2024-08-15T06:58:24-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-10-01 390884478 BELLIN MEMORIAL HOSPITAL INC BELL 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 JOHN CEELEN CFO 9204457260 2024-08-13 1 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-08-13 2022 2024-08-08 14:25:15Z JOHN CEELEN 744 S WEBSTER AVENUE GREEN BAY WI 54301 870061251 0 X WWW.BELLIN.ORG X 1908 WI BELLIN MEMORIAL HOSPITAL, INC. (BMH) PROVIDES HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BMH, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, BMH PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR ARE UNINSURED OR UNDERINSURED. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID, ARE ALSO CONSIDERED PART OF THE BELLIN HEALTH BENEFITS PROVIDED TO THE COMMUNITY SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN COST. 16 8 5177 225 -629594 0 12359167 3162165 683719953 709523707 11926534 18193165 7239673 15215240 715245327 746094277 417366 370153 0 0 388681979 448123218 0 0 0 299917865 270228938 689017210 718722309 26228117 27371968 907349413 1083165495 297888102 435967534 609461311 647197961 X BELLIN HEALTH IS A COMMUNITY OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR IMPROVING THE HEALTH AND WELLBEING OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN, AND ALL OTHERS WE SERVE. WE CARRY OUT THIS RESPONSIBILITY THROUGH INDIVIDUALIZED CARE EXCELLENCE, COMMUNITY HEALTH IMPROVEMENT, AND EQUITABLE HEALTHCARE FINANCING PLANS ALL DESIGNED TO POSITIVELY IMPACT HEALTH AND WELLBEING. WE ARE STEADFAST IN OUR COMMITMENT TO PROVIDING COMPASSIONATE, SAFE, AND COORDINATED CARE THAT IS ACCESSIBLE AND AFFORDABLE FOR EVERYONE. WE BUILD TRUSTED RELATIONSHIPS AND ADVANCE TRUE COLLABORATION, FUELING OUR DESIRE TO CONSTANTLY IMPROVE AND INNOVATE. 0 0 602191225 370153 722999732 THE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2023 35,889 INPATIENT DAYS WERE PROVIDED (27,406 ADULTS AND PEDIATRICS), AS COMPARED TO 38,920 (34,783 ADULTS AND PEDIATRICS) IN FISCAL YEAR 2022. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2023 AND 2022 WERE 188,613 AND 179,048, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 1,443,533 (AS COMPARED TO 1,217,838 IN 2022) PHYSICIAN CLINIC VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS. 602191225 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 376 0 5177 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ERIC JACOBSON 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 DAVID STAMPFL MD PHYSICIAN 40.00 X 1783573 0 44639 ROBERT ANDERSON MD PHYSICIAN 40.00 X 1633936 0 46003 CHRISTINE WOLESKE EXECUTIVE VICE PRESIDENT 50.00 1.55 X X 1323496 0 30380 PATRICK MCKENZIE MD PHYSICIAN 40.00 X 1197677 0 40151 JAMES SPEARS MD PHYSICIAN 40.00 X 1174033 0 41205 KANWAR ARORA MD PHYSICIAN 40.00 X 1109079 0 20868 SCOTT RATHGABER MD BOARD MEMBER/BGHS CEO 0.50 0.50 X 0 1020916 67219 STEVEN GERNDT MD BOARD MEMBER (THRU 12/2022) 50.00 0.50 X 1027761 0 38384 JENNIFER LYNCH MD B.M./PRESIDENT SPECIALTY GROUP 50.00 X 716659 0 21957 JIM DIETSCHE EVP/CFO/COO 50.00 X 624652 0 34569 PETER VANDEHOUTEN BOARD MEMBER/SVP-LEGAL COUNSEL 50.00 X 487169 0 30399 SHARLA BAENEN BOARD MEMBER/COO 50.00 0.50 X X 457331 0 39616 MICHAEL LANDRUM MD BOARD MEMBER/CMO 50.00 X 385910 0 42756 LAURA HIEB BOARD MEMBER/CNO 50.00 0.50 X 333362 0 25448 ROBERT MEAD MD B.M./PAST PRES. ME (THRU 03/2022) 50.00 0.50 X 319361 0 37328 LISA HARTON BOARD MEMBER (THRU 12/2022)/CQO 50.00 0.50 X 250970 0 24811 NAN BUSH BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 151472 0 33562 PAUL CASEY MD PRES MED STAFF (THRU 03/2022) 40.00 0.25 X 135250 0 0 STEVE LITTLE BMH CFO (START 08/2023) 45.00 2.00 X 0 0 0 GERALD OETZEL BMH CFO (THRU 08/2023) 45.00 2.00 X 0 0 0 TERRY FULWILER CHAIR 0.50 0.50 X X 0 0 0 JOHN DYKEMA VICE