2023-08-11T08:11:30-05:00 2022-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-10-01 390884478 BELLIN MEMORIAL HOSPITAL INC BELL 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 JULIE GRACEFFA VP FINANCE & REVENUE CYCLE 9204457260 2023-08-07 1 JULIE GRACEFFA 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2023-08-07 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JULIE GRACEFFA 744 S WEBSTER AVENUE GREEN BAY WI 54301 766373777 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. 23 17 4980 224 1972427 0 12382982 12359167 645692306 683719953 20818918 11926534 31821568 7239673 710715774 715245327 620721 417366 0 0 359521018 388681979 0 0 0 257337595 299917865 617479334 689017210 93236440 26228117 944354274 907349413 328605809 297888102 615748465 609461311 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 582262737 417366 686825781 THE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2022 38,920 INPATIENT DAYS WERE PROVIDED (34,873 ADULTS AND PEDIATRICS), AS COMPARED TO 36,484 (32,480 ADULTS AND PEDIATRICS) IN FISCAL YEAR 2021. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2022 AND 2021 WERE 179,048 AND 173,924, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 1,217,838 (AS COMPARED TO 1,183,171 IN 2021) PHYSICIAN CLINIC VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS. 582262737 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 1 327 0 4980 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 23 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JULIE GRACEFFA VP FINANCE & REVENUE CYCLE 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 CHRISTINE WOLESKE PRESIDENT/CEO 50.00 1.55 X X 1418528 0 201283 TERRY FULWILER BOARD 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 MARK MCMULLEN BOARD SECRETARY 0.50 0.50 X X 0 0 0 DANIEL ARIENS BOARD MEMBER 0.50 0.50 X 0 0 0 NANCY ARMBRUST BOARD MEMBER 0.50 0.50 X 0 0 0 SAIED ASSEF MD BOARD MEMBER/PHYSICIAN DIRECTOR 50.00 0.50 X 0 0 0 BILL BOHN BOARD MEMBER 0.50 0.50 X 0 0 0 ROBERT CLAUSEN BOARD MEMBER 0.50 0.50 X 0 0 0 G CORT CONDON BOARD MEMBER 0.50 0.50 X 0 0 0 SUSAN FINCO BOARD MEMBER 0.50 0.50 X 0 0 0 STEVEN GERNDT MD BOARD MEMBER/PRESIDENT MED STAFF 50.00 0.50 X 886679 0 39804 BARB GILLING BOARD MEMBER 0.50 1.00 X 0 0 0 MICHAEL HADDAD BOARD MEMBER 0.50 0.50 X 0 0 0 JENNIFER LYNCH MD BOARD MEMBER/PRESIDENT SPEC. GROUP 50.00 X 589896 0 23322 ROBERT MEAD MD BOARD MEMBER/PAST PRES. MED. STAFF 50.00 0.50 X 337990 0 41830 MARK RINGWELSKI MD BOARD MEMBER/FORM. PRES. SPEC. GROUP 40.00 X 27977 0 1956 FRED SCHMIDT MD BOARD MEMBER 0.50 0.50 X 0 0 0 KARL SCHMIDT BOARD MEMBER 0.50 0.50 X 0 0 0 SABINA SINGH MD BOARD MEMBER/PRESIDENT MED. GROUP 50.00 X 288754 0 32663 JAMIE SPITZER BOARD MEMBER 0.50 0.50 X 0 0 0 WILLIAM WITTMAN MD BOARD MEMBER/BMG PHYSICIAN 50.00 0.50 X 0 212247 24302 SAID HASSAN BOARD MEMBER 0.50 0.50 X 0 0 0 PAUL CASEY MD PRESIDENT MEDICAL STAFF-EMERGENCY 40.00 0.25 X 160563 0 0 JAMES DIETSCHE EVP-CFO (THRU 09/22) 50.00 0.80 X 712128 0 93493 DAVID STAMPFL MD PHYSICIAN 40.00 X 1741954 0 43504 PATRICK MCKENZIE MD