ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC (EIN 39-1127163)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-13
- IRS object ID
- 201202269349300990
- Schema version
- 2010v3.4
- 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) |
|---|---|---|
| Timestamp | 2012-08-13T10:13:19-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391127163 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NETWORK HEALTH SYSTEM INC | BusinessNameLine1 |
| Business Name Line2 | D/B/A AFFINITY MEDICAL GROUP | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NETW | NameControl |
| Phone | 9207382000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 800 1570 MIDWAY PLACE | AddressLine1 |
| City | MENASHA | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFF BADGER | Name |
| Title | CFO | Title |
| Phone | 9207382000 | Phone |
| Date Signed | 2012-08-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| Phone | 9206620016 | Phone |
| Date Prepared | 2012-08-02 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JEFF BADGER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 800 1570 MIDWAY PLACE | AddressLine1 |
| City | MENASHA | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 143517847 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AFFINITYHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1969 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1494 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 102307 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 55347 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 86259 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 130708874 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 142778852 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 169363 | InvestmentIncomePriorYear |
| Investment Income Current Year | 190440 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 96617 | OtherRevenuePriorYear |
| Other Revenue Current Year | 51826 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 131030201 | TotalRevenuePriorYear |
| Total Revenue Current Year | 143107377 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 117117463 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 127513957 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 37352212 | OtherExpensePriorYear |
| Other Expenses Current Year | 40720685 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 154469675 | TotalExpensesPriorYear |
| Total Expenses Current Year | 168234642 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -23439474 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -25127265 | RevenuesLessExpensesCY |
| Total Assets BOY | 129851451 | TotalAssetsBOY |
| Total Assets EOY | 149380977 | TotalAssetsEOY |
| Total Liabilities BOY | 130670361 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 160831853 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -818910 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -11450876 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 139956560 | Expense |
| Revenue | 142676545 | Revenue |
| Description | 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. | Description |
| Total Program Service Expense | 139956560 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 59 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1494 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFF BADGER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9207201300 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1570 MIDWAY PLACE | AddressLine1 |
| City | MENASHA | City |
| State | WI | State |
| ZIP Code | 54952 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (30 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CARLA ALTEPETER | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| NICHOLAS DESIEN | ||||||||
| PRESIDENT - MINISTRY | 0.30 | X | 0 | 0 | 0 | X | ||
| MARK FAUSTICH MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.30 | X | 369720 | 0 | 35440 | |||
| DAVID GITTER | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | X | ||
| MARY HARP-JIRSCHELE | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| FRED KLEIN MD | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| JOSEPH MCCORMICKMD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.30 | X | 1097589 | 0 | 41533 | |||