CHAIR 0.50 0.50 X X 0 0 0 ELL LEE DDS BOARD TREASURER 0.50 0.50 X X 0 0 0 NANCY ARMBRUST BOARD MEMBER 0.50 0.50 X 0 0 0 SAIED ASSEF MD B.M. /PHYSICIAN DIRECTOR 50.00 0.50 X 0 0 0 SUSAN FINCO BOARD MEMBER 0.50 0.50 X 0 0 0 BARB GILLING BOARD MEMBER 0.50 1.00 X 0 0 0 BRAD WOZNEY MD BOARD MEMBER 0.50 X 0 0 0 MARK MCMULLEN BOARD SECRETARY (THRU 03/2022) 0.50 0.50 X X 0 0 0 DANIEL ARIENS BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 CONNIE BOERST BOARD MEMBER (THRU 12/2022) 0.50 X 0 0 0 BILL BOHN BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 BOB CLAUSEN BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 G CORT CONDON BOARD MEMBER (THRU 03/2022) 0.50 0.50 X 0 0 0 JANE DANOWIT MD BOARD MEMBER (THRU 12/2022) 0.50 X 0 0 0 MICHAEL HADDAD BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 SAID HASSAN BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 GEORGE KERWIN BOARD MEMBER (THRU 12/2022) 0.50 X 0 0 0 CINDY LASECKI MD BOARD MEMBER 0.50 X 0 0 0 NICOLE POLAREK BOARD MEMBER (THRU 12/2022) 0.50 X 0 0 0 JAMES RIDER MD BOARD MEMBER (THRU 12/2022) 0.50 X 0 0 0 MARK RINGWELSKI MD B.M./FORM. PRES. S (THRU 03/2022) 40.00 X 0 0 0 FRED SCHMIDT MD BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 KARL SCHMIDT BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 SABINA SINGH MD BOARD MEMBER/PRES MED (THRU 03/2022) 50.00 X 0 0 0 JAMIE SPITZER BOARD MEMBER (THRU 12/2022) 0.50 0.50 X 0 0 0 WILLIAM WITTMAN MD B.M. (THRU 12/2022)/BMG PHYSICIAN 0.50 0.50 X 0 0 0 13111691 1020916 619295 574 0 1 1 MIRON CONSTRUCTION CO INC 1471 MCMAHON DR NEENAH WI 54956 GENERAL CONTRACTOR 32693209 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 CONTRACTED NURSING SERVICES 12128879 IEI GENERAL CONTRACTORS INC 1725 MIDWAY RD DE PERE WI 54115 FACILITY CONTRACTORS 9706843 COMPHEALTH MEDICAL STAFFING 6440 S MILLROCK DR STE 175 SALT LAKE CITY UT 84121 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 4902185 APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 4679362 66 1809960 430146 922059 3162165 NET PATIENT SERVICE REVENUE 621500 693900773 695113703 -1212930 CONTRACTED SERVICES 621110 2344250 2344250 CAFETERIA REVENUE 621110 1907509 1907509 11371175 10816464 533633 21078 709523707 11060280 11060280 988123 49703 547901 0 440222 49703 489925 49703 440222 130483978 67980 123414913 4160 7069065 63820 7132885 7132885 EHR INCENTIVE 621110 14440193 14440193 GAIN FROM HEALTHCARE AFFILIATES 900099 285122 285122 14725315 746094277 722999732 -629594 20561974 370153 370153 8687181 3834017 4853164 363120831 310272380 52848451 16018736 13655165 2363571 39079622 32362826 6716796 21216848 17684726 3532122 458094 458094 225691 225691 21104 21104 604307 604307 12224073 8938753 3285320 8181945 34389 8147556 5983817 3087197 2896620 16665765 2535929 14129836 9367127 8562712 804415 1488166 1054166 434000 2013083 1036819 976264 5650651 1162880 4487771 29922586 23601887 6320699 1421472 399394 1022078 SUPPLIES 135292165 135292165 EQUIPMENT RENT & MAINT 15063837 12660612 2403225 BAD DEBTS 13091929 13091929 WI MEDICAID ACCESS FEE 6746824 6746824 5806302 5806302 718722309 602191225 116531084 0 17629 18550 180262803 210714059 88921401 101931900 17840978 8826274 8227116 9708728 10229106 8827986 700660513 295718870 323260362 404941643 217121175 271503593 35083920 36926044 618206 0 25766717 29766718 907349413 1083165495 82973519 93132598 200000 0 83297695 215703875 131416888 127131061 297888102 435967534 X 604027313 641329740 5433998 5868221 609461311 647197961 907349413 1083165495 X 27371968 9720987 643695 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21104 21104 0 PART II-B, LINE 1: BELLIN MEMORIAL HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) & AMERICAN HOSPITAL ASSOCIATION VIA WHA. