ASCENSION CALUMET HOSPITAL INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: ASCENSION CALUMET HOSPITAL INC (EIN 39-0905385)
Tax period: 2014-07-01 to 2015-06-30
Filed: 2016-05-16
IRS object ID: 201641379349309539
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-05-16T16:54:26-05:00	ReturnTs
Tax Period End	2015-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	861065772	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Deloitte Tax LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	555 EAST WELLS STREET Suite 1400	AddressLine1Txt
City	Milwaukee	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53202	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2014-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390905385	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Calumet Medical Center Inc	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	CALU	BusinessNameControlTxt
Phone	9208492386	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	614 Memorial Drive	AddressLine1Txt
City	Chilton	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53014	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Brian Regan	PersonNm
Person Title	Interim CFO	PersonTitleTxt
Signature	2016-05-16	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Rachel Becker	PreparerPersonNm
PTIN	P00966076	PTIN
Phone	4142713000	PhoneNum
Preparation	2016-03-28	PreparationDt

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-08-17 19:52:53Z	BuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Timothy Richman	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	614 Memorial Drive	AddressLine1Txt
City	Chilton	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53014	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$28,218,072	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	1954	FormationYr
Legal Domicile State	WI	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	10	VotingMembersGoverningBodyCnt
Voting Members Independent	5	VotingMembersIndependentCnt
Total Employee	198	TotalEmployeeCnt
Total Volunteers	61	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$169,899	PYContributionsGrantsAmt
CY Contributions Grants	$1,050,096	CYContributionsGrantsAmt
PY Program Service Revenue	$25,150,223	PYProgramServiceRevenueAmt
CY Program Service Revenue	$26,685,834	CYProgramServiceRevenueAmt
PY Investment Income	$241,647	PYInvestmentIncomeAmt
CY Investment Income	$154,196	CYInvestmentIncomeAmt
PY Other Revenue	$162,720	PYOtherRevenueAmt
CY Other Revenue	$242,766	CYOtherRevenueAmt
PY Total Revenue	$25,724,489	PYTotalRevenueAmt
CY Total Revenue	$28,132,892	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	$11,089,732	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$12,024,757	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$10,255,921	PYOtherExpensesAmt
CY Other Expenses	$10,360,917	CYOtherExpensesAmt
PY Total Expenses	$21,345,653	PYTotalExpensesAmt
CY Total Expenses	$22,385,674	CYTotalExpensesAmt
PY Revenues Less Expenses	$4,378,836	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$5,747,218	CYRevenuesLessExpensesAmt
Total Assets BOY	$35,423,368	TotalAssetsBOYAmt
Total Assets EOY	$42,872,071	TotalAssetsEOYAmt
Total Liabilities BOY	$3,162,829	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$5,061,009	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$32,260,539	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$37,811,062	NetAssetsOrFundBalancesEOYAmt
Mission	The mission of Calumet Medical Center, 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	$17,792,776	ExpenseAmt
Revenue	$26,685,834	RevenueAmt
Desc	CALUMET MEDICAL CENTER, INC. OPERATES A 25-BED CRITICAL ACCESS HOSPITAL FACILITY PROVIDING MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, CLINIC, HOSPICE, AND HOME HEALTH SERVICES TO RESIDENTS IN CALUMET COUNTY, REGARDLESS OF ABILITY TO PAY. THE EMERGENCY DEPARTMENT INCLUDES 24 HOURS A DAY/7 DAYS A WEEK EMERGENCY PHYSICIAN COVERAGE. THE EMERGENCY DEPARTMENT ALSO OFFERS WALK-IN CLINIC SERVICES FOR AFTER DOCTOR'S OFFICE HOURS. DURING 2015, THE HOSPITAL COUNTED 2,054 PATIENT DAYS AND 439 TOTAL DISCHARGES AND ITS EMERGENCY DEPARTMENT RECEIVED 4,852 VISITS. SEE SCHEDULE H FOR FURTHER DETAILS REGARDING THE COMMUNITY BENEFITS THAT CALUMET MEDICAL CENTER PROVIDES.	Desc
Total Program Service Expenses	$17,792,776	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	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	Yes (true)	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	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
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	20	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	198	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
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	5	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 (16 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	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
TRAVIS ANDERSON
VICE CHAIRMAN (END 8/14)	1.00	26.50	Yes (X)	Yes (X)	$0	$344,821	$13,716
JAMES BURNETT
TREASURER	0.30	0	Yes (X)	Yes (X)	$0	$0	$0
MONICA ANN HILT
VICE CHAIRMAN	0.20	44.70	Yes (X)	Yes (X)	$0	$572,461	$19,954
