ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC (EIN 39-1127163)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-14
- IRS object ID
- 201541349349303204
- Schema version
- 2013v4.0
- 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 | 2015-05-14T10:46:13-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 555 East Wells Street Suite 1400 | AddressLine1 |
| City | Milwaukee | City |
| State | WI | State |
| ZIP Code | 53202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391127163 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Network Health System Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NETW | BusinessNameControlTxt |
| Phone | 9207382000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8005 1570 Midway Place | AddressLine1 |
| City | Menasha | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jeffrey Francis | PersonNm |
| Person Title | Ministry Healthcare CAFO | PersonTitleTxt |
| Phone | 9207382000 | PhoneNum |
| Signature | 2015-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rachel Becker | PreparerPersonNm |
| PTIN | P00966076 | PTIN |
| Phone | 4142713000 | PhoneNum |
| Preparation | 2015-05-07 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Affinity Medical Group | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jeffrey Francis | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8005 1570 Midway Place | AddressLine1 |
| City | Menasha | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $148,530,953 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.affinityhealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1969 | 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 | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1244 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $119,076 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $10,605 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $57,871 | PYContributionsGrantsAmt |
| CY Contributions Grants | $124,057 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $116,025,409 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $147,869,518 | CYProgramServiceRevenueAmt |
| PY Investment Income | $143,629 | PYInvestmentIncomeAmt |
| CY Investment Income | $211,561 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,308,898 | PYOtherRevenueAmt |
| CY Other Revenue | $221,125 | CYOtherRevenueAmt |
| PY Total Revenue | $117,535,807 | PYTotalRevenueAmt |
| CY Total Revenue | $148,426,261 | 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 | $101,652,300 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $133,129,266 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,745,262 | PYOtherExpensesAmt |
| CY Other Expenses | $38,198,474 | CYOtherExpensesAmt |
| PY Total Expenses | $130,397,562 | PYTotalExpensesAmt |
| CY Total Expenses | $171,327,740 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$12,861,755 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$22,901,479 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,053,540 | TotalAssetsBOYAmt |
| Total Assets EOY | $62,426,220 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $79,228,417 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $99,244,124 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$19,174,877 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$36,817,904 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Network Health System, Inc. has adopted the mission statement of Affinity Health System. The mission of Affinity Health System 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 | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $140,660,307 | ExpenseAmt |
| Revenue | $147,869,518 | RevenueAmt |
| Desc | Network Health System, Inc. is a regional health care organization focused on community-based care including outpatient, inpatient, ancillary, and long-term care as well as insurance services. The 23 clinics in the 12 communities around the Fox cities and Oshkosh area provide primary and specialty care close to home. | Desc |
