2015-05-14T10:46:13-05:00 2014-06-30 861065772 Deloitte Tax LLP 555 East Wells Street Suite 1400 Milwaukee WI 53202 990 2013-07-01 391127163 Network Health System Inc NETW 9207382000 PO Box 8005 1570 Midway Place Menasha WI 54952 Jeffrey Francis Ministry Healthcare CAFO 9207382000 2015-05-13 1 Rachel Becker P00966076 4142713000 2015-05-07 2013 2016-02-25 16:41:14Z Affinity Medical Group Jeffrey Francis PO Box 8005 1570 Midway Place Menasha WI 54952 148530953 0 X www.affinityhealth.org X 1969 WI To further the healing ministry of Jesus by improving the health and well-being of all people. 17 10 1244 10 119076 10605 57871 124057 116025409 147869518 143629 211561 1308898 221125 117535807 148426261 0 0 0 0 101652300 133129266 0 0 0 28745262 38198474 130397562 171327740 -12861755 -22901479 60053540 62426220 79228417 99244124 -19174877 -36817904 X 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. 0 0 140660307 147869518 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. 140660307 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 64 0 1 1244 1 1 1 0 0 0 0 0 0 0 0 0 X 17 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X Jeffrey Francis 4143593145 222 W College Ave 3rd Floor Appleton WI 54911 X Stephen Morton Chairman 0.40 1.10 X X 0 0 0 John Russo Vice Chairman (end 12/13) 0.40 1.10 X X 0 0 0 Daniel Neufelder Vice Chairman 5.00 55.10 X X 0 896266 89267 Wayne Trembley Secretary 0.40 1.10 X X 0 0 0 Kathryn Sieman Treasurer 0.40 1.10 X X 0 0 0 William J Calhoun Board Member 5.00 36.00 X 0 392457 47205 Lane Earns Board Member 0.40 1.10 X 0 0 0 Mark Faustich MD Sch O Board Member 0.40 1.10 X 409546 0 24567 Mary Harp-Jirschele Board Member 0.40 1.10 X 0 0 0 Fredrick Klein MD Board Member 0.40 1.10 X 0 0 0 Joseph McCormick MD Sch O Board Member 40.00 1.10 X 906132 0 54733 Kevin Ralofsky start 114 Board Member 0.40 1.10 X 0 0 0 Jay Sauter Board Member 0.40 1.10 X 0 0 0 Stacey Sensor DO Sch O Board Member 40.00 1.10 X 582436 0 36897 Sudeep Sodhi MD Sch O Board Member 40.00 1.10 X 851724 0 54749 Barbara Strand MD Sch O Board Member 40.00 1.10 X 313912 0 29366 Catherine Tierney Board Member 0.40 1.10 X 0 0 0 Monica Vomastic Board Member 0.40 1.10 X 0 0 0 Nicholas Desien Ministry Healthcare CEO 0.30 56.00 X 0 2061606 41974 Jeffrey Francis Ministry Healthcare CAFO 0.30 65.60 X 0 522252 124025 Jane Curran-Meuli COO 40.00 0.00 X 0 245535 30974 Mark W Kehrberg AHS Chief Medical Officer 5.00 20.60 X 0 394415 54779 Michael Hanson COO, MMG 40.00 40.30 X 459952 0 45949 David Romond NHS VP Specialty Care 40.00 0.00 X 364558 0 30379 Zenoun O Abouzelam Physician 40.00 0.00 X 1055235 0 43497 Khalid Alam Physician 40.00 0.00 X 899909 0 59666 Lee W Hash Physician 40.00 0.00 X 811938 0 60224 Michele A Holder Physician 40.00 0.00 X 1160301 0 60501 Douglas B Horan Physician 40.00 0.00 X 1334976 0 41212 Jeff Badger Former Officer 0.00 52.00 X 0 497813 62987 9150619 5010344 992951 193 1 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Locums 788431 Marshfield Laboratories 1000 N Oak Avenue Marshfield WI 544495795 Lab Service 577135 Phytel 11511 Luna Road Suite 600 Dallas TX 75234 Automated Care Tools 529936 Comp Health PO Box 972651 Dallas TX 753972651 Locums 444655 Neuroscience Group of NE WISC SC 1305 W American Drive Neenah WI 54956 Locums 414999 12 124002 55 124057 Net Patient Revenue 622110 140661133 140661133 Medicare Meaningful Us 900099 1463582 1463582 Misc. Operating Revenu 900099 1306432 1306432 Rent From Exempt Org 531190 305638 305638 Income from JV 532000 224589 224589 3908144 3908144 147869518 217222 217222 101185 99031 2154 2154 2154 5661 -5661 -5661 -5661 Cosmetic Sales 621110 119076 119076 Non-operating Rev 900099 63795 63795 Discounts 900099 36100 36100 218971 148426261 147869518 119076 313610 3257339 3257339 107836731 99332238 8504493 3109550 14954 3094596 13825737 10045946 3779791 5099909 5065770 34139 4008703 