TIMOTHY RICHMAN
PRESIDENT/CEO - CMC	40.00	0	Yes (X)	Yes (X)	$0	$244,701	$17,074
ALLAN UTECHT
SECRETARY	0.30	0	Yes (X)	Yes (X)	$0	$0	$0
WAYNE WIETING
CHAIRMAN	0.30	0	Yes (X)	Yes (X)	$0	$0	$0
JANE GEHL
BOARD MEMBER	0.30	0	Yes (X)		$0	$0	$0
PETER JANU MD
BOARD MEMBER	0.30	40.00	Yes (X)		$0	$557,877	$21,398
MARK KEHRBERG MD
BOARD MEMBER	0.30	40.30	Yes (X)		$0	$487,342	$16,019
CRAIG OLSEN MD
BOARD MEMBER	0.30	0	Yes (X)		$0	$0	$0
GENE TIPLER MD
BOARD MEMBER	0.30	40.00	Yes (X)		$0	$252,786	$20,043
NICHOLAS DESIEN
MINISTRY HEALTH CARE CEO	1.00	54.60		Yes (X)	$0	$2,134,343	$18,803
JEFFREY FRANCIS
MINISTRY HEALTH CARE CAFO	0.50	54.30		Yes (X)	$0	$1,021,840	$19,803
DANIEL NEUFELDER
SVP, HOSPITAL OPERATIONS & PRESIDENT	0.10	40.00		Yes (X)	$0	$1,071,649	$17,365
JENNIFER LEIGH MEDIN WEBER
MANAGER INPATIENT SRVCS	40.00	0			$132,921	$0	$16,683	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	$132,921	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$7,347,660	TotReportableCompRltdOrgAmt
Total Other Compensation	$194,690	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	1	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 (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
BOLDT COMPANY
LOCK BOX 285	MILWAUKEE	WI	53288	CONTRUCTION (SCH. O)	$5,324,598
REMEDY MEDICAL SERVICES
1320 W CLAIREMONT AVE	EAU CLAIRE	WI	54701	PROFESSIONAL SERVICES	$1,370,109
BAY CARE CLINIC
2253 W MASON STREET 100	GREEN BAY	WI	54303	PROFESSIONAL SERVICES	$490,722
GOLD CROSS AMBULANCE SERVICES INC
1055 WITTMANN DRIVE	MENASHA	WI	54952	PROFESSIONAL SERVICES	$441,857
Shared Medical Services
				Medical Services	$156,268

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	8	CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIII	Yes (X)	InfoInScheduleOPartVIIIInd
Federated Campaigns	$0	FederatedCampaignsAmt
Membership Dues	$0	MembershipDuesAmt
Fundraising	$0	FundraisingAmt
Related Organizations	$1,039,118	RelatedOrganizationsAmt
Government Grants	$10,978	GovernmentGrantsAmt
All Other Contributions	$0	AllOtherContributionsAmt
Noncash Contributions	$0	NoncashContributionsAmt
Total Contributions	$1,050,096	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net Patient Revenue	621110	$26,607,858	$26,607,858
Clinic Revenue	621110	$34,352	$34,352

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$43,624	TotalRevenueColumnAmt
Related Or Exempt Func Income	$43,624	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$26,685,834	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$201,560	TotalRevenueColumnAmt
Exclusion	$201,560	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$94,949	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$24,561	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$70,388	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$70,388	TotalRevenueColumnAmt
Exclusion	$70,388	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$13,255	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$60,619	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	-$47,364	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$47,364	TotalRevenueColumnAmt
Exclusion	-$47,364	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
Nutrition Services	621110	$63,002	$63,002
Purchasing Card Rev	621110	$12,244	$12,244
Other Non-Operating	900099	$8,432	$8,432

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$88,700	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$88,700	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$172,378	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$28,132,892	TotalRevenueColumnAmt
Related Or Exempt Func Income	$26,685,834	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$396,962	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$8,964,270	TotalAmt
Program Services	$7,036,276	ProgramServicesAmt
Management And General	$1,927,994	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$376,827	TotalAmt
Program Services	$293,925	ProgramServicesAmt
Management And General	$82,902	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,138,254	TotalAmt
Program Services	$1,667,838	ProgramServicesAmt
Management And General	$470,416	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$545,406	TotalAmt
Program Services	$425,417	ProgramServicesAmt
Management And General	$119,989	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$1,722	TotalAmt
Program Services	$1,722	ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$3,584,471	TotalAmt
Program Services	$3,317,661	ProgramServicesAmt
Management And General	$266,810	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$41,841	TotalAmt
Program Services	$41,841	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,148,953	TotalAmt
Program Services	$2,025,100	ProgramServicesAmt
Management And General	$123,853	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$565	TotalAmt
Program Services	$565	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$623,538	TotalAmt
Program Services	$469,552	ProgramServicesAmt
Management And General	$153,986	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$93,833	TotalAmt
Program Services	$25,834	ProgramServicesAmt