| Total Program Service Expenses | $140,660,307 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 64 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1244 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | 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 | Jeffrey Francis | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4143593145 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 222 W College Ave 3rd Floor | AddressLine1 |
| City | Appleton | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (30 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 Morton | ||||||||||
| Chairman | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| John Russo | ||||||||||
| Vice Chairman (end 12/13) | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Daniel Neufelder | ||||||||||
| Vice Chairman | 5.00 | 55.10 | Yes (X) | Yes (X) | $0 | $896,266 | $89,267 | |||
| Wayne Trembley | ||||||||||
| Secretary | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| Kathryn Sieman | ||||||||||
| Treasurer | 0.40 | 1.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| William J Calhoun | ||||||||||
| Board Member | 5.00 | 36.00 | Yes (X) | $0 | $392,457 | $47,205 | ||||
| Lane Earns | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Mark Faustich MD Sch O | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $409,546 | $0 | $24,567 | ||||
| Mary Harp-Jirschele | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Fredrick Klein MD | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Joseph McCormick MD Sch O | ||||||||||
| Board Member | 40.00 | 1.10 | Yes (X) | $906,132 | $0 | $54,733 | ||||
| Kevin Ralofsky start 114 | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Jay Sauter | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Stacey Sensor DO Sch O | ||||||||||
| Board Member | 40.00 | 1.10 | Yes (X) | $582,436 | $0 | $36,897 | ||||
| Sudeep Sodhi MD Sch O | ||||||||||
| Board Member | 40.00 | 1.10 | Yes (X) | $851,724 | $0 | $54,749 | ||||
| Barbara Strand MD Sch O | ||||||||||
| Board Member | 40.00 | 1.10 | Yes (X) | $313,912 | $0 | $29,366 | ||||
| Catherine Tierney | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Monica Vomastic | ||||||||||
| Board Member | 0.40 | 1.10 | Yes (X) | $0 | $0 | $0 | ||||
| Nicholas Desien | ||||||||||
| Ministry Healthcare CEO | 0.30 | 56.00 | Yes (X) | $0 | $2,061,606 | $41,974 | ||||
| Jeffrey Francis | ||||||||||
| Ministry Healthcare CAFO | 0.30 | 65.60 | Yes (X) | $0 | $522,252 | $124,025 | ||||
| Jane Curran-Meuli | ||||||||||
| COO | 40.00 | 0.00 | $0 | $245,535 | $30,974 | Yes (X) | ||||
| Mark W Kehrberg | ||||||||||
| AHS Chief Medical Officer | 5.00 | 20.60 | $0 | $394,415 | $54,779 | Yes (X) | ||||
| Michael Hanson | ||||||||||
| COO, MMG | 40.00 | 40.30 | $459,952 | $0 | $45,949 | Yes (X) | ||||
| David Romond | ||||||||||
| NHS VP Specialty Care | 40.00 | 0.00 | $364,558 | $0 | $30,379 | Yes (X) | ||||
| Zenoun O Abouzelam | ||||||||||
| Physician | 40.00 | 0.00 | $1,055,235 | $0 | $43,497 | Yes (X) | ||||
| Khalid Alam | ||||||||||
| Physician | 40.00 | 0.00 | $899,909 | $0 | $59,666 | Yes (X) | ||||
| Lee W Hash | ||||||||||
| Physician | 40.00 | 0.00 | $811,938 | $0 | $60,224 | Yes (X) | ||||
| Michele A Holder | ||||||||||
| Physician | 40.00 | 0.00 | $1,160,301 | $0 | $60,501 | Yes (X) | ||||
| Douglas B Horan | ||||||||||
| Physician | 40.00 | 0.00 | $1,334,976 | $0 | $41,212 | Yes (X) | ||||
| Jeff Badger | ||||||||||
| Former Officer | 0.00 | 52.00 | $0 | $497,813 | $62,987 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $9,150,619 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,010,344 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $992,951 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 193 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 753972633 | Locums | $788,431 |
| Marshfield Laboratories | |||||
| 1000 N Oak Avenue | Marshfield | WI | 544495795 | Lab Service | $577,135 |
| Phytel | |||||
| 11511 Luna Road Suite 600 | Dallas | TX | 75234 | Automated Care Tools | $529,936 |
| Comp Health | |||||
| PO Box 972651 | Dallas | TX | 753972651 | Locums | $444,655 |
| Neuroscience Group of NE WISC SC | |||||
| 1305 W American Drive | Neenah | WI | 54956 | Locums | $414,999 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $124,002 | RelatedOrganizationsAmt |