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED THE HOSPITAL THAT $21,104 OF THE COMBINED ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 2628543 156644 170469 23803 2931853 2831774 55830 -229949 29112 2628543 2628725 22638 209789 29378 2831774 2570504 29310 68422 39511 2628725 2516577 95800 42781 84654 2570504 0.00000 0.88357 0.11643 0 1 1 10199811 10199811 272262238 105224224 167038014 273198855 190494646 82704209 144999609 144999609 404941643 DEFERRED COMPENSATION 19526176 FINANCE LEASE OBLIGATIONS 94953916 OPERATING LEASE OGLIGATIONS 9223573 DUE TO RELATED PARTIES 3427396 127131061 PART V, LINE 4: A RELATED ORGANIZATION, THE BELLIN HEALTH FOUNDATION, INC., HAS SEVERAL ENDOWMENT FUNDS. THE ENDOWMENT FUNDS ARE DESIGNATED FOR SCHOLARSHIPS, HEALTH CARE SERVICES AND EMPLOYEE TRAINING AND DEVELOPMENT. 1 1 X 1 X 220.000000000000 1 X 1 1 1 0 1 1 4035734 4035734 0.00570 80181150 40674177 39506973 0.05600 84216884 40674177 43542707 0.06170 5374765 5374765 0.00760 6889488 6889488 0.00980 6690347 6690347 0.00950 18954600 18954600 0.02690 103171484 40674177 62497307 0.08860 369833 369833 0.00050 369833 369833 0.00050 1 4796683 0 209070699 242925946 -33855247 X 1 1 1 1 BELLIN MEMORIAL HOSPITAL 744 S WEBSTER AVE GREEN BAY WI 54305 WWW.BELLIN.ORG 147 X X X BELLIN MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 21 1 SEE PART V, SECTION B, LINE 7D 0 1 X 220.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C, LINES 16A-C X SEE PART V, SECTION C, LINES 16A-C X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE PRIORITIES FROM 2020-2021 WERE MENTAL HEALTH, ALCOHOL/DRUG USE AND ABUSE, AND NUTRITION/PHYSICAL ACTIVITY. WE NOW KNOW THAT WE NEED TO LOOK AT THE REASONS WHY HEALTH GAPS EXIST. COMMUNITY FEEDBACK WAS INCLUDED IN THE COMMUNITY MEMBER CHA SUMMARY. FEEDBACK WAS SOLICITED IN THE FOLLOWING WAYS:- ONGOING CHA/CHIP SURVEY ON THE BCHP WEBSITE, WHICH ASKS FOR FEEDBACK IN ENGLISH, HMONG OR SPANISH. SEVENY-NINE RESPONSES WERE RECEIVED FROM THE GENERAL PUBLIC. - ORGANIZATIONAL REPRESENTATIVES WERE ALSO SURVEYED AND ASKED FOR THEIR FEEDBACK ON THE PRIORITIES, WITH TWENTY-ONE RESPONSES, WITH THOSE ORGANIZATIONS LISTED BELOW.- ADS WERE RUN IN THE NEWSPAPER AND ON SOCIAL MEDIA ASKING FOR COMMUNITY MEMBERS' FEEDBACK -BEYOND HEALTH STEERING COMMITTEE, WHICH INCLUDES REPRESENTATION FROM LOCAL PUBLIC HEALTH AGENCIES, AREA HEALTH SYSTEMS, AND COMMUNITY AGENCIES. THE FOLLOWING ARE REPRESENTED ON THE BEYOND HEALTH STEERING COMMITTEE:- BROWN COUNTY PUBLIC HEALTH- DE PERE HEALTH DEPARTMENT- WI DEPARTMENT OF HEALTH SERVICES, DIVISION OF PUBLIC HEALTH- BROWN COUNTY UNITED WAY- NEW COMMUNITY CLINIC- PREVEA HEALTH- HSHS- ADVOCATE AURORA- BELLIN HEALTHORGANIZATIONS REPRESENTED THROUGH FEEDBACK TO SURVEYS:- UNIVERSITY OF WISCONSIN-MADISON, DIVISION OF EXTENSION BROWN COUNT- BROWN COUNTY VETERANS SERVICE- WELLO- FORWARD SERVICE CORPORATION- JACKIE NITSCHKE CENTER- THE FRIENDS OF THE FOX RIVER TRAIL- OPTIONS FOR INDEPENDENT LIVING- NWTC- GREEN BAY AREA PUBLIC SCHOOLS- CONNECTIONS FOR MENTAL WELLNESS- UNIVERSITY OF WISCONSIN-MADISON, DIVISION OF EXTENSION FOODWISE- ASHWAUBENON SCHOOL DISTRICT- UW CENTER FOR TOBACCO RESEARCH AND INTERVENTION- GREEN BAY POLICE DEPT- NEW NORTH, INC.- DOWNTOWN GREEN BAY, INC.- ONEIDA COMMUNITY HEALTH SERVICES- HMONG/ASIAN COMMUNITY BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: AURORA BAYCARE MEDICAL CENTER (GREEN BAY) AND ST. MARY'S AND ST. VINCENT HOSPITALS (HSHS, GREEN BAY) BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BEYOND HEALTH, A STEERING COMMITTEE COMPRISED OF LEADERS FROM BOTH THE PUBLIC AND PRIVATE SECTORS: HEALTHCARE PARTNERS, PUBLIC HEALTH AGENCIES, AND NON-PROFIT PARTNERS WHO WORK COLLABORATIVELY TO IDENTIFY ACTIONABLE PRIORITIES, MINIMIZE DISPARITIES IN HEALTH, AND ADAPT AS NEEDED TO NEW AND EMERGING HEALTH