Management And General	$67,999	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,069,276	TotalAmt
Program Services	$946,093	ProgramServicesAmt
Management And General	$123,183	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$56,284	TotalAmt
Management And General	$56,284	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Purchase Services	$1,687,558	$829,058	$858,500
Drugs	$579,210	$576,623	$2,587
Food	$85,666	$72,444	$13,222
Dues	$32,335	$6,214	$26,121

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$355,665	TotalAmt
Program Services	$56,613	ProgramServicesAmt
Management And General	$299,052	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$22,385,674	TotalAmt
Program Services	$17,792,776	ProgramServicesAmt
Management And General	$4,592,898	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$2,218	BOYAmt
EOY	$2,529	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$11,091,723	BOYAmt
EOY	$13,311,365	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$3,961,945	BOYAmt
EOY	$3,503,948	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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$31,128	BOYAmt
EOY	$27,331	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$20,631,341	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$1,764,329	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$13,155,687	BOYAmt
EOY	$18,867,012	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$1,924,793	BOYAmt
EOY	$1,929,113	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	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$5,255,874	BOYAmt
EOY	$5,230,773	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$35,423,368	BOYAmt
EOY	$42,872,071	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$2,195,552	BOYAmt
EOY	$3,840,592	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$97,497	BOYAmt
EOY	$35,604	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$869,780	BOYAmt
EOY	$1,184,813	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$3,162,829	BOYAmt
EOY	$5,061,009	EOYAmt

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$32,260,539	BOYAmt
EOY	$37,811,062	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$32,260,539	BOYAmt
EOY	$37,811,062	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$35,423,368	BOYAmt
EOY	$42,872,071	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$5,747,218	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$196,695	NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts	$0	DonatedServicesAndUseFcltsAmt
Investment Expense	$0	InvestmentExpenseAmt
Other Changes In Net Assets	$0	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	Yes (true)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (true)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$1,722	OtherActivitiesAmt
Total Lobbying Expenditures	$1,722	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	FormAndLineReferenceDesc
Explanation	Lobbying expenses represent the portion of dues paid to national and state hospital association that is specifically allocated to lobbying. Calumet Medical Center, Inc. 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.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,200,000	OtherCostOrOtherBasisAmt
Book Value	$3,200,000	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,139,858	OtherCostOrOtherBasisAmt
Depreciation	$736,530	DepreciationAmt
Book Value	$2,403,328	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$177,300	OtherCostOrOtherBasisAmt
Depreciation	$58,617	DepreciationAmt
Book Value	$118,683	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,152,125	OtherCostOrOtherBasisAmt
Depreciation	$969,182	DepreciationAmt
Book Value	$2,182,943	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$10,962,058	OtherCostOrOtherBasisAmt
Depreciation	$0	DepreciationAmt
Book Value	$10,962,058	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$18,867,012	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDesc	Book ValueBookValueAmt
INTEREST IN INVESTMENTS HEALTH BY ASCENSION HEALTH ALLIANCE	$4,910,971
UNEMPLOYMENT DEPOSIT	$169,348
OTHER ACCOUNTS RECEIVABLE	$110,275
DUE FROM RELATED ENTITIES	$40,179

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$5,230,773	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
Accumulated Accretion	$239,216
Retirement Obligation	$59,208
Due to Third Party Payor	$886,389

Field	Value	IRS element (for citing)
Total Liability	$1,184,813	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 Calumet Medical Center, 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 H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$34,851	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$34,851	NetCommunityBenefitExpnsAmt
Total Expense	0.0016	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$284,243	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$284,243	NetCommunityBenefitExpnsAmt
Total Expense	0.0126	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$319,094	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$319,094	NetCommunityBenefitExpnsAmt
Total Expense	0.0142	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Persons Served	1230	PersonsServedCnt