| All Other Contributions | $55 | AllOtherContributionsAmt |
| Total Contributions | $124,057 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Revenue | 622110 | $140,661,133 | $140,661,133 |
| Medicare Meaningful Us | 900099 | $1,463,582 | $1,463,582 |
| Misc. Operating Revenu | 900099 | $1,306,432 | $1,306,432 |
| Rent From Exempt Org | 531190 | $305,638 | $305,638 |
| Income from JV | 532000 | $224,589 | $224,589 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,908,144 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,908,144 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $147,869,518 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $217,222 | TotalRevenueColumnAmt |
| Exclusion | $217,222 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $101,185 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $99,031 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,154 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,154 | TotalRevenueColumnAmt |
| Exclusion | $2,154 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,661 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$5,661 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,661 | TotalRevenueColumnAmt |
| Exclusion | -$5,661 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Cosmetic Sales | 621110 | $119,076 | $119,076 | |
| Non-operating Rev | 900099 | $63,795 | $63,795 | |
| Discounts | 900099 | $36,100 | $36,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $218,971 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $148,426,261 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $147,869,518 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $119,076 | UnrelatedBusinessRevenueAmt |
| Exclusion | $313,610 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,257,339 | TotalAmt |
| Management And General | $3,257,339 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,836,731 | TotalAmt |
| Program Services | $99,332,238 | ProgramServicesAmt |
| Management And General | $8,504,493 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,109,550 | TotalAmt |
| Program Services | $14,954 | ProgramServicesAmt |
| Management And General | $3,094,596 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,825,737 | TotalAmt |
| Program Services | $10,045,946 | ProgramServicesAmt |
| Management And General | $3,779,791 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,099,909 | TotalAmt |
| Program Services | $5,065,770 | ProgramServicesAmt |
| Management And General | $34,139 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,008,703 | TotalAmt |
| Program Services | $1,543,909 | ProgramServicesAmt |
| Management And General | $2,464,794 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,280,576 | TotalAmt |
| Program Services | $4,397,818 | ProgramServicesAmt |
| Management And General | $882,758 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,393,902 | TotalAmt |
| Program Services | $6,600,733 | ProgramServicesAmt |
| Management And General | $793,169 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $894,612 | TotalAmt |
| Program Services | $468,404 | ProgramServicesAmt |
| Management And General | $426,208 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,376 | TotalAmt |
| Program Services | $500,376 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,193,504 | TotalAmt |
| Program Services | $1,523,719 | ProgramServicesAmt |
| Management And General | $669,785 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,390,146 | TotalAmt |
| Program Services | $1,131,929 | ProgramServicesAmt |
| Management And General | $258,217 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Purchased Services | $8,853,071 | $3,416,909 | $5,436,162 |
| Drugs | $4,060,867 | $4,040,659 | $20,208 |
| Food | $133,843 | $83,913 | $49,930 |
| Dues | $49,530 | $10,202 | $39,328 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,439,344 | TotalAmt |
| Program Services | $2,482,828 | ProgramServicesAmt |
| Management And General | $956,516 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,327,740 | TotalAmt |
