2013-08-15T18:21:27-05:00 2012-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2011-10-01 391127163 NETWORK HEALTH SYSTEM INC NETW 9207382000 PO BOX 8005 1570 MIDWAY PLACE MENASHA WI 54952 JEFF BADGER 9207382000 2013-08-15 1 TERRI REXRODE CPA MST P00096513 9206620016 2013-08-13 2011 2016-02-24 21:20:13Z AFFINITY MEDICAL GROUP JEFF BADGER PO BOX 8005 1570 MIDWAY PLACE MENASHA WI 54952 151307570 0 X WWW.AFFINITYHEALTH.ORG X 1969 WI NETWORK HEALTH SYSTEM INC D/B/A AFFINITY MEDICAL GROUP IS A TEAM OF ABOUT 200 HEALTH CARE PROFESSIONALS, PROVIDING MEDICAL CARE THROUGH A NETWORK OF 25 CLINICS IN 14 NORTHEAST WISCONSIN COMMUNITIES. OUR HISTORY OF PROVIDING HIGH-QUALITY HEALTH CARE TO THE COMMUNITY GOES BACK MORE THAN 50 YEARS. 15 9 1586 0 121725 6179 86259 20036 142778852 150199864 190440 194617 51826 491064 143107377 150905581 0 0 0 0 127513957 130751335 0 0 0 40720685 43845971 168234642 174597306 -25127265 -23691725 149380977 170071084 160831853 72382539 -11450876 97688545 X NETWORK HEALTH SYSTEM 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 145550647 150588142 NETWORK HEALTH SYSTEM 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 25 CLINICS IN THE 13 COMMUNITIES AROUND THE FOX CITIES AND OSHKOSH AREA PROVIDE PRIMARY AND SPECIALTY CARE CLOSE TO HOME. 15053219 15053219 145550647 1 1 0 0 0 0 0 0 0 0 1 1 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 0 0 0 1 56 0 1 1586 1 1 1 0 0 0 0 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JEFF BADGER 9207201300 1570 MIDWAY PLACE MENASHA WI 54952 DANIEL E NEUFELDER 12.30 X X 272096 627395 94160 JOHN RUSSO 0.30 X X 0 0 0 STEPHEN MORTON 0.30 X X 0 0 0 MARY HARP-JIRSCHELE 0.30 X 0 0 0 FRED KLEIN MD 0.30 X 0 0 0 THOMAS SCHMIDT 0.30 X 0 0 0 KATHRYN SIEMAN 0.30 X 0 0 0 WAYNE TREMBLY 0.30 X 0 0 0 MONICA VOMASTIC 0.30 X 0 0 0 RICHARD WELLS 0.30 X 0 0 0 JOSEPH P MCCORMICKMD 40.30 X 960725 0 40487 STACEY L SENSOR DO 40.30 X 515223 0 42399 MARK FAUSTICH MD 40.30 X 381831 0 35392 CHRISTOPHER ROCKE DO 40.30 X 235117 0 36683 BARBARA J STRAND MD 40.30 X 234612 0 46933 SUSAN VETTE 0.30 X 0 0 0 NICHOLAS DESIEN 0.30 X X 0 2017697 58526 JOHN OLIVERIO 0.30 X X 0 2520506 161546 JEFF S BADGER 12.00 X 139239 321055 69381 TIMOTHY E LOCH 40.00 X 282903 0 36957 CHRISTINE GRIGER 40.00 X 414467 0 54438 ZENOUN O ABOUZELAM MD 40.00 X 2325073 0 58366 DOUGLAS B HORAN MD 40.00 X 1411068 0 53644 MICHELE A HOLDER MD 40.00 X 1169277 0 47277 KHALID ALAM MD 40.00 X 1168787 0 54542 LEE W HASH MD 40.00 X 934627 0 33689 10445045 5486653 924420 225 0 1 0 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 LOCUMS 1762885 MARSHFIELD LABORATORIES 1000 N OAK AVENUE MARSHFIELD WI 54449 LAB SERVICES 792377 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUMS 628537 ENVIRONMENT CONTROL OF WI INC 1001 FOURIER DRIVE MADISON WI 53717 CLEANING SERVICES 368302 PHYTEL INC 11511 LUNA ROAD SUITE 600 DALLAS TX 75234 APPOINTMENTS 351535 12 20036 20036 NET PATIENT REVENUE 621110 146839711 146839711 OTHER OPERATING REVENU 621110 3238428 3238428 COSMETIC SALES 900099 121725 121725 150199864 183389 183389 383050 401989 -18939 -18939 -18939 11228 0 11228 11228 11228 EHR MEANINGFUL USE 900099 510003 510003 510003 150905581 150588142 121725 175678 3778973 2529402 1249571 102610454 90290974 12319480 4332028 3834242 497786 15179542 13301640 1877902 4850338 4235553 614785 12068204 4605880 7462324 13560 13560 13140107 12153798 