OCONTO HOSPITAL & MEDICAL CENTER INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- OCONTO HOSPITAL & MEDICAL CENTER INC (EIN 06-1745397)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-09
- IRS object ID
- 202232219349301753
- Schema version
- 2020v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-09T12:59:12-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061745397 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONTO HOSPITAL AND MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OCON | BusinessNameControlTxt |
| Phone | 9208351100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 820 ARBUTUS AVENUE | AddressLine1Txt |
| City | OCONTO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54153 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHARLA BAENEN | PersonNm |
| Person Title | PRESIDENT & COO | PersonTitleTxt |
| Phone | 9208351100 | PhoneNum |
| Signature | 2022-08-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SHARLA | PersonFirstNm |
| Person Last | BAENEN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2022-07-29 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN HEALTH OCONTO HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JULIE BIEBER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 820 ARBUTUS AVENUE | AddressLine1Txt |
| City | OCONTO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54153 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $112,534,705 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.OCONTOHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | OCONTO HOSPITAL & MEDICAL CENTER, INC. (THE ORGANIZATION) IS YOUR HOMETOWN HEALTHCARE SERVICE PROVIDER, CREATED TO MAKE OUTSTANDING HEALTHCARE CONVENIENT. BACKED BY THE RESOURCES OF BELLIN HEALTH, THE ORGANIZATION OFFERS OUTSTANDING HOSPITAL-BASED, EMERGENCY AND PRIMARY CARE SERVICES. THE ORGANIZATION OFFERS THE CARE YOU NEED WHERE YOU WANT IT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 346 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,868,323 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,598,653 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $66,380,773 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $86,249,933 | CYProgramServiceRevenueAmt |
| PY Investment Income | $80 | PYInvestmentIncomeAmt |
| CY Investment Income | $20,576 | CYInvestmentIncomeAmt |
| PY Other Revenue | $87,699 | PYOtherRevenueAmt |
| CY Other Revenue | $80,643 | CYOtherRevenueAmt |
| PY Total Revenue | $68,336,875 | PYTotalRevenueAmt |
| CY Total Revenue | $89,949,805 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $8,825 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $28,229,553 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $35,472,420 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $37,592,731 | PYOtherExpensesAmt |
| CY Other Expenses | $42,964,334 | CYOtherExpensesAmt |
| PY Total Expenses | $65,822,284 | PYTotalExpensesAmt |
| CY Total Expenses | $78,445,579 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,514,591 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $11,504,226 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $44,740,555 | TotalAssetsBOYAmt |
| Total Assets EOY | $60,351,775 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,869,243 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $49,922,196 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,128,688 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,429,579 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF OCONTO HOSPITAL & MEDICAL CENTER IS TO PROVIDE 24-HOUR LOCAL ACCESS TO EFFECTIVE, EFFICIENT HEALTH, WELLNESS AND PREVENTATIVE SERVICES TO OCONTO AND THE SURROUNDING RURAL COMMUNITIES. TOWARD THIS PURPOSE, OCONTO HOSPITAL & MEDICAL CENTER WORKS IN PARTNERSHIP WITH THE COMMUNITY, AND BELLIN HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $50,411,893 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $55,720,583 | RevenueAmt |
| Desc | THE OCONTO HOSPITAL & MEDICAL CENTER ALSO OPERATES A MULTISPECIALTY CLINIC IN MARINETTE WISCONSIN. SERVICES OFFERED AT THE MARINETTE LOCATION INCLUDE PRIMARY CARE SERVICES, RADIATION ONCOLOGY SERVICES, CHEMOTHERAPY, AND INFUSION SERVICES. IN ADDITION, THE ORGANIZATION HAS PRIMARY CARE CLINICS IN OCONTO, OCONTO FALLS, CRIVITZ, LAKEWOOD, SURING, AND PESHTIGO WISCONSIN, AND DAGGETT AND MENOMINEE MICHIGAN. THESE PROGRAM SERVICES PROVIDED 16,705 URGENT CARE VISITS, 66,127 PRIMARY CARE VISITS AND 33,309 SPECIALTY PROVIDER VISITS TO THESE COMMUNITIES DURING THE PERIOD OF OCTOBER 1,2020 TO SEPTEMBER 30, 2021. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $20,322,567 | ExpenseAmt |
