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 1a Travel for companions | Business travel expenses for spouses of executives and golf club memberships for executives are reimbursed as part of their executive flex credit account. Receipts are provided to the Sr. Administrative Assistant in HR who reviews for accuracy and completes a reimbursement form with substantiation to payroll for reimbursement. These reimbursements are taxable, and when added to the compensation package taken as a whole have been included when compared to the compensation studies. |
| 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 with 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 II, Column B in the year paid. No distributions were made from the plan during the year. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 2 EXPLANATION | MANY OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EMPLOYMENT BY MINISTRY HEALTH CARE, INC. RELATED ENTITIES. |
| Form 990, Part VI, Line 15 EXPLANATION | IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF AFFINITY HEALTH SYSTEM, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. THE 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 AFFINITY HEALTH SYSTEM, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE 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 THAT 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 | Affinity Health System, Inc. has a single corporate member, Ministry Health Care, Inc. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Affinity Health System, Inc. has a single corporate member, Ministry Health Care, Inc., who has the ability to elect members to the governing body of Affinity Health System, Inc. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | All decisions that have a material impact to Affinity Health System, Inc. 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, work diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. |
| Form 990, Part VI, 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 meeting 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 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 VII, Section A EXPLANATION | The compensation paid to Mark Faustich, M.D., Joseph McCormick, M.D., Stacey Sensor, D.O., Sudeep Sodhi, M.D., and Barbara Strand, M.D. is for their services as physicians for Network Health System, Inc., and not for their role as board members for Network Health System, Inc. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Pension Adjustment - -2647175; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (31 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ASCENSION HEALTH ALLIANCE | |||||||||||
| PO BOX 45998 | STLOUIS | MO | 63145 | 453358926 | NATIONAL HEALTH SYSTEM | MO | 501(c)(3 | Type I | N/A | false | |
| ASCENSION HEALTH | |||||||||||
| PO BOX 45998 | STLOUIS | MO | 63145 | 311662309 | NATIONAL HEALTH SYSTEM | MO | 501(c)(3 | Type I | false | ASCENSION HEALTH ALLIANCE | |
| MINISTRY HEALTH CARE INC | |||||||||||
| 10925 W LAKE PARK DR STE 100 | MILWAUKEE | WI | 53224 | 391490371 | PARENT CORPORATION | WI | 501(c)(3 | Type II | false | ASCENSION HEALTH | |
| AGAPE COMMUNITY CENTER OF MILWAUKEE INC | |||||||||||
| 6100 NORTH 42ND STREET | MILWAUKEE | WI | 53209 | 391461846 | COMMUNITY CENTER | WI | 501(c)(3 | 7 | Yes (true) | MINISTRY HEALTH CARE INC | |
| CALUMET MEDICAL CENTER INC | |||||||||||
| 614 MEMORIAL DRIVE | CHILTON | WI | 53014 | 390905385 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | AFFINITY HEALTH SYSTEM | |
| CATALPA HEALTH INC | |||||||||||
| N4642 COUNTY N | APPLETON | WI | 54914 | 454681563 | MENTAL HEALTH FACILITY | WI | 501(c)(3 | 3 | Yes (true) | STELIZABETH HOSPITAL INC | |
| SAINT MICHAEL'S FOUNDATION OF STEVENS POINT INC | |||||||||||
| 900 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 391657410 | CHARITABLE FOUNDATION | WI | 501(c)(3 | Type I | Yes (true) | SAINT MICHAEL'S HOSPITAL OF STEVENS POINT | |
| DOOR COUNTY MEMORIAL HOSPITAL | |||||||||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | 390806324 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CAREINC | |
| DR KATE NEWCOMB CONVALESCENT CENTER INC | |||||||||||
| PO BOX 829 | WOODRUFF | WI | 54568 | 391357365 | NURSING/ASSISTED LIVING SERVICES | WI | 501(c)(3 | 9 | Yes (true) | HOWARD YOUNG HEALTH CARE INC | |
| EAGLE RIVER MEMORIAL HOSPITAL INCORPORATED | |||||||||||