| STEPHEN MORTON | ||||||||
| BOARD TREASURER | 0.30 | X | 0 | 0 | 0 | X | ||
| JAY MULLER MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.30 | X | 373057 | 0 | 37687 | |||
| DANIEL E NEUFELDER | ||||||||
| PRESIDENT/CEO - AHS | 12.30 | X | 255085 | 579069 | 65401 | X | ||
| JOHN OLIVERIO | ||||||||
| PRESIDENT - WHEATON | 0.30 | X | 0 | 1813218 | 157725 | X | ||
| CHRISTOPHER ROCKE DO | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.30 | X | 232694 | 0 | 35386 | |||
| JOHN RUSSO | ||||||||
| BOARD SECRETARY | 0.30 | X | 0 | 0 | 0 | X | ||
| THOMAS SCHMIDT | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| STACEY SENSOR DO | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.30 | X | 482023 | 0 | 40878 | |||
| KATHRYN SIEMAN | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| BARBARA STRAND MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.30 | X | 264298 | 0 | 43300 | |||
| CATHERINE TIERNEY | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | X | ||
| WAYNE TREMBLY | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| MONICA VOMASTIC | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| SUSAN VETTE | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| RICHARD WELLS | ||||||||
| BOARD MEMBER | 0.30 | X | 0 | 0 | 0 | |||
| JEFF BADGER | ||||||||
| CFO - AHS | 12.00 | 135925 | 308566 | 62470 | X | |||
| CHRISTINE GRIGER | ||||||||
| PRESIDENT - NHS | 40.00 | 192749 | 0 | 12456 | X | |||
| TIMOTHY LOCH | ||||||||
| COO - AHS | 40.00 | 282761 | 0 | 38248 | X | |||
| ZENOUN ABOUZELAM MD | ||||||||
| CARDIOLOGIST | 40.00 | 1875300 | 0 | 52990 | X | |||
| DOUGLAS HORAN MD | ||||||||
| DERMATOLOGIST | 40.00 | 1206497 | 0 | 52396 | X | |||
| MICHELE HOLDER MD | ||||||||
| DERMATOLOGIST | 40.00 | 1077960 | 0 | 45760 | X | |||
| KHALID ALAM MD | ||||||||
| GASTROENTEROLOGIST | 40.00 | 1117235 | 0 | 49605 | X | |||
| JOHN BRADFORD PRACYK MD | ||||||||
| NEURO SURGEON | 40.00 | 808739 | 0 | 28884 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 9771632 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2700853 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 800159 | TotalOtherCompensation |
| Number Individuals GT100 K | 198 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| WEATHERBY LOCUMS INC | |||||
| PO BOX 97633 | DALLAS | TX | 75397 | LOCUMS | 1503262 |
| MARSHFIELD LABORATORIES | |||||
| 1000 N OAK AVENUE | MARSHFIELD | WI | 54449 | LAB SERVICES | 879863 |
| COMPHEALTH | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | LOCUMS | 428607 |
| PHYTEL INC | |||||
| 11511 LUNA ROAD SUITE 600 | DALLAS | TX | 75234 | APPOINTMENTS | 424863 |
| ST ELIZABETH HOSPITAL | |||||
| 1506 S ONEIDA ST | APPLETON | WI | 54915 | SALARIES/LAB SERVICES | 418687 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| All Other Contributions | 86259 | AllOtherContributions |
| Total Contributions | 86259 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621110 | 138613276 | 138613276 | |
| OTHER OPERATING REVENU | 621110 | 4063269 | 4063269 | |
| COSMETIC SALES | 900099 | 102307 | 102307 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 142778852 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 190440 | TotalRevenueColumn |
| Exclusion | $190,440 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 462296 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 410470 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 51826 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51826 | TotalRevenueColumn |
| Exclusion | $51,826 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 143107377 | TotalRevenueColumn |
| Related Or Exempt Function Income | 142676545 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 102307 | UnrelatedBusinessRevenue |
| Exclusion | $242,266 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4009932 | Total |
| Program Services | 3053605 | ProgramServices |
| Management And General | 956327 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99821498 | Total |
| Program Services | 87982369 | ProgramServices |
| Management And General | 11839129 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4732771 | Total |
| Program Services | 4179491 | ProgramServices |