Total Community Benefit Expns	$50,678	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$50,678	NetCommunityBenefitExpnsAmt
Total Expense	0.0023	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	1	PersonsServedCnt
Total Community Benefit Expns	$3,824	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,824	NetCommunityBenefitExpnsAmt
Total Expense	0.0002	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	7	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$34,446	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,001	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$24,445	NetCommunityBenefitExpnsAmt
Total Expense	0.0011	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	18	ActivitiesOrProgramsCnt
Persons Served	1231	PersonsServedCnt
Total Community Benefit Expns	$88,948	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,001	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$78,947	NetCommunityBenefitExpnsAmt
Total Expense	0.0035	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	18	ActivitiesOrProgramsCnt
Persons Served	1231	PersonsServedCnt
Total Community Benefit Expns	$408,042	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$10,001	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$398,041	NetCommunityBenefitExpnsAmt
Total Expense	0.0177	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$1,069	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,069	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	130	PersonsServedCnt
Total Community Benefit Expns	$30,455	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$30,455	NetCommunityBenefitExpnsAmt
Total Expense	0.0014	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$0	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	130	PersonsServedCnt
Total Community Benefit Expns	$31,524	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$31,524	NetCommunityBenefitExpnsAmt
Total Expense	0.0014	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReportedInd
Bad Debt Expense	$646,920	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$14,643,839	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$12,120,794	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$2,523,045	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Calumet Medical Center Inc	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	614 Memorial Drive	AddressLine1Txt
City	Chilton	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53014	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.affinityhealth.org	WebsiteAddressTxt
State License	1020	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Calumet Medical Center Inc	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	12	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	http://www.affinityhealth.org/Affinity-Files/Community-Health-Needs-Assessments/FY2013-CMC-CHNA_FINA	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	12	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	http://www.affinityhealth.org/Affinity-Files/Community-Health-Needs-Assessments/FY2013_CMC_Implement	StrategyWebsiteURLTxt
Strategy Attached	false	StrategyAttachedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	2.0	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	4.0	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/FINANCIAL_ASSISTANCE_PROGRAM_RC08.PDF	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/MHC_FINANCIALAID_APPLICATION_REV4.PDF	FAPAppAvailableOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Medicare Rates	Yes (X)	MedicareRatesInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - CALUMET MEDICAL CENTER, INC.. CALUMET MEDICAL CENTER PARTICIPATED IN THE ASSESSMENT PROCESSES THAT GATHERED INPUT FROM PRIVATE AND PUBLIC CALUMET, WINNEBAGO AND OUTAGAMIE COUNTY ORGANIZATION MEMBERS INCLUDING: MEDICAL STAFF, NURSES AND ADMINISTRATORS; CLINIC PERSONNEL; PUBLIC HEALTH NURSES AND EDUCATORS; BEHAVIORAL HEALTH STAFF AND LEADERS; HEALTH INSURANCE-HEALTH MANAGEMENT STAFF, ELEMENTARY, HIGH SCHOOL AND POST HIGH SCHOOL EDUCATORS, NURSES AND ADMINISTRATORS; POLICE AND EMERGENCY PERSONNEL; CHILD, WOMEN'S, FAMILY AND SENIOR SOCIAL SERVICES; AS WELL AS COMMUNITY MEMBERS INTERESTED IN THE HEALTH NEEDS ASSESSMENT PROCESS. SEVERAL AFFINITY REPRESENTATIVES PARTICIPATED AS MEMBERS OF THE FOX VALLEY L.I.F.E. STUDY AND/OR FOX VALLEY REGIONAL COMMUNITY HEALTH COALITION THROUGHOUT THE ASSESSMENT PROCESS. ERNESTO GONZALEZ, CASA HISPANA WAS CONSULTED ABOUT THE LATINO COMMUNITY HEALTH NEEDS. AS PART OF THE FOX CITIES L.I. F.E. STUDY, KRISTENE STACKER, FOX CITIES COMMUNITY HEALTH CLINIC WAS CONSULTED ABOUT THE MEDICALLY UNDERSERVED COMMUNITY HEALTH NEEDS. CALUMET COUNTY PUBLIC HEALTH EXPERTS - BONNIE KOLBE, HEALTH DIVISION MANAGER/HEALTH OFFICER CALUMET COUNTY HEALTH AND HUMAN SERVICES - TWENTY-FIVE YEARS OF EXPERIENCE. CITY OF MENASHA PUBLIC HEALTH EXPERTS - SUE NETT, PUBLIC HEALTH DIRECTOR CITY OF MENASHA HEALTH DEPARTMENT BSN AND MASTER IN PUBLIC ADMINISTRATION - TWENTY-EIGHT YEARS OF EXPERIENCE AS CITY OF MENASHA PUBLIC HEALTH DIRECTOR OVERSEEING THE HEALTH OF THE COMMUNITY - TEN YEARS OF EXPERIENCE CONDUCTING AND OVERSEEING COMMUNITY NEEDS ASSESSMENTS (AS PART OF THE FOX CITIES LIFE STUDY).