PHYSICIAN 40.00 X 1196765 0 40162 JAMES SPEARS MD PHYSICIAN 40.00 X 1323850 0 40721 ROBERT ANDERSON MD PHYSICIAN 40.00 X 1605145 0 43401 KANWAR ARORA MD PHYSICIAN 40.00 X 1046554 0 26161 11336783 212247 652602 454 0 1 0 MIRON CONSTRUCTION CO INC 1471 MCMAHON DR NEENAH WI 54956 GENERAL CONTRACTOR 6210687 COMPHEALTH MEDICAL STAFFING 6440 S MILLROCK DR STE 175 SALT LAKE CITY UT 84121 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 3945214 APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 3938468 HAMMEL GREEN & ABRAHAMSON INC 420 N 5TH ST STE 100 MINNEAPOLIS MN 55401 ARCHITECTURE, ENGINEERING, PLANNING SERV 3240990 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 CONTRACTED NURSING SERVICES 2868466 63 2363495 8157606 1838066 12359167 NET PATIENT SERVICE REVENUE 621500 672357329 671066131 1291198 CONTRACTED SERVICES 621110 2206358 2206358 RENT FROM AFFILIATES 621110 2089977 2089977 CAFETERIA REVENUE 621110 1828715 1828715 5237574 4581325 635171 21078 683719953 6187791 6187791 1025907 46058 714282 0 311625 46058 357683 46058 311625 56137945 14966 50411690 2478 5726255 12488 5738743 5738743 EHR INCENTIVE 621110 7904484 7904484 LOSS FROM HEALTHCARE AFFILIATES 900099 -1022494 -1022494 6881990 715245327 686825781 1972427 14087952 417366 417366 4630914 2305626 2325288 310117616 268308101 41809515 15541225 12886550 2654675 38337744 31652793 6684951 20054480 16828971 3225509 332234 332234 1772841 1772841 1408358 1408358 21104 21104 636671 636671 47722054 45130931 2591123 7851129 36258 7814871 8557836 4190265 4367571 14182053 1621123 12560930 7883010 6992720 890290 1148423 913093 235330 1801379 982941 818438 6098069 1215928 4882141 29258542 23407803 5850739 914968 395831 519137 SUPPLIES 121414775 121414775 BAD DEBTS 20682249 20682249 EQUIPMENT RENT & MAINT 14018209 11665002 2353207 DUES/SUBSCRIPTIONS 10559109 8260180 2298929 3654852 2621997 1032855 689017210 582262737 106754473 0 17319 17629 230573639 180262803 100241238 88921401 23425251 17840978 8438761 8227116 8264761 10229106 589956497 266696135 286609238 323260362 244151872 217121175 24422898 35083920 1355767 618206 16853530 25766717 944354274 907349413 92516454 82973519 212852 200000 88131466 83297695 147745037 131416888 328605809 297888102 X 605978577 604027313 9769888 5433998 615748465 609461311 944354274 907349413 X 26228117 -35727802 3212531 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: AHA AND WHA DUES 2942164 78 -140314 5540 2796388 2813187 365 140490 11878 2942164 2778946 5651 46602 18012 2813187 2697255 63290 27788 9387 2778946 2689035 50 32052 23882 2697255 0.00000 0.89300 0.10700 1 1 1 10199811 10199811 264463977 91778385 172685592 246172746 174917750 71254996 69119963 69119963 323260362 DEFERRED COMPENSATION 17253163 FINANCE LEASE OBLIGATIONS 101590632 INTEREST RATE SWAP VALUATION 1922874 OPERATING LEASE OGLIGATIONS 10650219 131416888 PART V, LINE 4: ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR HEALTH CARE SERVICES AND EMPLOYEE TRAINING AND DEVELOPMENT. 