1543909 2464794 5280576 4397818 882758 7393902 6600733 793169 894612 468404 426208 500376 500376 2193504 1523719 669785 1390146 1131929 258217 Purchased Services 8853071 3416909 5436162 Drugs 4060867 4040659 20208 Food 133843 83913 49930 Dues 49530 10202 39328 3439344 2482828 956516 171327740 140660307 30667433 0 963665 14013 3557177 5696929 13528018 15633822 753592 -688724 26792273 1930337 26607249 24861936 1728940 879184 12914899 16029060 60053540 62426220 40926508 67148574 38301909 32095550 79228417 99244124 X -19174877 -36817904 0 0 -19174877 -36817904 60053540 62426220 X -22901479 5258452 X 0 1 X 1 0 X Schedule A, Part I, Public Charity Status: 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1608832 1608832 18558835 831208 17727627 6428795 1079988 5348807 195811 19141 176670 24861936 457B Plan 9635199 Due from Affiliates 4947832 Other Accounts Receivable 928482 PP&E Held For Sale 475000 Deposits 42547 16029060 Pension Liability 13436310 Retirement Plan Contribution 9635199 Intercompany Debt with Ministry Health Care, Inc. 8942728 Asset Retirement Obligation 81313 32095550 X Part X, Line 2: 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. 0 1 0 0 0 0 0 0 0 Daniel Neufelder Vice Chairman 0 770217 0 95952 0 30097 0 70286 0 18981 0 985533 0 0 William J Calhoun Board Member 0 330620 0 44429 0 17408 0 29514 0 17691 0 439662 0 0 Mark Faustich MD Sch O Board Member 387296 0 0 0 22250 0 20384 0 4183 0 434113 0 0 0 Joseph McCormick MD Sch O Board Member 891235 0 0 0 14897 0 35000 0 19733 0 960865 0 0 0 Stacey Sensor DO Sch O Board Member 567140 0 0 0 15296 0 17500 0 19397 0 619333 0 0 0 Sudeep Sodhi MD Sch O Board Member 834731 0 0 0 16993 0 35000 0 19749 0 906473 0 0 0 Barbara Strand MD Sch O Board Member 246953 0 40532 0 26427 0 21723 0 7643 0 343278 0 0 0 Nicholas Desien Ministry Healthcare CEO 0 1004953 0 329299 0 727354 0 15000 0 26974 0 2103580 0 0 Jeffrey Francis Ministry Healthcare CAFO 0 427032 0 63804 0 31416 0 101523 0 22502 0 646277 0 0 Jane Curran-Meuli COO 0 170623 0 42783 0 32129 0 14184 0 16790 0 276509 0 0 Mark W Kehrberg AHS Chief Medical Officer 0 333905 0 25071 0 35439 0 39160 0 15619 0 449194 0 0 Michael Hanson COO, MMG 299202 0 45610 0 115140 0 30300 0 15649 0 505901 0 0 0 David Romond NHS VP Specialty Care 257662 0 50663 0 56233 0 15000 0 15379 0 394937 0 0 0 Zenoun O Abouzelam Physician 1033682 0 0 0 21553 0 23000 0 20497 0 1098732 0 0 0 Khalid Alam Physician 863641 0 0 0 36268 0 40093 0 19573 0 959575 0 0 0 Lee W Hash Physician 774025 0 0 0 37913 0 40500 0 19724 0 872162 0 0 0 Michele A Holder Physician 1119028 0 0 0 41273 0 40500 0 20001 0 1220802 0 0 0 Douglas B Horan Physician 1329828 0 0 0 5148 0 23000 0 18212 0 1376188 0 0 0 Jeff Badger Former Officer 0 405962 0 56934 0 34917 0 44888 0 18099 0 560800 0 0 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. 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. 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 Ascension Health Alliance 0 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 Ascension Health 0 Affinity Health System 1570 Midway Place Menasha WI 54952 391568866 Support Related Healthcare Organziations IL Section 501(c)(3) Schedule A, Line 11b Ministry Health Care Inc 0 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 Ministry Health Care Inc 0 Calumet Medical Center Inc 614 Memorial Drive Chilton WI 53014 390905385 Hospital WI Section 501(c)(3) Schedule A, Line 3 Affinity Health System 1 Catalpa Health Inc N4642 County N Appleton WI 54914 454681563 Mental Health Facility WI Section 501(c)(3) Schedule A, Line 3 St Elizabeth Hospital Inc 0 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 Saint Michael's Hospital of Stevens Point Inc 0 Door County Memorial Hospital 323 South 18th Avenue Sturgeon Bay WI 54235 390806324 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 0 Dr Kate Newcomb