| Management And General | 553280 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14190553 | Total |
| Program Services | 12531620 | ProgramServices |
| Management And General | 1658933 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4759203 | Total |
| Program Services | 4202833 | ProgramServices |
| Management And General | 556370 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12963645 | Total |
| Program Services | 4060147 | ProgramServices |
| Management And General | 8903498 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 750 | Total |
| Program Services | 750 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10746394 | Total |
| Program Services | 10550325 | ProgramServices |
| Management And General | 196069 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6663125 | Total |
| Program Services | 6037531 | ProgramServices |
| Management And General | 625594 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 204207 | Total |
| Program Services | 160724 | ProgramServices |
| Management And General | 43483 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 173609 | Total |
| Program Services | 172387 | ProgramServices |
| Management And General | 1222 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1343263 | Total |
| Program Services | 1205918 | ProgramServices |
| Management And General | 137345 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1667929 | Total |
| Program Services | 1517815 | ProgramServices |
| Management And General | 150114 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1546850 | Total |
| Management And General | 1546850 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 3496430 | 3496430 | |
| MISCELLANEOUS | 1163678 | 72390 | 1091288 |
| RECRUITMENT | 374145 | 374145 | |
| GAIN SHARE EXPENSE | 263438 | 263438 | |
| DUES & LICENSES | 113222 | 94642 | 18580 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168234642 | Total |
| Program Services | 139956560 | ProgramServices |
| Management And General | 28278082 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3433010 | BOY |
| EOY | 3746617 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16586882 | BOY |
| EOY | 17764739 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 711970 | BOY |
| EOY | 1038798 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 71863 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 833205 | BOY |
| EOY | 1349513 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 50673642 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 29863900 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20958970 | BOY |
| EOY | 20809742 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61959577 | BOY |
| EOY | 74312062 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25367837 | BOY |
| EOY | 30287643 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129851451 | BOY |
| EOY | 149380977 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86957945 | BOY |
| EOY | 106785733 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43712416 | BOY |
| EOY | 54046120 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 130670361 | BOY |
| EOY | 160831853 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -818910 | BOY |
| EOY | -11450876 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -818910 | BOY |
| EOY | -11450876 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129851451 | BOY |
| EOY | 149380977 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -25127265 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 14495299 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1460578 | OtherCostOrOtherBasis |
| Book Value | 1460578 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22280255 | OtherCostOrOtherBasis |
| Depreciation | 6950828 | Depreciation |
| Book Value | 15329427 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26932809 | OtherCostOrOtherBasis |
| Depreciation | 22913072 | Depreciation |
| Book Value | 4019737 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 20809742 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN NHP | 72783555 | C |
| INVESTMENT IN TWIN MEDICAL | 886949 | C |