1 1 X 1 X 220.000000000000 1 X 1 1 1 0 1 1 6726548 6726548 0.01010 78360055 37380698 40979357 0.06130 85086603 37380698 47705905 0.07140 5277035 5277035 0.00790 2238878 2238878 0.00330 1928827 1928827 0.00290 9444740 9444740 0.01410 94531343 37380698 57150645 0.08550 576415 576415 0.00090 576415 576415 0.00090 1 8020089 191487256 220606278 -29119022 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 2021-2023 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. SEVENTY-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:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/PDF/BELLIN_FY2021-CHNA.PDFFULL URL FOR PART V, SECTION B, LINE 10A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BELLIN_FY2021-ASSESSMENT_CHIP.PDF 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 33 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 DE PERE EAST 555 REDBIRD CIRCLE DE PERE WI 54115 PROVIDER CLINIC SITE 5 - NEUROLOGY CONSULTANTS OF BELLIN HEALTH 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 6 - FAMILY MEDICAL CENTER BELLEVUE 3263 EATON RD GREEN BAY WI 543116830 PROVIDER CLINIC SITE 7 - FAMILY MEDICAL CENTER HOWARD 2714 RIVERVIEW GREEN BAY WI 54313 PROVIDER CLINIC SITE 8 - BELLIN HEALTH ESCANABA 610 S LINCOLN ROAD ESCANABA MI 49829 PROVIDER CLINIC SITE 9 - FAMILY MEDICAL CENTER GREEN BAY 704 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 10 - BELLIN HEALTH GENERATIONS 704 S WEBSTER AVE SUITE 300 GREEN BAY WI 54301 PROVIDER CLINIC SITE 11 - FAMILY MEDICAL CENTER DE PERE WEST 1800 LAWRENCE DR DE PERE WI 54115 PROVIDER CLINIC SITE 12 - BELLIN HEALTH EAR NOSE AND THROAT 923 ELIZA ST GREEN BAY WI 54301 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 - BELLIN HEALTH ASTHMA & ALLERGY 519 S MONROE AVENUE GREEN BAY WI 54301 PROVIDER CLINIC SITE 18 - FAMILY MEDICAL CENTER MANITOWOC 3415 CUSTER ST SUITE D MANITOWOC WI 54221 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 - FAMILY MEDICAL CENTER DENMARK 595 COUNTY ROAD R DENMARK WI 54208 PROVIDER CLINIC SITE 22 - BELLIN HEALTH ENDOCRINOLOGY 704 S WEBSTER SUITE 501 GREEN BAY WI 54301 PROVIDER CLINIC SITE 23 - FAMILY MEDICAL CENTER PULASKI 723 S WISCONSIN ST PULASKI WI 541620109 PROVIDER CLINIC SITE 24 - FAMILY MEDICAL CENTER STURGEON BAY 311 N 3RD AVE STURGEON BAY WI 43235 PROVIDER CLINIC SITE 25 - FAMILY MEDICAL CENTER SEYMOUR 405 COMMERCIAL ST SEYMOUR WI 54165 PROVIDER CLINIC SITE 26 - GASTROENTEROLOGY ASSOCIATES OF GREEN BAY 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 27 - FAMILY MEDICAL CENTER LUXEMBURG 140 B SCHOOL CREEK TRAIL LUXEMBURG WI 54217 PROVIDER CLINIC SITE 28 - FAMILY MEDICAL CENTER WRIGHTSTOWN 555 QUALITY CT WRIGHTSTOWN WI 54180 PROVIDER CLINIC SITE 29 - FAMILY MEDICAL CENTER BONDUEL 401 W MILL ST BONDUEL WI 54107 PROVIDER CLINIC SITE 30 - BELLIN HEALTH NEPHROLOGY 2020 RIVERSIDE DR SUITE 200 GREEN BAY WI 54301 PROVIDER CLINIC SITE 31 - BELLIN HEALTH FASTCARE - GREEN BAY EAST 1976 LIME KILN RD GREEN BAY WI 54311 CONVENIENT CARE CENTER 32 - BELLIN HEALTH FASTCARE - GREEN BAY WEST 2015 SHAWANO AVE GREEN BAY WI 54303 CONVENIENT CARE CENTER 33 - BELLIN HEALTH CARDIOVASCULAR & THORACIC 720 S VAN BUREN ST SUITE 303 GREEN BAY WI 54301 PROVIDER CLINIC SITE PART I, LINE 6A: BELLIN MEMORIAL HOSPITAL IN 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 $20,682,249 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 2022 AND 2021. 