Convalescent Center Inc PO Box 829 Woodruff WI 54568 391357365 LTC Facility WI Section 501(c)(3) Schedule A, Line 9 Howard Young Health Care Inc 0 Eagle River Memorial Hospital Incorporated 201 Hospital Road Eagle River WI 54521 390985690 Hospital WI Section 501(c)(3) Schedule A, Line 3 The Howard Young Medical Center Inc 0 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 Ministry Health Care Inc 0 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 Saint Joseph's Hospital of Marshfield Inc 0 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 Ministry Health Care Inc 0 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 Good Samaritan Health Center of Merrill Wisconsin Inc 0 Howard Young Foundation Inc 240 Maple Street Woodruff WI 54568 391521169 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 7 Howard Young Health Care Inc 0 Howard Young Health Care Inc 240 Maple Street Woodruff WI 54568 391499115 Home Office WI Section 501(c)(3) Schedule A, Line 11b Ministry Health Care Inc 0 The Howard Young Medical Center Inc 240 Maple Street Woodruff WI 54568 390873606 Hospital WI Section 501(c)(3) Schedule A, Line 3 Howard Young Health Care Inc 0 Mercy Health Foundation Inc PO Box 3370 Oshkosh WI 54903 237140261 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 9 Affinity Health System 1 Mercy Medical Center of Oshkosh Inc 500 S Oakwood Road Oshkosh WI 54904 390806268 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 0 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 Ministry Health Care Inc 0 Ministry Medical Group Inc 824 Illinois Avenue Stevens Point WI 54481 391965593 Clinics WI Section 501(c)(3) Schedule A, Line 11c Ministry Health Care Inc 0 Ministry Weight Management Inc 2251 North Shore Drive Rhinelander WI 54501 391829015 Health Services WI Section 501(c)(3) Schedule A, Line 3 Sacred Heart-St Mary's Hospitals Inc 0 Our Lady of Victory Hospital Inc 1120 Pine Street Stanley WI 54768 390807065 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 0 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 Ministry Health Care Inc 0 Saint Clare's Hospital of Weston Inc 3400 Ministry Parkway Weston WI 54476 721531917 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 0 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 Ministry Health Care Inc 0 St Elizabeth Hospital Foundation Inc 1506 S Oneida Street Appleton WI 54915 391256677 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 7 Affinity Health System 1 St Elizabeth Hospital Inc 1506 S Oneida Street Appleton WI 54915 390816818 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 0 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 Ministry Health Care Inc 0 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 Ministry Health Care Inc 0 Twin Med LLP PO Box 8005 Menasha WI 54952 391180341 Rental Property WI Network Health System Inc Excluded -4633 229198 0 1 0.64050 Network Health Plan Inc 1570 Midway Place Menasha WI 54952 391442058 Insurance WI Network Health System Inc C 1.00000 1 Ministry Holdings Inc 1570 Midway Place Menasha WI 54952 422966177 Insurance Holding Company WI N/A C 0 1 0 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 St Elizabeth Hospital Inc A 161609 FMV Calumet Medical Center Inc A 137940 FMV St Elizabeth Hospital Foundation Inc C 101317 FMV Ministry Health Care Inc E 8942728 FMV Ministry Health Care Inc J 417824 FMV Ministry Health Care Inc L 136401 FMV Ministry Health Care Inc O 14817664 FMV St Elizabeth Hospital Inc O 231896 FMV Mercy Medical Center of Oshkosh Inc O 71082 FMV Ministry Health Care Inc P 36337837 FMV Mercy Medical Center of Oshkosh Inc P 1351895 FMV St Elizabeth Hospital Inc P 2644362 FMV Mercy Medical Center of Oshkosh Inc Q 371817 FMV Calumet Medical Center Inc Q 1252058 FMV Ministry Home Care Inc L 67619 FMV St Elizabeth Hospital Inc Q 890747 FMV Ministry Health Care Inc S 500376 FMV