986309 6916352 6275606 640746 499368 440003 59365 153683 150167 3516 469784 427503 42281 2976906 2708984 267922 1133973 1133973 BAD DEBT EXPENSE 4094619 4094619 MISCELLANEOUS 1890221 51641 1838580 RECRUITMENT 295821 295821 DUES & LICENSES 188040 135921 52119 5333 5333 174597306 145550647 29046659 0 3746617 1274420 9795945 17764739 18631025 1038798 865901 71863 38969 1349513 948833 60237595 32017022 20809742 28220573 74312062 87347285 30287643 22948133 149380977 170071084 106785733 24879966 54046120 47502573 160831853 72382539 X -11450876 97688545 -11450876 97688545 149380977 170071084 X -23691725 132831146 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1459081 1459081 24102461 8745860 15356601 26632466 23255399 3377067 8043587 15763 8027824 28220573 INVESTMENT IN NHP 85885996 F INVESTMENT IN TWIN MEDICAL 793421 F INVESTMENT FOR UNEMPLOYMENT RESERVE 667868 F 87347285 DUE FROM AFFILIATES 16251450 DEPOSITS 42547 457B PLAN 6654136 22948133 RETIREMENT PLAN CONTRIBUTION 6654136 DEFERRED COMPENSATION 1544219 PENSION LIABILITY 29737305 ASSET RETIREMENT OBLIGATION 66913 LONG-TERM DEBT 9500000 47502573 150905581 174597306 -23691725 13270285 119560861 132831146 109139421 160433512 13270286 401989 13672275 146761237 4144344 4144344 150905581 170854951 401989 401989 170452962 4144344 4144344 174597306 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MINISTRY RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS FOR MINISTRY'S NOT-FOR-PROFIT CORPORATIONS INCLUDE THEIR TAX-EXEMPT STATUS AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING RECOGNIZED UPON ULTIMATE SETTLEMENT. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION ADJUSTMENT -2,287,203. ADJUSTMENT TO INVESTMENT IN SUBSIDIARY 412,221. WORKERS COMPENSATION ADJ -555,450. PPE FMV ADJ 2,116,895. REFINANCING OF DEBT 120,374,398. DISTRIBUTION -500,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: 119,560,861. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSE ALLOCATION TO RENTAL INCOME 401,989. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,094,619. PHYSICIAN GAIN SHARING REVENUE 49,725. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSE ALLOCATION TO RENTAL INCOME 401,989. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,094,619. PHYSICIAN GAIN SHARING REVENUE 49,725. X X X 1 1 X X X X X 0 0 0 1 0 0 0 0 0 DANIEL E NEUFELDER 197146 454576 68480 157900 6470 14919 21730 50106 6753 15571 300579 693072 0 0 JOSEPH P MCCORMICKMD 959585 0 0 0 1140 0 18827 0 21660 0 1001212 0 0 0 STACEY L SENSOR DO 512804 0 0 0 2419 0 22598 0 19801 0 557622 0 0 0 MARK FAUSTICH MD 378875 0 0 0 2956 0 28478 0 6914 0 417223 0 0 0 CHRISTOPHER ROCKE DO 234764 0 0 0 353 0 18046 0 18637 0 271800 0 0 0 BARBARA J STRAND MD 233200 0 0 0 1412 0 22117 0 24816 0 281545 0 0 0 NICHOLAS DESIEN 0 923911 0 362645 0 731141 0 39630 0 18896 0 2076223 0 0 JOHN OLIVERIO 0 952774 0 662500 0 905232 0 99519 0 62027 0 2682052 0 0 JEFF S BADGER 103607 238895 27283 62910 8349 19250 13445 31001 7543 17392 160227 369448 0 0 TIMOTHY E LOCH 237126 0 30639 0 15138 0 15813 0 21144 0 319860 0 0 0 CHRISTINE GRIGER 396532 0 0 0 17935 0 23737 0 30701 0 468905 0 0 0 ZENOUN O ABOUZELAM MD 2316187 0 0 0 8886 0 26690 0 31676 0 2383439 0 0 0 DOUGLAS B HORAN MD 1406166 0 0 0 4902 0 28422 0 25222 0 1464712 0 0 0 MICHELE A HOLDER MD 1167567 0 0 0 1710 0 23013 0 24264 0 1216554 0 0 0 KHALID ALAM MD 1166165 0 0 0 