| Program Services | $140,660,307 | ProgramServicesAmt |
| Management And General | $30,667,433 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $963,665 | BOYAmt |
| EOY | $14,013 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,557,177 | BOYAmt |
| EOY | $5,696,929 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,528,018 | BOYAmt |
| EOY | $15,633,822 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $753,592 | BOYAmt |
| EOY | -$688,724 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $26,792,273 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,930,337 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,607,249 | BOYAmt |
| EOY | $24,861,936 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,728,940 | BOYAmt |
| EOY | $879,184 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,914,899 | BOYAmt |
| EOY | $16,029,060 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,053,540 | BOYAmt |
| EOY | $62,426,220 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,926,508 | BOYAmt |
| EOY | $67,148,574 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,301,909 | BOYAmt |
| EOY | $32,095,550 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,228,417 | BOYAmt |
| EOY | $99,244,124 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$19,174,877 | BOYAmt |
| EOY | -$36,817,904 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$19,174,877 | BOYAmt |
| EOY | -$36,817,904 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,053,540 | BOYAmt |
| EOY | $62,426,220 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$22,901,479 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $5,258,452 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part IV Form990ScheduleAPartIVGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part I, Public Charity Status: | FormAndLineReferenceDesc |
| Explanation | Network Health System, Inc. is exempt as a hospital under Internal Revenue Code Section 170(b)(1)(A)(iii); however, it is not a hospital as defined by Form 990, Schedule H Instructions. | ExplanationTxt |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,608,832 | OtherCostOrOtherBasisAmt |
| Book Value | $1,608,832 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,558,835 | OtherCostOrOtherBasisAmt |
| Depreciation | $831,208 | DepreciationAmt |
| Book Value | $17,727,627 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,428,795 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,079,988 | DepreciationAmt |
| Book Value | $5,348,807 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $195,811 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,141 | DepreciationAmt |
| Book Value | $176,670 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,861,936 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| 457B Plan | $9,635,199 |
| Due from Affiliates | $4,947,832 |
| Other Accounts Receivable | $928,482 |
| PP&E Held For Sale | $475,000 |
| Deposits | $42,547 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $16,029,060 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Pension Liability | $13,436,310 |
| Retirement Plan Contribution | $9,635,199 |
| Intercompany Debt with Ministry Health Care, Inc. | $8,942,728 |
| Asset Retirement Obligation | $81,313 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $32,095,550 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | From the consolidated audited financial statements of Ministry Health Care, Inc. which include the activity of Network 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 or expected to be taken in a tax returns. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 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 | ||||||||||||||
| Vice Chairman | $0 | $770,217 | $0 | $95,952 | $0 | $30,097 | $0 | $70,286 | $0 | $18,981 | $0 | $985,533 | $0 | $0 |
| William J Calhoun | ||||||||||||||
| Board Member | $0 | $330,620 | $0 | $44,429 | $0 | $17,408 | $0 | $29,514 | $0 | $17,691 | $0 | $439,662 | $0 | $0 |
| Mark Faustich MD Sch O | ||||||||||||||
| Board Member | $387,296 | $0 | $0 | $0 | $22,250 | $0 | $20,384 | $0 | $4,183 | $0 | $434,113 | $0 | $0 | $0 |
| Joseph McCormick MD Sch O | ||||||||||||||