| Grant | $8,825 | GrantAmt |
| Revenue | $30,529,876 | RevenueAmt |
| Desc | AS A KEY REGIONAL ASSET, THE ORGANIZATION IS A NOT-FOR-PROFIT HEALTHCARE PROVIDER. THE ORGANIZATION PROVIDES ACUTE HOSPITAL, EMERGENCY AND URGENT CARE TO RESIDENTS OF OCONTO, WISCONSIN, AND THE SURROUNDING COMMUNITIES. DURING THE PERIOD OF OCTOBER 1, 2020 TO SEPTEMBER 30, 2021, 282 INPATIENT DAYS WERE PROVIDED AND 1,512 SWING BED DAYS WERE PROVIDED. THE NUMBER OF OUTPATIENTS REGISTERED DURING THE SAME 12 MONTH PERIOD WAS 22,580. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $70,734,460 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 346 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARA ARNDT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204457260 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2020 SOUTH WEBSTER AVENUE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CHARLES HEYKA MD | ||||||||
| PRESIDENT OF MEDICAL STAFF | 50.00 | Yes (X) | $378,751 | $0 | $46,728 | |||
| LAURA HIEB | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $316,100 | $57,056 | 50.00 | ||
| SHARLA BAENEN | ||||||||
| PRESIDENT & COO | 0.50 | Yes (X) | $0 | $258,065 | $64,894 | 50.00 | Yes (X) | |
| JULIE BIEBER | ||||||||
| VP | 50.00 | Yes (X) | $145,282 | $0 | $21,857 | Yes (X) | ||
| SARA ARNDT | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $84,568 | $28,008 | 45.00 | ||
| DAVE HONISH | ||||||||
| CHAIRPERSON | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ROD JOHNSON | ||||||||
| SECRETARY/TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CRAIG ALWIN | ||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| JAMES DIETSCHE | ||||||||
| COO/CFO | 0.50 | $0 | $665,488 | $68,111 | 50.00 | Yes (X) | ||
| DAVID HOYER MD | ||||||||
| PHYSICIAN | 50.00 | $497,187 | $0 | $26,676 | Yes (X) | |||
| PAWNEET SINGH MD | ||||||||
| PHYSICIAN | 50.00 | $488,162 | $0 | $23,594 | Yes (X) | |||
| MICHAEL BRENNER MD | ||||||||
| PHYSICIAN | 50.00 | $368,910 | $0 | $41,075 | Yes (X) | |||
| JON SIMMONS MD | ||||||||
| PHYSICIAN | 50.00 | $345,816 | $0 | $25,529 | Yes (X) | |||
| NICOLE HINIKER MD | ||||||||
| PHYSICIAN | 50.00 | $304,507 | $0 | $38,729 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,528,615 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,324,221 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $442,257 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 44 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BELLIN MEMORIAL HOSPITAL INC | |||||
| 744 S WEBSTER AVE | GREEN BAY | WI | 54301 | ADMINISTRATIVE SERVICES | $4,618,855 |
| SYNERGY SURGICALISTS | |||||
| 280 W KAGY BLVD STE D 320 | BOZEMAN | MT | 59715 | PROFESSIONAL SURGICAL SERVICES | $961,945 |
| UROLOGY ASSOC OF GREEN BAY SC | |||||
| 720 S VAN BURENT ST | GREEN BAY | WI | 54301 | HOUSEKEEPING SERVICES | $768,000 |
| THARIO BUILDING SERVICES | |||||
| 2936 HOLMGREN WAY | GREEN BAY | WI | 54304 | HOUSEKEEPING SERVICES | $518,544 |
| RADIOLOGY ASSOCIATES OF APPLETON | |||||
| 2500 E CAPITAL DR | APPLETON | WI | 54911 | RADIATION ONCOLOGY PROVIDER SERVICES | $442,191 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,598,653 | GovernmentGrantsAmt |
| Total Contributions | $3,598,653 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621300 | $85,398,676 | $85,398,676 |
| CONTRACTED SERVICES | 621300 | $680,857 | $680,857 |
| RENT FROM AFFILIATES | 900099 | $120,000 | $120,000 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,400 | TotalRevenueColumnAmt |
| Exclusion | $50,400 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $86,249,933 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76 | TotalRevenueColumnAmt |
| Exclusion | $76 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $86,261 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $56,544 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,717 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,717 | TotalRevenueColumnAmt |
| Exclusion | $29,717 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $22,548,856 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $22,528,356 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $20,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,500 | TotalRevenueColumnAmt |