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 ASSITANCE. THE ORGANIZATION WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE DETERMING WHETHER A GUARANTOR IS ELIGILBE FOR ASSISTANCE UNTER 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 FY2022, BELLIN MEMORIAL HOSPITAL CONTINUALLY ASSESSED THE HEALTHCARE NEEDS OF OUR COMMUNITIES, INCLUDING ONGOING COVID-19 RELATED NEEDS AND DATA. IN PARTNERSHIP WITH THE BEYOND HEALTH COLLABORATIVE OF BROWN COUNTY, INTENTIONAL EFFORTS HAVE BEEN MADE TO UNDERSTAND HEALTHCARE DISPARITIES AROUND DEPRESSION SCREENINGS (PHQ-9), BREAST CANCER SCREENING, 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. 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 GREEN BAY AREA CHAMBER OF COMMERCE 300 N BROADWAY STE 3A GREEN BAY WI 54303 390318170 501(C)(3) 34400 0 DONATION ENCOMPASS EARLY EDUCATION AND CARE 2589 S WEBSTER AVE GREEN BAY WI 54301 390824004 501(C)(3) 30000 0 DONATION 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 UNIV OF WI GREEN BAY 2420 NICOLET DR GREEN BAY WI 54311 391805963 GOVT-STATE AGENCY 22500 0 MARK REINKE, MD MEMORIAL SCHOLARSHIP GREATER GREEN BAY COMMUN FOUNDATION 310 W WALNUT GREEN BAY WI 54303 391699966 501(C)(3) 21500 0 GREEN BAY NEIGHBORHOOD LEADERSHIP COUNCIL, ACHIEVE BROWN COUNTY ACHIEVE BROWN COUNTY 340 N BROADWAY STE 400 GREEN BAY WI 54303 474100686 501(C)(3) 20000 0 CAMPAIGN PLEDGE CURATIVE CONNECTIONS 2900 CURRY LN GREEN BAY WI 54311 390806435 501(C)(3) 15000 0 DONATION FAMILY SERVICES OF NORTHEAST WISCONSIN INC 300 CROOKS ST GREEN BAY WI 54305 390827320 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 MUSEUM 10000 0 DONATION 11 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 1739766 0 1000 0 1188 0 21700 0 21804 0 1785458 0 0 0 ROBERT ANDERSON MD PHYSICIAN 1594880 0 9077 0 1188 0 21700 0 21701 0 1648546 0 0 0 CHRISTINE WOLESKE PRESIDENT/CEO 827437 0 568087 0 23004 0 181537 0 19746 0 1619811 0 0 0 JAMES SPEARS MD PHYSICIAN 1292932 0 29730 0 1188 0 18176 0 22545 0 1364571 0 0 0 PATRICK MCKENZIE MD PHYSICIAN 1194577 0 1000 0 1188 0 20315 0 19847 0 1236927 0 0 0 KANWAR ARORA MD PHYSICIAN 1045140 0 1000 0 414 0 19301 0 6860 0 1072715 0 0 0 STEVEN GERNDT MD BOARD MEMBER/PRESIDENT MED STAFF 844905 0 41000 0 774 0 20000 0 19804 0 926483 0 0 0 JAMES DIETSCHE EVP-CFO (THRU 09/22) 500744 0 210970 0 414 0 67008 0 26485 0 805621 0 0 0 JENNIFER LYNCH MD BOARD MEMBER/PRESIDENT SPEC. GROUP 562682 0 26800 0 414 0 22042 0 1280 0 613218 0 0 0 ROBERT MEAD MD BOARD MEMBER/PAST PRES. MED. STAFF 308810 0 27992 0 1188 0 18208 0 23622 0 379820 0 0 0 SABINA SINGH MD BOARD MEMBER/PRESIDENT MED. GROUP 259966 0 28406 0 382 0 14477 0 18186 0 321417 0 0 0 WILLIAM WITTMAN MD BOARD MEMBER/BMG PHYSICIAN 0 197105 0 12856 0 2286 0 14750 0 9552 0 236549 0 0 PAUL CASEY MD PRESIDENT MEDICAL STAFF-EMERGENCY 160563 0 0 0 0 0 0 0 0 0 160563 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. JAMES DIETSCHE AND CHRISTINE WOLESKE PARTICIPATED IN THE 457(F) PLAN. THERE WERE NO DISTRIBUTIONS DURING CALENDAR YEAR 2021. THE FOLLOWING AMOUNTS WERE ACCRUED DURING CALENDAR YEAR 2021: JAMES DIETSCHE $52,748 CHRISTINE WOLESKE $161,537 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 $190,500 DURING CALENDAR YEAR 2021. 