| Board Member | $891,235 | $0 | $0 | $0 | $14,897 | $0 | $35,000 | $0 | $19,733 | $0 | $960,865 | $0 | $0 | $0 |
| Stacey Sensor DO Sch O | ||||||||||||||
| Board Member | $567,140 | $0 | $0 | $0 | $15,296 | $0 | $17,500 | $0 | $19,397 | $0 | $619,333 | $0 | $0 | $0 |
| Sudeep Sodhi MD Sch O | ||||||||||||||
| Board Member | $834,731 | $0 | $0 | $0 | $16,993 | $0 | $35,000 | $0 | $19,749 | $0 | $906,473 | $0 | $0 | $0 |
| Barbara Strand MD Sch O | ||||||||||||||
| Board Member | $246,953 | $0 | $40,532 | $0 | $26,427 | $0 | $21,723 | $0 | $7,643 | $0 | $343,278 | $0 | $0 | $0 |
| Nicholas Desien | ||||||||||||||
| Ministry Healthcare CEO | $0 | $1,004,953 | $0 | $329,299 | $0 | $727,354 | $0 | $15,000 | $0 | $26,974 | $0 | $2,103,580 | $0 | $0 |
| Jeffrey Francis | ||||||||||||||
| Ministry Healthcare CAFO | $0 | $427,032 | $0 | $63,804 | $0 | $31,416 | $0 | $101,523 | $0 | $22,502 | $0 | $646,277 | $0 | $0 |
| Jane Curran-Meuli | ||||||||||||||
| COO | $0 | $170,623 | $0 | $42,783 | $0 | $32,129 | $0 | $14,184 | $0 | $16,790 | $0 | $276,509 | $0 | $0 |
| Mark W Kehrberg | ||||||||||||||
| AHS Chief Medical Officer | $0 | $333,905 | $0 | $25,071 | $0 | $35,439 | $0 | $39,160 | $0 | $15,619 | $0 | $449,194 | $0 | $0 |
| Michael Hanson | ||||||||||||||
| COO, MMG | $299,202 | $0 | $45,610 | $0 | $115,140 | $0 | $30,300 | $0 | $15,649 | $0 | $505,901 | $0 | $0 | $0 |
| David Romond | ||||||||||||||
| NHS VP Specialty Care | $257,662 | $0 | $50,663 | $0 | $56,233 | $0 | $15,000 | $0 | $15,379 | $0 | $394,937 | $0 | $0 | $0 |
| Zenoun O Abouzelam | ||||||||||||||
| Physician | $1,033,682 | $0 | $0 | $0 | $21,553 | $0 | $23,000 | $0 | $20,497 | $0 | $1,098,732 | $0 | $0 | $0 |
| Khalid Alam | ||||||||||||||
| Physician | $863,641 | $0 | $0 | $0 | $36,268 | $0 | $40,093 | $0 | $19,573 | $0 | $959,575 | $0 | $0 | $0 |
| Lee W Hash | ||||||||||||||
| Physician | $774,025 | $0 | $0 | $0 | $37,913 | $0 | $40,500 | $0 | $19,724 | $0 | $872,162 | $0 | $0 | $0 |
| Michele A Holder | ||||||||||||||
| Physician | $1,119,028 | $0 | $0 | $0 | $41,273 | $0 | $40,500 | $0 | $20,001 | $0 | $1,220,802 | $0 | $0 | $0 |
| Douglas B Horan | ||||||||||||||
| Physician | $1,329,828 | $0 | $0 | $0 | $5,148 | $0 | $23,000 | $0 | $18,212 | $0 | $1,376,188 | $0 | $0 | $0 |
| Jeff Badger | ||||||||||||||
| Former Officer | $0 | $405,962 | $0 | $56,934 | $0 | $34,917 | $0 | $44,888 | $0 | $18,099 | $0 | $560,800 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | Ministry Health Care, Inc., a related organization of Network Health System, Inc., uses the following methods 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. |
| Part I, Line 4b | 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 from the supplemental nonqualified retirement plan were made in the current year. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | 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, Section A, line 6 | Network Health System, Inc. has a single corporate member, Affinity Health System. |
| Form 990, Part VI, Section A, line 7a | Network Health System, Inc. has a single corporate member, Affinity Health System, who has the ability to elect members to the governing body of Network Health System, Inc. |
| Form 990, Part VI, Section A, line 7b | All decisions that have a material impact to the Network Health System, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, Affinity Health System. |
| Form 990, Part VI, Section B, line 11 | 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, Section B, line 12c | The Organization regularly and consistently monitors and enforces compliance with the Conflict of Interest Policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the Conflict of Interest Policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. |