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - CALUMET MEDICAL CENTER, INC.. THE CHNA WAS CONDUCTED WITH ST. ELIZABETH HOSPITAL, MERCY MEDICAL CENTER, THEDACARE AND AURORA HEALTH.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - CALUMET MEDICAL CENTER, INC.. THE CHNA WAS CONDUCTED WITH THE HEALTH DEPARTMENTS OF: APPLETON, NEENAH, MENASHA, CALUMET COUNTY, OUTAGAMIE COUNTY & WINNEBAGO COUNTY.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - CALUMET MEDICAL CENTER, INC.. HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS: USING THE CHNA COMPLETED IN FISCAL YEAR 2013, THE HOSPITAL DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A 2014-2016 IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. IN 2014, THE HOSPITAL IMPLEMENTED THE FOLLOWING PLAN TO ADDRESS THE PRIORITY NEEDS: 1.EXCESSIVE ALCOHOL CONSUMPTION: - DECREASE THE PERCENTAGE OF ADULTS AND ADOLESCENSTS WHO BINGE DRINK IN CALUMET COUNTY. - PUBLIC AWARENESS EFFORTS TO INFORM THE COMMUNITY ABOUT THE ISSUES OF EXCESSIVE ALCOHOL CONSUMPTION (PAMPHLETS AND FACEBOOK PAGE). - PREVENTION EDUCATION PROGRAMS FOR PARENTS, YOUTH AND THE GENERAL COMMUNITY (POST-PROM EVENT, NATIONAL NIGHT OUT, PARENTS WHO HOST). 2.MENTAL HEALTH: - DECREASE THE RATE OF SUICIDE IN CALUMET COUNTY AND THE FOX VALLEY. - CREATE QPR (QUESTION. PERSUADE. REFER) PORTAL TO PROMOTE QPR TRAINING AND RESOURCES. - EXPAND QPR TRAININGS TO SPANISH SPEAKING POPULATION IN THE AREA. - CREATE A COMMUNITY-WIDE SUICIDE PREVENTION COLLABORATION. 3.OBESITY: - REDUCE OBESITY IN CALUMET COUNTY RESIDENTS. - ORGANIZE A KICK-OFF EVENT FOR WEIGHT OF THE FOX VALLEY ACTION TEAMS. - EXPAND WEIGHT OF THE FOX VALLEY'S WEB AND SOCIAL MEDIA PRESENCE. - ESTABLISH A PROCESS TO SHARE BMI INFORMATION BETWEEN WEIGHT OF THE FOX VALLEY PARTNERS. - PROVIDE HEALTHY LIVING COOKING CLASSES. - PROVIDE A CALUMET MEDICAL CENTER COMMUNITY GARDEN. NEEDS NOT BEING ADDRESSED AND REASONS WHY: FOURTEEN OTHER HEALTH ISSUES WERE IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. GIVEN THE REASONS INDICATED BELOW, CALUMET MEDICAL CENTER WILL NOT BE FOCUSING ON THESE HEALTH NEEDS AT THIS TIME. - ACCESS TO DENTAL CARE - ALREADY BEING ADDRESSED BY OTHERS IN THE COMMUNITY. - LOW BIRTH WEIGHTS - ISSUE IS NOT A PRIORITY FOR COMMUNITY MEMBERS AND THEREFORE APPROACH IS UNLIKELY TO SUCCEED. - TEEN BIRTH RATE UP - NEED IS NOT AS LIKELY TO BE RESOLVED AS OTHER PROBLEMS. - HIGH COST OF CHILD CARE - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - INCREASED GAPS IN CARE MANAGEMENT FOR PEOPLE WITH DISABILITIES OF ALL AGES - NEED IS NOT AS LIKELY TO BE RESOLVED AS OTHER PROBLEMS. - INCREASE IN LOW INCOME STUDENTS - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - DECREASED WATER QUALITY - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - INCREASED ELDER ABUSE - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - INCREASE IN VIOLENT CRIME ESPECIALLY DRUG-RELATED - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - INCREASED HOMELESSNESS RELATED TO UNEMPLOYMENT (MORE CHILDREN) - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - INCREASED FOODSHARE RECIPIENTS - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - INCREASED FOOD INSECURITY AND HUNGER - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - TRANSPORTATION CHALLENGES - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED. - AVAILABILITY OF JOBS WITH HEALTH CARE BENEFITS - HOSPITAL DOES NOT HAVE THE EXPERTISE TO EFFECTIVELY ADDRESS THE NEED.

Field	Value	IRS element (for citing)
Facility	0	FacilityNum

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 3c Description of Income Based Criteria	It is the policy of the Organization to provide medically necessary health care services to people in the communities it serves, regardless of their ability to pay. Affinity Care Financial Assistance is granted based upon the patient's inability to pay and to individuals who are uninsured, underinsured or medically indigent. Affinity Care works in collaboration with other financial (both public and private) assistance programs. This is to ensure holistic wellness of patients by facilitating knowledge of available services and programs for health while practicing good stewardship of funds. Key criteria utilized to determine eligibility for Affinity Care Financial Assistance includes family size, federal poverty income guidelines and available assets. The available asset test includes consideration of the amount of equity in a home, automobiles, and savings accounts which are considered part of total allowable income when assessing against the federal poverty income guidelines.