2622 0 25602 0 28940 0 1223329 0 0 0 LEE W HASH MD 933398 0 0 0 1229 0 13665 0 20024 0 968316 0 0 0 PART I, LINE 1B BUSINESS TRAVEL EXPENSES FOR SPOUSES OF EXECUTIVES AND GOLF CLUB MEMBERSHIP FOR EXECUTIVES ARE REIMBURSED AS PART OF THEIR EXECUTIVE FLEX CREDIT ACCOUNT. RECEIPTS ARE PROVIDED TO SR. ADMINISTRATIVE ASSISTANT IN HR WHO REVIEWS FOR ACCURACY, COMPLETES A REIMBURSEMENT FORM WITH SUBSTANTIATION TO PAYROLL FOR REIMBURSEMENT. THESE REIMBURSEMENTS ARE TAXABLE AND, WHEN ADDED TO THE COMPENSATION PACKAGE TAKEN AS A WHOLE, HAVE BEEN INCLUDED WHEN COMPARED TO THE COMPENSATION STUDIES. PART I, LINE 5 EXECUTIVE INCENTIVE PLAN WAS ACCRUED FOR HOWEVER NO PAYMENTS WERE MADE FOR FY 2012. FORM 990, PART VI, SECTION A, LINE 6 NETWORK HEALTH SYSTEM HAS ONE CORPORATE MEMBER, AFFINITY HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A NETWORK HEALTH SYSTEM'S CORPORATE MEMBER, AFFINITY HEALTH SYSTEM, HAS THE POWER TO ELECT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS MUST BE APPROVED BY NETWORK HEALTH SYSTEM'S CORPORATE MEMBER, AFFINITY HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 THE CONTROLLER AND CFO OF AFFINITY HEALTH SYSTEM PERFORM A DETAIL REVIEW OF THE 990. AFTER MANAGEMENT REVIEW, A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS RECEIVE A CONFLICT OF INTEREST QUESTIONNAIRE EVERY YEAR. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR THE ORGANIZATION ENGAGES AN INDEPENDENT COMPENSATION FIRM TO PROVIDE MARKET DATA FOR CEO, EXECUTIVES AND KEY EMPLOYEE POSITIONS. THIS STUDY IS SHARED WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND RECOMMENDATIONS REGARDING ANY COMPENSATION CHANGES. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS. THE CEO REVIEWS EACH EXECUTIVE AND KEY EMPLOYEE'S ANNUAL PERFORMANCE APPRAISAL RATINGS IN MAKING HIS COMPENSATION RECOMMENDATIONS TO THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE HAS THE FINAL AUTHORITY TO APPROVE ANY AND ALL AMOUNTS OF COMPENSATION FOR MEMBERS OF THE EXECUTIVE TEAM. THE FINAL APPROVAL OF COMPENSATION AMOUNTS ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 13,270,285. PENSION ADJUSTMENT -2,287,203. ADJUSTMENT TO INVESTMENT IN SUBSIDIARY 412,221. WORKERS COMPENSATION ADJ -555,450. PPE FMV ADJ 2,116,895. REFINANCING OF DEBT 120,374,398. DISTRIBUTION -500,000. TOTAL TO FORM 990, PART XI, LINE 5: 132,831,146. PROCESS FOR OVERSIGHT OF AUDITED FINANCIAL STATEMENTS FORM 990 PART XI LINE 2B-2C NETWORK HEALTH SYSTEM, INC. DOES NOT RECEIVE SEPARATELY AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS AUDITED AND REPORTED THROUGH CONSOLIDATED FINANCIAL STATEMENTS. THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE AUDITOR SELECTION. THE AUDIT STATEMENTS ARE REVIEWED BY THE CONTROLLER, CFO, MINISTRY HEALTH CFO, AND THE AUDIT COMMITTEE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, SCHEDULE A, PART 1, LINE 3 NETWORK HEALTH SYSTEM, INC. IS A CLINIC AND NOT A LICENSED HOSPITAL. SCHEDULE H IS NOT REQUIRED. HOURS WORKED FOR RELATED ORGANIZATIONS: FORM 990, PART VII DANIEL NEUFELDER WORKED AN AVERAGE OF 28 HOURS PER WEEK FOR RELATED ORGANIZATIONS. JEFF BADGER WORKED AN AVERAGE OF 28 HOURS PER WEEK FOR RELATED ORGANIZATIONS. NICHOLAS DESIEN WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATION. JOHN OLIVERIO WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATION. 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