| 201 HOSPITAL ROAD | EAGLE RIVER | WI | 54521 | 390985690 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | THE HOWARD YOUNG MEDICAL CENTER INC | |
| FOUNDATION OF SAINT CLARE'S HOSPITAL OF WESTON INC | |||||||||||
| 3400 MINISTRY PARKWAY | WESTON | WI | 54476 | 753193633 | CHARITABLE FOUNDATION | WI | 501(c)(3 | Type I | Yes (true) | MINISTRY HEALTH CARE INC | |
| FOUNDATION OF SAINT JOSEPH'S HOSPITAL OF MARSHFIELD | |||||||||||
| 611 SAINT JOSEPH AVENUE | MARSHFIELD | WI | 54449 | 391684957 | CHARITABLE FOUNDATION | WI | 501(c)(3 | Type I | Yes (true) | SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC | |
| GOOD SAMARITAN HEALTH CENTER OF MERRILL WISCONSIN INC | |||||||||||
| 601 SOUTH CENTER AVENUE | MERRILL | WI | 54452 | 390808503 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| 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 | Yes (true) | GOOD SAMARITAN HEALTH CENTER OF MERRILL | |
| HOWARD YOUNG FOUNDATION INC | |||||||||||
| 240 MAPLE STREET | WOODRUFF | WI | 54568 | 391521169 | CHARITABLE FOUNDATION | WI | 501(c)(3 | 7 | Yes (true) | HOWARD YOUNG HEALTH CARE INC | |
| HOWARD YOUNG HEALTH CARE INC | |||||||||||
| 240 MAPLE STREET | WOODRUFF | WI | 54568 | 391499115 | HOME OFFICE | WI | 501(c)(3 | Type II | Yes (true) | MINISTRY HEALTH CARE INC | |
| THE HOWARD YOUNG MEDICAL CENTER INC | |||||||||||
| 240 MAPLE STREET | WOODRUFF | WI | 54568 | 390873606 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | HOWARD YOUNG HEALTH CARE INC | |
| MERCY HEALTH FOUNDATION INC | |||||||||||
| PO BOX 3370 | OSHKOSH | WI | 54903 | 237140261 | CHARITABLE FOUNDATION | WI | 501(c)(3 | 9 | Yes (true) | AFFINITY HEALTH SYSTEM | |
| MERCY MEDICAL CENTER OF OSHKOSH INC | |||||||||||
| 500 S OAKWOOD ROAD | OSHKOSH | WI | 54904 | 390806268 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| MINISTRY HOMECARE INC | |||||||||||
| 611 STJOSEPH AVENUE 4S | MARSHFIELD | WI | 54449 | 391936201 | HOME CARE/ HOSPICE | WI | 501(c)(3 | 9 | Yes (true) | MINISTRY HEALTH CARE INC | |
| MINISTRY MEDICAL GROUP INC | |||||||||||
| 824 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 391965593 | CLINICS | WI | 501(c)(3 | Type III-FI | Yes (true) | MINISTRY HEALTH CARE INC | |
| MINISTRY WEIGHT MANAGEMENT INC | |||||||||||
| 2251 NORTH SHORE DRIVE | RHINELANDER | WI | 54501 | 391829015 | HEALTH SERVICES | WI | 501(c)(3 | 3 | Yes (true) | SACRED HEART - STMARY'S HOSPITALS INC | |
| OUR LADY OF VICTORY HOSPITAL | |||||||||||
| 1120 PINE STREET | STANLEY | WI | 54768 | 390807065 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| SACRED HEART-STMARY'S HOSPITALS INC | |||||||||||
| PO BOX 347 | STEVENS POINT | WI | 54481 | 391390638 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| SAINT CLARE'S HOSPITAL OF WESTON INC | |||||||||||
| 3400 MINISTRY PARKWAY | WESTON | WI | 54476 | 721531917 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | |||||||||||
| 1200 GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HOSPITAL | MN | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| ST ELIZABETH'S HOSPITAL FOUNDATION INC | |||||||||||
| 1506 S ONEIDA STREET | APPLETON | WI | 54915 | 391256677 | CHARITABLE FOUNDATION | WI | 501(c)(3 | 7 | Yes (true) | AFFINITY HEALTH SYSTEM | |
| ST ELIZABETH HOSPITAL INC | |||||||||||
| 1506 S ONEIDA STREET | APPLETON | WI | 54915 | 390816818 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC | |||||||||||
| 611 SAINT JOSEPH AVENUE | MARSHFIELD | WI | 54449 | 391847631 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| SAINT MICHAEL'S HOSPITAL OF STEVENS POINT INC | |||||||||||
| 900 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 390808443 | HOSPITAL | WI | 501(c)(3 | 3 | Yes (true) | MINISTRY HEALTH CARE INC | |
| NETWORK HEALTH SYSTEM INC | |||||||||||
| 1570 APPLETON RD | MENASHA | WI | 54952 | 391127163 | CLINICAL HEALTHCARE SERVICES | WI | 501(c)(3 | 3 | Yes (true) | AFFINITY HEALTH SYSTEM | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN MED LLP | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8005 | AddressLine1Txt |
| City | MENASHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54952 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391180341 | EIN |
| Primary Activities | RENTAL PROPERTY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | N/A | PredominantIncomeTypeTxt |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Ministry Health Care Inc | ||
| O | $26,858,514 | FMV |
| Ministry Health Care Inc | ||
| P | $7,869,892 | FMV |