Schedule H, Part I, Line 6a PREPARATION OF COMMUNITY BENEFIT REPORT	Calumet Medical Center, Inc. is included in the annual community benefit report which is published by Ministry Health Care, Inc. (EIN: 39-1490371) and available to the public on its website, www.ministryhealth.org. This report includes all of the related entities within the Ministry Health Care network of hospitals, clinics and other health-related organizations.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	Amounts calculated in part I, Line 7 are determined both on a cost accounting system and a cost-to-charge ratio. Other benefits are determined based on the direct and indirect costs (where allocated) associated with a program net of earned revenue. Detail for each program/activity is maintained and determined at the department level. Charity care and means-tested programs are determined based on a cost-to-charge ratio consistent with worksheet 2, ratio of patient care cost to charges. Prior year cost report settlements are excluded from the shortfall calculation in order to get a true fiscal year shortfall amount.
Schedule H, Part II Community Building Activities	Community building activities include programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental problems. These activities support community assets by offering the expertise and resources of the organization. Costs for these activities include cash, in-kind donations, and expenditures for the development of the variety of community health programs and partnerships. Another example is health career presentations in which professionals from Calumet Medical Center, Inc. go to career classes at area high schools and universities to talk about their professionals (i.e. physical therapy, occupational therapy, speech therapy, cardiac & pulmonary rehab).
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	Calumet Medical Center, Inc. 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 consolidated audited financial statements of Ministry Health Care, Inc. (which includes the activity of Calumet Medical Center, Inc.): 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	Calumet Medical Center, Inc. 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	- Calumet Medical Center, Inc.: 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	- Calumet Medical Center, Inc.: Line 16b URL: HTTP://MINISTRYHEALTH.ORG/MINISTRY_HEALTH_CARE/MHC_FINANCIALAID_APPLICATION_REV4.PDF;
Schedule H, Part VI, Line 2 Needs assessment	Calumet Medical Center, Inc. performs community needs assessments as needed. 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	Calumet Medical Center, Inc. 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 financial assistance policy. The financial assistance policy and application is posted on the organization's website. Admissions and other key areas contain summary information of the financial assistance policy. As part of the intake/discharge process, patients are provided with a copy of the brochure and other information for financial assistance. If during the course of the patient registration process, care encounter, treatment, or upon discharge it becomes evident that a patient may need financial assistance; the patient shall be referred to Calumet Medical Center, Inc.'s financial assistance program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of financial assistance can be initiated by any member of the Hospital's workforce, including medical staff members, who become aware of the patients potential need for financial assistance. The financial assistance policy was also translated into dialects prevalent in the community in order to reach out to those that may speak another language (Spanish and Hmong). Patient registration staff and financial counselors are provided with scripts to follow when interacting with patients. As part of the financial assistance 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. The Organization 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. Calumet Medical Center, Inc., like most community hospitals, was created and is maintained in order to provide care locally - care that without our hospital, may not be available locally. Certain specialized services available include: I/P rehabilitation services, I/P sub-acute (snf) services. The Town of Chilton is located in Calumet County. According to the 2010 census, there were 3,933 people living in Chilton, consisting of 1,687 households and 1,027 families. The population density of Chilton was 990.7 people per square mile. The population consisted of 95.8% White, 1.1% Hispanic, 0.2% African American, 0.4% Native American, 0.5% Asian, and 2% Other. Of the 1,687 households in Chilton, 29.4% of those had children under the age of 18, living at home. The 1,687 households are categorized as 48.0% married couples living together, 4.7% had a male head of household with no wife present, 8.2% had a female head of household with no husband present, and 39.1% were non-families. 34.7% of the households consisted of individuals and 16.7% had someone 65 and older living alone. The age population is widely spread. 24% were under 18, 6.3% were 19-24, 26.3% were 25-44, 25.9% were 45-64, and 17.5% were 65+. The median income for a household was $51,106 and the median income for a family was $63,038. The per capita income for the city was $24,842. The largest industry in Chilton is manufacturing (32.4%). Educational, health and social services (20.3%) and retail trade (10.6%) are the next largest industries in Chilton. Roughly 11.4% of families and 14.5% of the population were below the poverty line. That includes 25.9% of those under 18 years old and 4.9% of those 65 and older. The unadjusted seasonal unemployment rate for Calumet County was 3.7%, compared to a state unemployment rate of 5.1% and a national unemployment rate of 7.9%.