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 275000 44994006 528236 44465770 2009 0 1 1 1 B 1445000 12944000 79844 2001 1 0 1 1 C 41624205 12546069 314452 28763684 0 0 0 1 D 8351848 74748 8277100 2021 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 1 0 0 0 0 1 B 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 SUSAN FINCO OWNER OF LEONARD & FINCO COMMUNICATIONS 180320 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 -1,250,419. INTEREST RATE SWAP AGREEMENT 4,462,701. OTHER CHANGES IN NET ASSETS 249. 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. ASHLAND WEST LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 REAL ESTATE WI 0 0 BELLIN MEMORIAL HOSPITAL INC BELLIN NORTH VENTURES LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 REAL ESTATE WI 0 0 BELLIN MEMORIAL HOSPITAL INC BELLIN-THEDACARE ENTERPRISES LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 REAL ESTATE WI 0 0 BELLIN MEMORIAL HOSPITAL INC ASHWAUBENON WEST PROPERTIES LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 871079621 REAL ESTATE WI 0 18481131 BELLIN MEMORIAL HOSPITAL INC WEST GB LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 REAL ESTATE WI 0 0 BELLIN MEMORIAL HOSPITAL INC LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 12B, II BELLIN HEALTH SYSTEMS INC 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PSYCHIATRIC HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HOSPITAL WI 501(C)(3) LINE 3 BELLIN MEMORIAL HOSPITAL INC 1 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) LINE 12B, II N/A 0 UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HOSPICE, PALLIATIVE & BEREAVEMENT SERVICES WI 501(C)(3) LINE 10 N/A 0 BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 1 BELLIN INVESTMENTS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391564939 OTHER WI N/A C 1 0 1 1 1 1 0 0 0 0 1 1 0 1 1 1 1 0 1 0 OCONTO HOSPITAL & MEDICAL CENTER INC D 1713758 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER INC E 25749994 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER INC J 120000 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER INC K 2052363 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER INC M 8133393 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER INC O 9216273 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER INC P 63000000 ACTUAL BELLIN HEALTH FOUNDATION INC C 2363495 ACTUAL BELLIN HEALTH FOUNDATION INC O 572888 ACTUAL BELLIN HEALTH FOUNDATION INC R 2112000 ACTUAL BELLIN PSYCHIATRIC CENTER INC E 12382336 ACTUAL BELLIN PSYCHIATRIC CENTER INC K 57076 ACTUAL BELLIN PSYCHIATRIC CENTER INC M 2540494 ACTUAL BELLIN PSYCHIATRIC CENTER INC P 18500000 ACTUAL