CONCERNS. BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A & 10A:HTTPS://BELLIN.ORG/ABOUT-BELLIN-HEALTH/COMMUNITY-HEALTH-INITIATIVES BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2021 THROUGH 2023.AS DETAILED IN THE CHNA REPORT, BELLIN HEALTH, IN COLLABORATION WITH COMMUNITY PARTNERS, IDENTIFIED THE FOLLOWING HEALTH PRIORITIES IN BROWN COUNTY: EQUITABLE ACCESS SOCIAL COHESION UNIFIED PLANNING AND POLICYUNDER THE BROAD UMBRELLAS OF THESE PRIORITIES, BASED ON THE HEALTH OUTCOME DATA AND OBSERVED COMMUNITY NEEDS, BELLIN HAS CHOSEN TO FOCUS SPECIFICALLY ON THE AREAS OUTLINED IN THE ACTION PLAN.PLANNED ACTIONS EQUITABLE ACCESSSTRATEGY: PARTNER WITH LOCAL HEALTH SYSTEMS AND THE N.E.W. COMMUNITY CLINIC ON EFFORTS TO INCREASE ACCESS TO PREVENTATIVE SCREENINGS AND EARLY INTERVENTION SERVICES FOR DIVERSE POPULATIONS. PRIORITY FOCUS WILL BE AROUND ACCESS TO DIABETES SERVICES AND EQUITABLE ACCESS TO DEPRESSION SCREENINGS.STRATEGY: INCREASE ACCESS TO SCREENINGS AND EARLY INTERVENTION SERVICES FOR INDIVIDUALS OF COLOR AND THE SOMALI AND REFUGEE COMMUNITY.STRATEGY: CONTINUE TO SUPPORT THE ORAL HEALTH PARTNERSHIP AND PROVIDE ACCESS TO ORAL CARE FOR THE LOW-INCOME CHILDREN IN OUR COMMUNITY.PLANNED ACTIONS UNIFIED POLICY AND PLANNINGSTRATEGY: CONTINUE TO SUPPORT THE ALCOHOL AND DRUG COALITION FOR CHANGE WITH COMMUNITY PARTNERS TO INCREASE POLICY CHANGES THAT CREATE SAVER COMMUNITIES AND SUPPORT CULTURAL CHANGE AROUND ALCOHOL AND DRUG USE.STRATEGY: LEAD A UNIQUE COLLABORATION WITH LOCAL NURSING HOME, HEALTH SYSTEM, COLLEGE, AND THE WISCONSIN NATIONAL GUARD TO PRODUCE MORE CERTIFIED NURSING ASSISTANTS (CNAS) AND INCREASE CAPACITY AT A LOCAL NURSING HOME.PLANNED ACTIONS SOCIAL COHESIONSTRATEGY: FACILITATION OF THE COMMUNITY-WIDE ALCOHOL AND DRUG COALITION FOR CHANGES WITH A FOCUS ON INTERVENTIONS THAT LEAD TO INCREASED SOBER AWARENESS AND CULTURAL CHANGE AT LOCAL EVENTS AND BUSINESSES.HEALTH NEEDS THAT WILL NOT BE ADDRESSED AT THIS TIME:IN ADDITION TO THE HEALTH NEEDS BELLIN SELECTED AS TOP PRIORITIES, THE CHNA IDENTIFIED OTHER SIGNIFICANT HEALTH NEEDS IN BROWN COUNTY. STRATEGY OWNERS/ORGANIZATIONS ARE ASSIGNED TO LEAD WORK WITHIN THIS SPACE AND CAPITALIZE ON COMMUNITY RESOURCES AND PARTNERS COLLABORATING TO ADDRESS THE NEEDS. BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY INCLUDES FACTORS AS: HOMELESS, DECEASED WITH NO KNOWN ESTATE, APPROVED COURT BANKRUPTCY, PAYMENT ASSISTANCE RANK ORDER SCORE, ELIGIBLE FOR STATE OF WI FOOD SHARE PROGRAM. PART V, SECTION B, LINES 16A-C: PART V, SECTION B, LINE 16A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BELLIN_-_BUSOF.001_-_FINANCIAL_ASSISTANCE_POLICY.PDFPART V, SECTION B, LINE 16B:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/COMMUNITY_CARE_APPLICATION.PDFPART V, SECTION B, LINE 16C:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BELLIN_-_PLAIN_LANGUAGE_SUMMARY_-_PATIENT_FINANCIAL_ASSISTANCE.PDF 34 1 - FAMILY MEDICAL CENTER ASHWAUBENON 1630 COMMANCHE AVE GREEN BAY WI 54313 PROVIDER CLINIC SITE 2 - BELLIN HEALTH TITLETOWN SPORTS MEDICINE 1970 S RIDGE ROAD GREEN BAY WI 54304 PROVIDER CLINIC SITE 3 - BELLIN HEALTH IRON MOUNTAIN 440 WOODWARD AVE IRON MOUNTAIN MI 49801 PROVIDER CLINIC SITE 4 - FAMILY MEDICAL CENTER BELLEVUE 3263 EATON RD GREEN BAY WI 543116830 PROVIDER CLINIC SITE 5 - FAMILY MEDICAL CENTER DE PERE EAST 555 REDBIRD CIRCLE DE PERE WI 54115 PROVIDER CLINIC SITE 6 - NEUROLOGY CONSULTANTS OF BELLIN HEALTH 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 7 - BELLIN HEALTH ESCANABA 610 S LINCOLN ROAD ESCANABA MI 49829 PROVIDER CLINIC SITE 8 - FAMILY MEDICAL CENTER HOWARD 2714 RIVERVIEW GREEN BAY WI 54313 PROVIDER CLINIC SITE 9 - BELLIN HEALTH GENERATIONS 704 S WEBSTER AVE SUITE 300 GREEN BAY WI 54301 PROVIDER CLINIC SITE 10 - FAMILY MEDICAL