| INVESTMENT FOR UNEMPLOYMENT RESERVE | 641558 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 74312062 | TotalOfBookValueSecurities |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM AFFILIATES | 24930865 |
| DEPOSITS | 42547 |
| 457B PLAN | 5281856 |
| DUE TO 3RD PARTY PAYORS | 32375 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 30287643 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| RETIREMENT PLAN CONTRIBUTION | $5,281,856 |
| DEFERRED COMPENSATION | $1,631,986 |
| PENSION LIABILITY | $28,431,929 |
| ASSET RETIREMENT OBLIGATION | $66,913 |
| LONG-TERM DEBT | $18,633,436 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 54046120 | TotalOfAmounts |
| Total Revenue | 143107377 | TotalRevenue |
| Total Expenses | 168234642 | TotalExpenses |
| Excess Or Deficit For Year | -25127265 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 22110643 | NetUnrealizedGLOnInvestments |
| Other | -$7,615,344 | OtherAmount |
| Total Adjustments | 14495299 | TotalAdjustments |
| Excess Or Deficit Per FS | -10631966 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 165623591 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 22110644 | NetUnrealizedGainsInvestments |
| Other Revenues | 410470 | OtherRevenues |
| Revenue Not Rptd F990 | 22521114 | RevenueNotRptdF990 |
| Revenue Subtotal | 143102477 | RevenueSubtotal |
| Other Revenues Not Included | 4900 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 4900 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 143107377 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 168645112 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 410470 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 410470 | ExpensesNotRptdF990 |
| Expenses Subtotal | 168234642 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 168234642 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | FASB ASC SUBTOPIC 740-10, INCOME TAXES OVERALL, PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE AMOUNT OF UNRECOGNIZED TAX EXPENSE RELATED TO THESE CRITERIA FOR THE CORPORATION WAS ZERO AS OF SEPTEMBER 30, 2011 AND 2010. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | PENSION ADJUSTMENT -8,401,779. ADJUSTMENT TO INVESTMENT IN SUBSIDIARY 786,435. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | EXPENSE ALLOCATION TO RENTAL INCOME 410,470. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | DONATION FROM ST. ELIZABETH COMMUNITY FOUNDATION 4,900. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | EXPENSE ALLOCATION TO RENTAL INCOME 410,470. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (16 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK FAUSTICH MD | |||||||||||||
| 368541 | 0 | 0 | 0 | 1179 | 0 | 28196 | 0 | 7244 | 0 | 405160 | 0 | 0 | 0 |
| JOSEPH MCCORMICKMD | |||||||||||||
| 1096449 | 0 | 0 | 0 | 1140 | 0 | 18640 | 0 | 22893 | 0 | 1139122 | 0 | 0 | 0 |
| JAY MULLER MD | |||||||||||||
| 372671 | 0 | 0 | 0 | 386 | 0 | 18692 | 0 | 18995 | 0 | 410744 | 0 | 0 | 0 |
| DANIEL E NEUFELDER | |||||||||||||
| 187978 | 426730 | 64971 | 147491 | 2136 | 4848 | 15266 | 34655 | 4734 | 10746 | 275085 | 624470 | 0 | 0 |
| JOHN OLIVERIO | |||||||||||||
| 0 | 918033 | 0 | 527500 | 0 | 367685 | 0 | 92775 | 0 | 64950 | 0 | 1970943 | 0 | 350448 |
| CHRISTOPHER ROCKE DO | |||||||||||||
| 232298 | 0 | 0 | 0 | 396 | 0 | 17670 | 0 | 17716 | 0 | 268080 | 0 | 0 | 0 |
| STACEY SENSOR DO | |||||||||||||
| 480983 | 0 | 0 | 0 | 1040 | 0 | 22374 | 0 | 18504 | 0 | 522901 | 0 | 0 | 0 |
| BARBARA STRAND MD | |||||||||||||
| 262911 | 0 | 0 | 0 | 1387 | 0 | 22346 | 0 | 20954 | 0 | 307598 | 0 | 0 | 0 |
| JEFF BADGER | |||||||||||||
| 99405 | 225661 | 29694 | 67409 | 6826 | 15496 | 13001 | 29514 | 6102 | 13853 | 155028 | 351933 | 0 | 0 |
| CHRISTINE GRIGER | |||||||||||||
| 162881 | 0 | 0 | 0 | 29868 | 0 | 0 | 0 | 12456 | 0 | 205205 | 0 | 0 | 0 |
| TIMOTHY LOCH | |||||||||||||
| 229390 | 0 | 46169 | 0 | 7202 | 0 | 15941 | 0 | 22307 | 0 | 321009 | 0 | 0 | 0 |
| ZENOUN ABOUZELAM MD | |||||||||||||
| 1870378 | 0 | 0 | 0 | 4922 | 0 | 26426 | 0 | 26564 | 0 | 1928290 | 0 | 0 | 0 |
| DOUGLAS HORAN MD | |||||||||||||
| 1201461 | 0 | 0 | 0 | 5036 | 0 | 28141 | 0 | 24255 | 0 | 1258893 | 0 | 0 | 0 |
| MICHELE HOLDER MD | |||||||||||||
| 1076250 | 0 | 0 | 0 | 1710 | 0 | 22785 | 0 | 22975 | 0 | 1123720 | 0 | 0 | 0 |