Schedule H, Part VI, Line 5 Promotion of community health	Calumet Medical Center, Inc.'s governing board consists primarily of persons who reside within the primary service area who are not employees of the organization. The Organization strives to further its exempt purposes by the following: - Calumet Medical Center, Inc. participates in government-sponsored health programs (Medicare, Medicaid, Champus, general relief, and specialized county programs). - Calumet Medical Center, Inc. donates food to area shelters. They also donate medical supplies and medications to clinics in third world countries. Calumet Medical Center, Inc. donated funds to support area organizations that provide services to the following sectors of our population: low-income, homeless, physically and mentally challenged and chronically ill. - Calumet Medical Center, Inc. operates the only paramedic-level ambulance service in Calumet County. This service operates at a loss and is subsidized by the Hospital. - Calumet Medical Center, Inc. provides community health improvement services through health education lectures, health fairs and support groups. - Calumet Medical Center, Inc. conducts cardiac rehabilitation and diabetic education sessions. This service is provided at a cost to the patient that is far below the cost to offer the service. - Discounted care is provided to low income families up to 662% of federal poverty guidelines. - Calumet Medical Center, Inc. serves as a sponsor site for clinical training of college students in various health care programs. - Calumet Medical Center, Inc. offers athletic training services to local high schools that would otherwise not have this service available to their students. The service is offered at a cost to the schools that is far below the cost to offer the service.
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 (see Note 3). 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) (through 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. Mission 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: - 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. - 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. - 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. - 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 $12,600 and $18,400 for the years ended June 30, 2015 and 2014, 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 J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (10 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
TRAVIS ANDERSON
VICE CHAIRMAN (END 8/14)	$0	$176,807	$0	$136,945	$0	$31,068	$0	$0	$0	$13,716	$0	$358,537	$0	$0
MONICA ANN HILT
VICE CHAIRMAN	$0	$331,953	$0	$118,639	$0	$121,869	$0	$0	$0	$19,954	$0	$592,415	$0	$0
TIMOTHY RICHMAN
PRESIDENT/CEO - CMC	$0	$174,029	$0	$54,851	$0	$15,821	$0	$0	$0	$17,074	$0	$261,775	$0	$0
PETER JANU MD
BOARD MEMBER	$0	$543,360	$0	$0	$0	$14,517	$0	$0	$0	$21,398	$0	$579,275	$0	$0
MARK KEHRBERG MD
BOARD MEMBER	$0	$113,129	$0	$344,147	$0	$30,066	$0	$0	$0	$16,019	$0	$503,361	$0	$0
GENE TIPLER MD
BOARD MEMBER	$0	$218,817	$0	$0	$0	$33,969	$0	$0	$0	$20,043	$0	$272,829	$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
DANIEL NEUFELDER
SVP, HOSPITAL OPERATIONS & PRESIDENT	$0	$791,344	$0	$259,379	$0	$20,926	$0	$0	$0	$17,365	$0	$1,089,014	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Schedule J, Part I, Line 3 EXPLANATION

MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF CALUMET MEDICAL CENTER, 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 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. THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS OF: JEFFREY FRANCIS $260,079 MONICA HILT $52,618

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Line 15 COMPENSATION OF OFFICERS	IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF CALUMET MEDICAL CENTER, 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 WHO 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 DETERMINED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF CALUMET MEDICAL CENTER, 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 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 2 FAMILY/BUSINESS RELATIONSHIPS AMONGST INTERESETD PERSONS	MANY OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EMPLOYMENT BY RELATED MINISTRY HEALTH CARE, INC. RELATED ENTITIES.
Form 990, Part VI, Line 6 Classes of members or stockholders	Calumet Medical Center, Inc. has two corporate members, Affinity Health System and Calumet Area Community Health Foundation, Inc.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	One of Calumet Medical Center, Inc.'s members, Affinity Health System, has the ability to elect members to the governing board of Calumet Medical Center, Inc.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	Affinity Health System and Calumet Area Community Health Foundation, Inc. have the authority to approve any changes to the Articles of Incorporation, and all modifications to the purposes, Board of Directors and member provisions of the Bylaws of Calumet Medical Center, Inc., as well as to approve the dissolution, consolidation or merger of Calumet Medical Center, Inc. All decisions that have a material impact to Calumet Medical Center, Inc's financial information or corporation as a whole are subject to approval by Affinity Health System, the managing member of Calumet Medical Center, 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 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 Compensation	The compensation paid to Peter Janu, M.D., Mark Kehrberg, M.D., and Gene Tipler, M.D.is for their services as physicians for Network Health System, Inc., and not for their role as board members for Calumet Medical Center.
Form 990, Part VIII, Line 2f Other Program Service Revenue	OTHER REV - Total Revenue: 43624, Related or Exempt Function Revenue: 43624, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Admin meaningful use Medicaid/MISC OTHER OPER REV - Total Revenue: 88700, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 88700;
Form 990, Part IX, Line 11g Other Fees	Physician Medical Services - Total Expense: 3394741, Program Service Expense: 3157109, Management and General Expenses: 237632, Fundraising Expenses: ; Non Physician Medical Services - Total Expense: 189730, Program Service Expense: 160552, Management and General Expenses: 29178, Fundraising Expenses: ;
Form 990, Part VII, Section B Compensation paid to Boldt Company	Payments made to Boldt Company constitute payments for both materials and services. These amounts cannot be separated.