| Form 990, Part VI, Section B, line 15 | In determining compensation of the organization's CEO, the process, performed by Ministry Health Care, Inc., a related organization of Network 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 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 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 Network 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 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, Section C, line 19 | 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: | 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: | Pension Curtailment Adjustment 5,258,452. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (31 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Ascension Health Alliance | |||||||||||
| PO Box 45998 | St Louis | MO | 631455998 | 453358926 | National Health System | MO | Section 501(c)(3) | Schedule A, Line 11a | N/A | 0 | |
| Ascension Health | |||||||||||
| PO Box 45998 | St Louis | MO | 631453806 | 311662309 | National Health System | MO | Section 501(c)(3) | Schedule A, Line 11a | 0 | Ascension Health Alliance | |
| Ministry Health Care Inc | |||||||||||
| 10925 W Lake Park Dr Ste 100 | Milwaukee | WI | 53224 | 391490371 | Parent Corporation | WI | Section 501(c)(3) | Schedule A, Line 11b | 0 | Ascension Health | |
| Affinity Health System | |||||||||||
| 1570 Midway Place | Menasha | WI | 54952 | 391568866 | Support Related Healthcare Organziations | IL | Section 501(c)(3) | Schedule A, Line 11b | 0 | Ministry Health Care Inc | |
| Agape Community Center of Milwaukee Inc | |||||||||||
| 6100 North 42nd Street | Milwaukee | WI | 532093560 | 391461846 | Community Center | WI | Section 501(c)(3) | Schedule A, Line 7 | 0 | Ministry Health Care Inc | |
| Calumet Medical Center Inc | |||||||||||
| 614 Memorial Drive | Chilton | WI | 53014 | 390905385 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | Yes (1) | Affinity Health System | |
| Catalpa Health Inc | |||||||||||
| N4642 County N | Appleton | WI | 54914 | 454681563 | Mental Health Facility | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | St Elizabeth Hospital Inc | |
| Saint Michael's Foundation of Stevens Point Inc | |||||||||||
| 900 Illinois Avenue | Stevens Point | WI | 54481 | 391657410 | Charitable Foundation | WI | Section 501(c)(3) | Schedule A, Line 11a | 0 | Saint Michael's Hospital of Stevens Point Inc | |
| Door County Memorial Hospital | |||||||||||
| 323 South 18th Avenue | Sturgeon Bay | WI | 54235 | 390806324 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Dr Kate Newcomb Convalescent Center Inc | |||||||||||
| PO Box 829 | Woodruff | WI | 54568 | 391357365 | LTC Facility | WI | Section 501(c)(3) | Schedule A, Line 9 | 0 | Howard Young Health Care Inc | |
| Eagle River Memorial Hospital Incorporated | |||||||||||
| 201 Hospital Road | Eagle River | WI | 54521 | 390985690 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | 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 | Section 501(c)(3) | Schedule A, Line 11a | 0 | Ministry Health Care Inc | |
| Foundation of Saint Joseph's Hospital of Marshfield Inc | |||||||||||
| 611 Saint Joseph Avenue | Marshfield | WI | 54449 | 391684957 | Charitable Foundation | WI | Section 501(c)(3) | Schedule A, Line 11a | 0 | 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 | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Good Samaritan Hlth Cntr Foundation of Merrill Wisconsin Inc | |||||||||||
| 601 South Center Avenue | Merrill | WI | 54452 | 391627755 | Charitable Foundation | WI | Section 501(c)(3) | Schedule A, Line 11a | 0 | Good Samaritan Health Center of Merrill Wisconsin Inc | |
| Howard Young Foundation Inc | |||||||||||
| 240 Maple Street | Woodruff | WI | 54568 | 391521169 | Charitable Foundation | WI | Section 501(c)(3) | Schedule A, Line 7 | 0 | Howard Young Health Care Inc | |
| Howard Young Health Care Inc | |||||||||||
| 240 Maple Street | Woodruff | WI | 54568 | 391499115 | Home Office | WI | Section 501(c)(3) | Schedule A, Line 11b | 0 | Ministry Health Care Inc | |
| The Howard Young Medical Center Inc | |||||||||||
| 240 Maple Street | Woodruff | WI | 54568 | 390873606 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Howard Young Health Care Inc | |
| Mercy Health Foundation Inc | |||||||||||
| PO Box 3370 | Oshkosh | WI | 54903 | 237140261 | Charitable Foundation | WI | Section 501(c)(3) | Schedule A, Line 9 | Yes (1) | Affinity Health System | |
| Mercy Medical Center of Oshkosh Inc | |||||||||||