| KHALID ALAM MD | |||||||||||||
| 1114778 | 0 | 0 | 0 | 2457 | 0 | 25349 | 0 | 24256 | 0 | 1166840 | 0 | 0 | 0 |
| JOHN BRADFORD PRACYK MD | |||||||||||||
| 807375 | 0 | 0 | 0 | 1364 | 0 | 13229 | 0 | 15655 | 0 | 837623 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 III | SCHEDULE J PART I LINE 4B JOHN OLIVERIO RECEIVED A 2010 TAXABLE PAYOUT OF $350,448 RELATED TO A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN KNOWN AS THE WHEATON FRANCISCAN SERVICES BENEFIT RESTORATION PLAN. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| THE BOARD OF DIRECTORS RECEIVE A CONFLICT OF INTEREST QUESTIONNAIRE EVERY YEAR. | FORM 990, PART VI, SECTION B, LINE 12C | |
| EACH YEAR THE ORGANIZATION ENGAGES AN INDPENDENT 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 B, LINE 15 | |
| THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 22,110,643. PENSION ADJUSTMENT -8,401,779. ADJUSTMENT TO INVESTMENT IN SUBSIDIARY 786,435. TOTAL TO FORM 990, PART XI, LINE 5: 14,495,299. | FORM 990, PART XI, LINE 5: |
| AUDITED FINANCIAL STATEMENTS | 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 PART XI LINE 2B-2C |
| NETWORK HEALTH SYSTEM, INC. IS A CLINIC AND NOT A LICENSED HOSPITAL. SCHEDULE H IS NOT REQUIRED. | FORM 990, SCHEDULE A, PART 1, LINE 3 | |
| HOURS WORKED FOR RELATED ORGANIZATIONS | JOHN OLIVERIO WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. 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. | FORM 990, PART VII |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AFFINITY HEALTH SYSTEM | |||||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 391568866 | SUPPORT RELATED HEALTHCARE ORGANIZATIONS | IL | 501(C)(3) | 3 | N/A | 0 | |
| MERCY MEDICAL CENTER OF OSHKOSH INC | |||||||||||
| 500 S OAKWOOD | OSHKOSH | WI | 54904 | 390806268 | HEALTH CARE SERVICES | WI | 501(C)(3) | 3 | 0 | AFFINITY HEALTH SYSTEM | |
| ST ELIZABETH HOSPITAL INC | |||||||||||
| 1506 S ONEIDA STREET | APPLETON | WI | 54915 | 390816818 | HEALTH CARE SERVICES | WI | 501(C)(3) | 3 | 0 | AFFINITY HEALTH SYSTEM | |
| ST ELIZABETH HOSPITAL FOUNDATION | |||||||||||
| 1506 S ONEIDA STREET | APPLETON | WI | 54915 | 391256677 | RAISE FUNDS IN SUPPORT OF ST. ELIZABETH HOSPITAL AND RELATED ENTITIES | WI | 501(C)(3) | 7 | 0 | AFFINITY HEALTH SYSTEM | |
| WHEATON FRANCISCAN SERVICES INC | |||||||||||
| 26 W171 ROOSEVELT ROAD | WHEATON | IL | 60187 | 363262111 | SUPPORT RELATED HEALTHCARE ORGANIZATIONS | IL | 501(C)(3) | 11A-1 | N/A | 0 | |
| MERCY HEALTH FOUNDATION INC | |||||||||||
| PO BOX 3370 | OSHKOSH | WI | 54903 | 237140261 | PUBLIC WELFARE THROUGH COMMUNITY HEALTH DEVELOPMENT | WI | 501(C)(3) | 9 | 0 | AFFINITY HEALTH SYSTEM | |
| CALUMET MEDICAL CENTER INC | |||||||||||
| 614 MEMORIAL DRIVE | CHILTON | WI | 53014 | 390905385 | HOSPITAL | WI | 501(C)(3) | 3 | 0 | AFFINITY HEALTH SYSTEM | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN MED LLP | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 22 W COLLEGE AVE SUITE 3B | AddressLine1 |
| City | APPLETON | City |
| State | WI | State |
| ZIP Code | 54911 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391180341 | EIN |
| Primary Activity | RENTAL PROPERTY | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
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 | RELATED | PredominantIncomeType |
| Share Of Total Income | 373376 | ShareOfTotalIncome |
| Share Of EOY Assets | 988602 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| Percentage Ownership | 0.64000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NETWORK HEALTH PLAN | |||||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 391442058 | INSURANCE | WI | NETWORK HEALTH SYSTEM INC | C | 30544538 | 103113529 | 1.00000 |
| NETWORK HEALTH INSURANCE CORPORATION | |||||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 392020474 | INSURANCE | WI | NETWORK HEALTH PLAN | C | -4320742 | 51574868 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 1 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| NETWORK HEALTH PLAN | ||
| A | 6375000 | FAIR MARKET VALUE |
| TWIN MED LLP | ||
| A | 407326 | FAIR MARKET VALUE |
| TWIN MED LLP | ||
| J | 642360 | FAIR MARKET VALUE |
| NETWORK HEALTH PLAN | ||
| N | 16101227 | FAIR MARKET VALUE |