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	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
ASCENSION HEALTH ALLIANCE
PO BOX 45998	ST LOUIS	MO	63145	453358926	NATIONAL HEALTH SYSTEM	MO	501(c)(3	Type I	NA	false
ASCENSION HEALTH
PO BOX 45998	ST LOUIS	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	false
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	false
CATALPA HEALTH INC
N4642 COUNTY N	APPLETON	WI	54914	454681563	MENTAL HEALTH FACILITY	WI	501(c)(3	3	ST ELIZABETH HOSPITAL INC	false
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	false
DOOR COUNTY MEMORIAL HOSPITAL
323 SOUTH 18TH AVENUE	STURGEON BAY	WI	54235	390806324	HOSPITAL	WI	501(c)(3	3	MINISTRY HEALTH CAREINC	false
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	false
EAGLE RIVER MEMORIAL HOSPITAL INCORPORATED
201 HOSPITAL ROAD	EAGLE RIVER	WI	54521	390985690	HOSPITAL	WI	501(c)(3	3	THE HOWARD YOUNG MEDICAL CENTER INC	false
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	false
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	false
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	false
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	false
HOWARD YOUNG FOUNDATION INC
240 MAPLE STREET	WOODRUFF	WI	54568	391521169	CHARITABLE FOUNDATION	WI	501(c)(3	7	HOWARD YOUNG HEALTH CARE INC	false
HOWARD YOUNG HEALTH CARE INC
240 MAPLE STREET	WOODRUFF	WI	54568	391499115	HOME OFFICE	WI	501(c)(3	Type II	MINISTRY HEALTH CARE INC	false
THE HOWARD YOUNG MEDICAL CENTER INC
240 MAPLE STREET	WOODRUFF	WI	54568	390873606	HOSPITAL	WI	501(c)(3	3	HOWARD YOUNG HEALTH CARE INC	false
MERCY HEALTH FOUNDATION INC
PO BOX 3370	OSHKOSH	WI	54903	237140261	CHARITABLE FOUNDATION	WI	501(c)(3	9	AFFINITY HEALTH SYSTEM	Yes (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	false
MINISTRY HOMECARE INC
611 STJOSEPH AVENUE 4S	MARSHFIELD	WI	54449	391936201	HOME CARE/ HOSPICE	WI	501(c)(3	9	MINISTRY HEALTH CARE INC	false
MINISTRY MEDICAL GROUP INC
824 ILLINOIS AVENUE	STEVENS POINT	WI	54481	391965593	CLINICS	WI	501(c)(3	Type III-FI	MINISTRY HEALTH CARE INC	false
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	false
OUR LADY OF VICTORY HOSPITAL
1120 PINE STREET	STANLEY	WI	54768	390807065	HOSPITAL	WI	501(c)(3	3	MINISTRY HEALTH CARE INC	false
SACRED HEART-STMARY'S HOSPITALS INC
PO BOX 347	STEVENS POINT	WI	54481	391390638	HOSPITAL	WI	501(c)(3	3	MINISTRY HEALTH CARE INC	false
SAINT CLARE'S HOSPITAL OF WESTON INC
3400 MINISTRY PARKWAY	WESTON	WI	54476	721531917	HOSPITAL	WI	501(c)(3	3	MINISTRY HEALTH CARE INC	false
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	false
ST ELIZABETH HOSPITAL FOUNDATION INC
1506 S ONEIDA STREET	APPLETON	WI	54915	391256677	CHARITABLE FOUNDATION	WI	501(c)(3	7	AFFINITY HEALTH SYSTEM	Yes (true)
ST ELIZABETH HOSPITAL INC
1506 S ONEIDA STREET	APPLETON	WI	54915	390816818	HOSPITAL	WI	501(c)(3	3	MINISTRY HEALTH CARE INC	false
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	false
SAINT MICHAEL'S HOSPTIAL OF STEVENS POINT INC
900 ILLINOIS AVENUE	STEVENS POINT	WI	54481	390808443	HOSPITAL	WI	501(c)(3	3	MINISTRY HEALTH CARE INC	false
NETWORK HEALTH SYSTEM INC
1570 APPLETON RD	MENASHA	WI	54952	391127163	CLINICAL HEALTHCARE SERVICES	WI	501(c)(3	3	AFFINITY HEALTH SYSTEM	Yes (true)

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 (3 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
Network Health Insurance Corporation
1570 Midway Place	Menasha	WI	54952	392020474	Insurance	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	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	false	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
St Elizabeth Hospital Foundation
C	$1,039,118	FMV
Network Health Systems
O	$122,945	FMV
Network Health Systems
P	$81,467	FMV
Network Health Systems
M	$1,203,833	FMV
Ministry Health Care Inc
Q	$3,205,707	FMV
MInistry Health Care Inc
S	$105,572	FMV
Ministry Health Care Inc
R	$775,363	FMV