CENTER GREEN BAY 704 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 11 - BELLIN HEALTH EAR NOSE AND THROAT 923 ELIZA ST GREEN BAY WI 54301 PROVIDER CLINIC SITE 12 - FAMILY MEDICAL CENTER DE PERE WEST 1800 LAWRENCE DR DE PERE WI 54115 PROVIDER CLINIC SITE 13 - FAMILY MEDICAL CENTER KEWAUNEE 575 - 4TH STREET KEWAUNEE WI 54216 PROVIDER CLINIC SITE 14 - FAMILY MEDICAL CENTER BRILLION 964 W RYAN ST SUITE B BRILLION WI 54110 PROVIDER CLINIC SITE 15 - THE CANCER TEAM OF BELLIN HEALTH 1580 COMMANCHE AVE GREEN BAY WI 54313 HOSPITAL BASED SITE 16 - FAMILY MEDICAL CENTER ALGOMA 831 PARKER AVE ALGOMA WI 54201 PROVIDER CLINIC SITE 17 - FAMILY MEDICAL CENTER MANITOWOC 3415 CUSTER ST SUITE D MANITOWOC WI 54221 PROVIDER CLINIC SITE 18 - BELLIN HEALTH ASTHMA & ALLERGY 519 S MONROE AVENUE GREEN BAY WI 54301 PROVIDER CLINIC SITE 19 - BELLIN HEALTH SURGICAL ASSOCIATES 720 S VAN BUREN ST SUITE 201 GREEN BAY WI 54301 PROVIDER CLINIC SITE 20 - CARDIOLOGY ASSOCIATES OF BELLIN HEALTH 744 S WEBSTER AVE GREEN BAY WI 54301 HOSPITAL BASED SITE 21 - GASTROENTEROLOGY ASSOCIATES OF GREEN BAY 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 22 - FAMILY MEDICAL CENTER DENMARK 595 COUNTY ROAD R DENMARK WI 54208 PROVIDER CLINIC SITE 23 - BELLIN HEALTH ENDOCRINOLOGY 704 S WEBSTER SUITE 501 GREEN BAY WI 54301 PROVIDER CLINIC SITE 24 - FAMILY MEDICAL CENTER SEYMOUR 405 COMMERCIAL ST SEYMOUR WI 54165 PROVIDER CLINIC SITE 25 - FAMILY MEDICAL CENTER PULASKI 723 S WISCONSIN ST PULASKI WI 541620109 PROVIDER CLINIC SITE 26 - FAMILY MEDICAL CENTER LUXEMBURG 140 B SCHOOL CREEK TRAIL LUXEMBURG WI 54217 PROVIDER CLINIC SITE 27 - FAMILY MEDICAL CENTER STURGEON BAY 311 N 3RD AVE STURGEON BAY WI 43235 PROVIDER CLINIC SITE 28 - FAMILY MEDICAL CENTER WRIGHTSTOWN 555 QUALITY CT WRIGHTSTOWN WI 54180 PROVIDER CLINIC SITE 29 - BELLIN HEALTH NEPHROLOGY 2020 RIVERSIDE DR SUITE 200 GREEN BAY WI 54301 PROVIDER CLINIC SITE 30 - FAMILY MEDICAL CENTER BONDUEL 401 W MILL ST BONDUEL WI 54107 PROVIDER CLINIC SITE 31 - BELLIN HEALTH FASTCARE - GREEN BAY WEST 2015 SHAWANO AVE GREEN BAY WI 54303 CONVENIENT CARE CENTER 32 - BELLIN HEALTH FASTCARE - GREEN BAY EAST 1976 LIME KILN RD GREEN BAY WI 54311 CONVENIENT CARE CENTER 33 - FAMILY MEDICAL CENTER TWO RIVERS 1516 WASHINGTON STREET TWO RIVERS WI 54241 PROVIDER CLINIC SITE 34 - BELLIN HEALTH CARDIOVASCULAR & THORACIC SU 720 S VAN BUREN ST SUITE 303 GREEN BAY WI 54301 PROVIDER CLINIC SITE PART I, LINE 6A: BELLIN MEMORIAL HOSPITAL IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. PART I, LINE 7: AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $13,091,929 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES FOCUS ON SOCIAL CONDITIONS THAT CONTRIBUTE TO HEALTH PROBLEMS, SUCH AS HOMELESSNESS, POVERTY, AND OTHER LIVING CONDITIONS AFFECTING THE QUALITY OF LIFE. THESE RANGE FROM DEVELOPING COMMUNITY LEADERS, DISASTER READINESS, AND SUPPORT OF LOCAL ECONOMIC DEVELOPMENT, TO HEALTH IMPROVEMENT ADVOCACY. BELLIN MEMORIAL HOSPITAL IS ACTIVE IN THE GREEN BAY PUBLIC SCHOOLS WITH OUR THRIVE PROGRAM THAT ASSISTS IN SETTING AND MEETING HEALTH AND WELLNESS GOALS FOR STUDENTS IN THIS SCHOOL SYSTEM. BELLIN ALSO HOLDS AN ANNUAL BELLIN RUN/WALK 10K EVENT EACH YEAR WITH OVER 7,000 PARTICIPANTS OF ALL AGES LEARNING FIRST-HAND THE VALUE OF EXERCISE IN DAILY LIFE. PART III, LINE 2: THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS. PART III, LINE 3: THE HOSPITAL UTILIZES HFMA #15 THEREFORE NONE OF THE BAD DEBT WOULD BE DEEMED CHARITY CARE. PART III, LINE 4: THE ATTACHED FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES DESCRIBES THE HOSPITAL'S POLICY ON PAGE 19 OF THE FINANCIAL STATEMENTS. CONSISTENT WITH BELLIN HEALTH SYSTEMS' MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, BELLIN HEALTH SYSTEMS HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS BELLIN HEALTH SYSTEMS EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. BELLIN HEALTH SYSTEMS' POLICY IS TO PROVIDE A 35% DISCOUNT FROM ESTABLISHED CHARGES TO UNINSURED PATIENTS. THIS POLICY DID NOT CHANGE IN 2023 AND 2022. PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RULE 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENT WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, FOR-PROFIT HOSPITALS HAVE CARVED OUT HIGH-MARGIN SERVICES (I.E. ONCOLOGY, ORTHO, ETC.) LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS MEANS THAT THE SHORTFALL IS NOT NECESSARILY FROM INEFFICIENT OPERATIONS. MEDICARE CAN BE THE LARGEST PAYOR AND HOSPITALS HAVE NO ABILITY TO DENY COVERAGE. THIS, IN TURN, IS A PROMOTION OF ACCESS TO HEALTHCARE SERVICES (A COMMUNITY BENEFIT). ALSO, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. PART III, LINE 9B: FOR PATIENTS WHO CANNOT MEET THE EXPECTATIONS OF THE DEBT COLLECTION POLICY, THE ORGANIZATION OFFERS FINANCIAL ASSISTANCE. THE ORGANIZATION WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE DETERMINING WHETHER A GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM AS PART OF THE REGISTRATION PROCESS IN ADDITION, ALL STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE AVAILABILITY. PART VI, LINE 2: IN FY2023, BELLIN MEMORIAL HOSPITAL CONTINUALLY ASSESSED THE HEALTHCARE NEEDS OF OUR COMMUNITIES, IN PARTNERSHIP WITH THE BEYOND HEALTH COLLABORATIVE OF BROWN COUNTY, WIUNDER STRATEGY 1.3 IMPROVING EQUITABLE ACCESS TO HEALTHCARE, EFFORTS CONTINUE TO ASSESS AND ADDRESS HEALTHCARE DISPARITIES AROUND DEPRESSION SCREENINGS (PHQ-9), BREAST CANCER SCREENINGS, AND COLORECTAL CANCER SCREENING FOR OUR POPULATIONS. BELLIN HEALTH HAS IMPLEMENTED TARGETED IMPROVEMENT EFFORTS TO STRATIFY OUR DATA BY RACE, ETHNICITY, GENDER, AND PAYER TO IDENTIFY AND GAIN KNOWLEDGE OF ROOT CAUSES OF DISPARITIES. INTERVENTIONS INCLUDE TARGETED OUTREACH AND EDUCATION IN PATIENT'S PREFERRED LANGUAGE, COLLECTION, AND REVIEW OF QUANTITATIVE AND QUALITATIVE DATA FROM COMMUNITY POPULATIONS, AND EFFORTS TO REMOVE BARRIERS TO SCREENING WITH EXTENDED HOURS OF SERVICE AS WELL AS TRANSPORTATION AND TARGETED STRATEGIES WITH PAYER AND EMPLOYER POPULATIONS. DATA COLLECTION ON THE SOCIAL DETERMINANTS OF HEALTH CONTINUE TO INFORM TEAMS AND DRIVE DECISIONS ON CONNECTING PATIENTS TO LOCAL RESOURCES. MONTHLY MEETINGS CONTINUE VIRTUALLY TO ADDRESS THESE DISPARITIES AND ENGAGE MULTIPLE INTERNAL AND EXTERNAL STAKEHOLDERS INCLUDING EMPLOYER PARTNERS. PART VI, LINE 3: FINANCIAL COUNSELORS ADVISE PATIENTS OF ASSISTANCE PROGRAMS. A SERVICE CALLED HRS ERASE IS USED TO REVIEW SELF-PAY ACCOUNTS FOR POSSIBLE COVERAGE THROUGH GOVERNMENT PROGRAMS. PART VI, LINE 4: BELLIN MEMORIAL HOSPITAL SERVES NORTHEAST WISCONSIN AND UPPER MICHIGAN. THE BELLIN REGION ENCOMPASSES A POPULATION OF OVER 968,000 PEOPLE, WITH A MEDIAN AGE OF 42 YEARS OLD. THE AREA IS APPROXIMATELY 44% URBAN, 36% RURAL AND 20% SUBURBAN. REGIONALLY, 88% OF THE POPULATION IS WHITE NON-HISPANIC, 5% HISPANIC, 1% BLACK NON-HISPANIC, AND 6% OTHER NON-HISPANIC. OUR CURRENT PAYOR SUPPLEMENTAL INFORMATION MIX IS 43% MEDICARE AND 42% MEDICAID. PART VI, LINE 5: A MAJORITY OF BELLIN MEMORIAL HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN BELLIN MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, BELLIN MEMORIAL HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. BELLIN MEMORIAL HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, EDUCATION, AND FACILITIES. PART VI, LINE 6: BELLIN HEALTH IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. DIRECTLY, AND IN PARTNERSHIP WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE GUIDE INDIVIDUALS AND FAMILIES IN THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. WE ARE COMMITTED TO PROVIDING SAFE, RELIABLE, COST-EFFECTIVE TOTAL HEALTH SOLUTIONS WITH RESPECT AND COMPASSION. OUR INNOVATIVE WORK WILL IMPACT HEALTHCARE DELIVERY IN OUR REGION AS WELL AS THROUGHOUT THE WORLD. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 NEW COMMUNITY CLINIC 610 N BROADWAY GREEN BAY WI 54303 391200636 501(C)(3) 50000 0 DONATION FAMILY SERVICES OF NORTHEAST WISCONSIN INC 300 CROOKS ST GREEN BAY WI 54305 390827320 501(C)(3) 45000 0 DONATION ENCOMPASS EARLY EDUCATION AND 2589 S WEBSTER AVE GREEN BAY WI 54301 390824004 501(C)(3) 30000 0 DONATION GREATER GREEN BAY COMMUN FOUND 310 W WALNUT GREEN BAY WI 54303 391699966 501(C)(3) 49400 0 GREEN BAY NEIGHBORHOOD LEADERSHIP COUNCIL, ACHIEVE BROWN COUNTY ALTRUSA HOUSE 1116 E MASON ST GREEN BAY WI 54301 391593989 501(C)(3) 25000 0 COMMUNITY SPONSORSHIP YWCA GREATER GREEN BAY 230 S MADISON ST GREEN BAY WI 54301 390806277 501(C)(3) 25000 0 DONATION ACHIEVE BROWN COUNTY 340 N BROADWAY STE 400 GREEN BAY WI 54303 474100686 501(C)(3) 20000 0 CAMPAIGN PLEDGE UNIV OF WI GREEN BAY 2420 NICOLET DR GREEN BAY WI 54311 391805963 GOVT-STATE AGENCY 20000 0 MARK REINKE, MD MEMORIAL SCHOLARSHIP CURATIVE CONNECTIONS 2900 CURRY LN GREEN BAY WI 54311 390806435 501(C)(3) 15000 0 DONATION KIWANIS SKI CLUB LOWER PINE MOUNTAIN RD IRON MOUNTAIN MI 49801 383254313 501(C)(3) 10000 0 COMMUNITY SPONSORSHIP NEVILLE PUBLIC MUSEUM PO BOX 325 GREEN BAY WI 54305 930756332 501(C)(3) 10000 0 DONATION ALZHEIMER'S ASSOCIATION 225 N MICHIGAN AVE FLOOR 17 CHICAGO IL 60601 133039601 501(C)(3) 5500 0 DONATION 12 0 PART I, LINE 2: THE ORGANIZATION REQUIRES A COMPREHENSIVE REQUEST OF THE GRANTEE TO PROVIDE RATIONALE FOR THE REQUEST. REQUIRED INFORMATION TO BE PROVIDED BY THE GRANTEE INCLUDES, TAX-EXEMPT STATUS, IDENTIFICATION OF USE OF RESOURCES AND FOLLOW UP INFORMATION AS TO THE UTILIZATION OF THE RESOURCES. THE ORGANIZATION REVIEWS EACH GRANTEE REQUEST IN RELATIONSHIP TO THE MISSION OF THE ORGANIZATION AND COMMUNITY SUPPORT. ALL REQUESTS REQUIRE APPROVAL BY SENIOR LEADERSHIP OF THE ORGANIZATION. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 DAVID STAMPFL MD PHYSICIAN 1686385 0 96000 0 1188 0 21166 0 23473 0 1828212 0 0 0 ROBERT ANDERSON MD PHYSICIAN 1536804 0 94846 0 2286 0 22650 0 23353 0 1679939 0 0 0 CHRISTINE WOLESKE EXECUTIVE VICE PRESIDENT 918647 0 250000 0 154849 0 19922 0 10458 0 1353876 0 141843 0 PATRICK MCKENZIE MD PHYSICIAN 1194391 0 1000 0 2286 0 19385 0 20766 0 1237828 0 0 0 JAMES SPEARS MD PHYSICIAN 905552 0 266195 0 2286 0 17732 0 23473 0 1215238 0 0 0 KANWAR ARORA MD PHYSICIAN 1012305 0 96000 0 774 0 18217 0 2651 0 1129947 0 0 0 SCOTT RATHGABER MD BOARD MEMBER/BGHS CEO 0 1015579 0 180 0 5157 0 44225 0 22994 0 1088135 0 0 STEVEN GERNDT MD BOARD MEMBER (THRU 12/2022) 903669 0 123318 0 774 0 17661 0 20723 0 1066145 0 0 0 JENNIFER LYNCH MD B.M./PRESIDENT SPECIALTY GROUP 620195 0 96050 0 414 0 20677 0 1280 0 738616 0 0 0 JIM DIETSCHE EVP/CFO/COO 514542 0 50000 0 60110 0 6962 0 27607 0 659221 0 49313 0 PETER VANDEHOUTEN BOARD MEMBER/SVP-LEGAL COUNSEL 367216 0 88375 0 31578 0 19728 0 10671 0 517568 0 30804 0 SHARLA BAENEN BOARD MEMBER/COO 366586 0 60000 0 30745 0 14581 0 25035 0 496947 0 20236 0 MICHAEL LANDRUM MD BOARD MEMBER/CMO 326936 0 58560 0 414 0 24198 0 18558 0 428666 0 0 0 LAURA HIEB BOARD MEMBER/CNO 298065 0 0 0 35297 0 13665 0 11783 0 358810 0 28553 0 ROBERT MEAD MD B.M./PAST PRES. ME (THRU 03/2022) 289970 0 27105 0 2286 0 15741 0 21587 0 356689 0 0 0 LISA HARTON BOARD MEMBER (THRU 12/2022)/CQO 215556 0 35000 0 414 0 15337 0 9474 0 275781 0 0 0 NAN BUSH BOARD MEMBER (THRU 12/2022) 134186 0 15000 0 2286 0 10848 0 22714 0 185034 0 0 0 PART I, LINE 1A BELLIN MEMORIAL HOSPITAL PAYS FOR A PORTION OF MEMBERSHIP DUES AT A LOCAL COUNTRY CLUB FOR CHRISTINE WOLESKE IN ORDER TO HOLD VARIOUS EVENTS AT THE CLUB. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION. PART I, LINE 4B THE HOSPITAL HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. LAURA HIEB, PETER VANDEHOUTEN, SHARLA BAENEN, JAMES DIETSCHE AND CHRISTINE WOLESKE PARTICIPATED IN THE 457(F) PLAN. THE FOLLOWING DISTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2022: CHRISTINE WOLESKE $141,843 JAMES DIETSCHE $49,313 PETER VANDEHOUTEN $30,804 LAURA HIEB $28,553 SHARLA BAENEN $20,236 FORM 990, PART VII, SECTION A, LINE 5 SAIED ASSEF WAS COMPENSATED BY BELLIN HEALTH PARTNERS, AN UNRELATED ORGANIZATION, FOR INDIVIDUAL SERVICES RENDERED TO BELLIN MEMORIAL HOSPITAL, INC. IN THE AMOUNT OF $180,875 DURING CALENDAR YEAR 2022. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DLH7 2015-04-09 44994006 REFUND AND LEGALLY DEFEASE 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2011-11-23 12944000 REFINANCING OF 2001 BONDS 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-08-29 35000000 FUNDING OF NICU EXPANSION PROJECT AND VARIOUS RENOVATION AND EQUIPMENT PURCH 0 0 0 D WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-08-29 8000000 FUNDING OF IT INFRASTRUCTURE 0 0 0 A 2355000 44994006 528236 44465770 2009 0 1 1 1 B 1514000 12944000 79844 2001 1 0 1 1 C 41624205 12546069 314452 28763684 2023 0 0 1 1 D 8351848 74748 8277100 2023 0 0 1 1 A 0 1 1 1 0 0.01000 0.01000 1 0 1 B 0 1 1 1 0 0.01000 0.01000 1 0 1 C 0 1 1 1 0 0.01000 0.01000 1 0 1 D 0 1 1 1 0 0.01000 0.01000 1 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2022-12-14 100000000 AMBULATORY SURGERY CENTER BUILDING COMPONENTS 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712JGU1 2022-12-14 30000000 AMBULATORY SURGERY CENTER MOVEABLES AND EQUIPMENT 0 0 0 A 106130278 2073735 982522 103074021 0 0 0 1 B 31617523 31302977 314546 0 0 0 1 A 0 1 1 1 0 0.01000 0.01000 1 0 1 B 0 1 1 1 0 0.01000 0.01000 1 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 SUSAN FINCO OWNER OF LEONARD & FINCO COMMUNICATIONS 51513 PROVISION OF MARKETING SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 SABINA SINGH, MARK MCMULLEN, AND TERRY FULWILER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC. HAS THE POWER TO APPOINT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC., HAS THE POWER TO APPROVE MAJOR EXPENDITURES AND LONG-TERM BORROWINGS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED IN DETAIL BY SENIOR ADMINISTRATION AND IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR A CONFLICT OF INTEREST REQUEST DOCUMENT IS PROVIDED TO EACH BOARD MEMBER. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. ALL EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AS PART OF ANNUAL MANDATORY EDUCATION. IF THERE IS A CONFLICT OF INTEREST, THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE WHICH IS A COMMITTEE OF THE BOARD OF DIRECTORS IS NOTIFIED. THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE ADDRESSES THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANT'S REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. CEO COMPENSATION: CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA TO THE RESULTS AND COMES UP WITH A RECOMMENDATION. THE CHAIR FACILITATES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. SENIOR LEADERS: COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. 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. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 953,821. INTEREST RATE SWAP AGREEMENT -310,126. FORM 990, PART XI, LINE 2B-2C BELLIN MEMORIAL HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED AUDIT OF BELLIN HEALTH SYSTEMS, INC. THE BOARD OF DIRECTORS OF BELLIN HEALTH SYSTEMS, INC. ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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