| 500 S Oakwood Road | Oshkosh | WI | 54904 | 390806268 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Ministry Home Care Inc | |||||||||||
| 611 St Joseph Avenue 4S | Marshfield | WI | 54449 | 391936201 | Home Care/Hospice | WI | Section 501(c)(3) | Schedule A, Line 9 | 0 | Ministry Health Care Inc | |
| Ministry Medical Group Inc | |||||||||||
| 824 Illinois Avenue | Stevens Point | WI | 54481 | 391965593 | Clinics | WI | Section 501(c)(3) | Schedule A, Line 11c | 0 | Ministry Health Care Inc | |
| Ministry Weight Management Inc | |||||||||||
| 2251 North Shore Drive | Rhinelander | WI | 54501 | 391829015 | Health Services | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Sacred Heart-St Mary's Hospitals Inc | |
| Our Lady of Victory Hospital Inc | |||||||||||
| 1120 Pine Street | Stanley | WI | 54768 | 390807065 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Sacred Heart-St Mary's Hospitals Inc | |||||||||||
| PO Box 347 | Stevens Point | WI | 54481 | 391390638 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Saint Clare's Hospital of Weston Inc | |||||||||||
| 3400 Ministry Parkway | Weston | WI | 54476 | 721531917 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Saint Elizabeth's Hospital of Wabasha Inc | |||||||||||
| 1200 Grant Blvd West | Wabasha | MN | 55981 | 410693877 | Hospital | MN | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| St Elizabeth Hospital Foundation Inc | |||||||||||
| 1506 S Oneida Street | Appleton | WI | 54915 | 391256677 | Charitable Foundation | WI | Section 501(c)(3) | Schedule A, Line 7 | Yes (1) | Affinity Health System | |
| St Elizabeth Hospital Inc | |||||||||||
| 1506 S Oneida Street | Appleton | WI | 54915 | 390816818 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Saint Joseph's Hospital of Marshfield Inc | |||||||||||
| 611 Saint Joseph Avenue | Marshfield | WI | 54449 | 390847631 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
| Saint Michael's Hospital of Stevens Point Inc | |||||||||||
| 900 Illinois Avenue | Stevens Point | WI | 54481 | 390808443 | Hospital | WI | Section 501(c)(3) | Schedule A, Line 3 | 0 | Ministry Health Care Inc | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Twin Med LLP | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 8005 | AddressLine1 |
| City | Menasha | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
| 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 | Network Health System Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Excluded | PredominantIncomeTypeTxt |
| Share Of Total Income | -$4,633 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $229,198 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.64050 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Network Health Plan Inc | |||||||||||
| 1570 Midway Place | Menasha | WI | 54952 | 391442058 | Insurance | WI | Network Health System Inc | C | 1.00000 | Yes (1) | |
| Ministry Holdings Inc | |||||||||||
| 1570 Midway Place | Menasha | WI | 54952 | 422966177 | Insurance Holding Company | WI | C | 0 | N/A | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (17 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| St Elizabeth Hospital Inc | ||
| A | $161,609 | FMV |
| Calumet Medical Center Inc | ||
| A | $137,940 | FMV |
| St Elizabeth Hospital Foundation Inc | ||
| C | $101,317 | FMV |
| Ministry Health Care Inc | ||
| E | $8,942,728 | FMV |
| Ministry Health Care Inc | ||
| J | $417,824 | FMV |
| Ministry Health Care Inc | ||
| L | $136,401 | FMV |
| Ministry Health Care Inc | ||
| O | $14,817,664 | FMV |
| St Elizabeth Hospital Inc | ||
| O | $231,896 | FMV |
| Mercy Medical Center of Oshkosh Inc | ||
| O | $71,082 | FMV |
| Ministry Health Care Inc | ||
| P | $36,337,837 | FMV |
| Mercy Medical Center of Oshkosh Inc | ||
| P | $1,351,895 | FMV |
| St Elizabeth Hospital Inc | ||
| P | $2,644,362 | FMV |
| Mercy Medical Center of Oshkosh Inc | ||
| Q | $371,817 | FMV |
| Calumet Medical Center Inc | ||
| Q | $1,252,058 | FMV |
| Ministry Home Care Inc | ||
| L | $67,619 | FMV |
| St Elizabeth Hospital Inc | ||
| Q | $890,747 | FMV |
| Ministry Health Care Inc | ||
| S | $500,376 | FMV |