| Exclusion | $20,500 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCENTIVE PAYMENTS | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $50,926 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $50,926 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $50,926 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,949,805 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $86,250,459 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $100,693 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,825 | TotalAmt |
| Program Services | $8,825 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $610,154 | TotalAmt |
| Program Services | $433,706 | ProgramServicesAmt |
| Management And General | $176,448 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,899,186 | TotalAmt |
| Program Services | $28,343,727 | ProgramServicesAmt |
| Management And General | $555,459 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,464,211 | TotalAmt |
| Program Services | $1,429,831 | ProgramServicesAmt |
| Management And General | $34,380 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,718,074 | TotalAmt |
| Program Services | $2,668,190 | ProgramServicesAmt |
| Management And General | $49,884 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,780,795 | TotalAmt |
| Program Services | $1,732,868 | ProgramServicesAmt |
| Management And General | $47,927 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,673,813 | TotalAmt |
| Program Services | $5,539,620 | ProgramServicesAmt |
| Management And General | $134,193 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,065 | TotalAmt |
| Program Services | $1,274 | ProgramServicesAmt |
| Management And General | $24,791 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,339 | TotalAmt |
| Program Services | $707,100 | ProgramServicesAmt |
| Management And General | $57,239 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,711 | TotalAmt |
| Program Services | $19,662 | ProgramServicesAmt |
| Management And General | $49 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,832,151 | TotalAmt |
| Program Services | $3,832,151 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,607 | TotalAmt |
| Program Services | $353,849 | ProgramServicesAmt |
| Management And General | $3,758 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,767 | TotalAmt |
| Program Services | $76,528 | ProgramServicesAmt |
| Management And General | $31,239 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,906,350 | TotalAmt |
| Program Services | $59,766 | ProgramServicesAmt |
| Management And General | $1,846,584 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,797,418 | TotalAmt |
| Program Services | $3,396,483 | ProgramServicesAmt |
| Management And General | $400,935 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $110,713 | TotalAmt |
| Program Services | $32,634 | ProgramServicesAmt |
| Management And General | $78,079 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $21,651,519 | $17,525,061 | $4,126,458 |
| EQUIPMENT RENT/REPAIRS | $2,495,314 | $2,481,400 | $13,914 |
| BAD DEBT EXPENSE | $1,927,327 | $1,927,327 | |
| DUES & SUBSCRIPTIONS | $200,855 | $119,507 | $81,348 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,385 | TotalAmt |
| Program Services | $44,951 | ProgramServicesAmt |
| Management And General | $48,434 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,445,579 | TotalAmt |
| Program Services | $70,734,460 | ProgramServicesAmt |
| Management And General | $7,711,119 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,180,625 | BOYAmt |
| EOY | $3,047,860 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,872,545 | BOYAmt |
| EOY | $12,290,467 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,266,869 | BOYAmt |
| EOY | $1,427,445 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,481 | BOYAmt |
| EOY | $4,372 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $50,134,945 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,450,256 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,908,805 | BOYAmt |
| EOY | $25,684,689 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,940 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,250,290 | BOYAmt |
| EOY | $17,896,942 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,740,555 | BOYAmt |
| EOY | $60,351,775 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,632,048 | BOYAmt |
| EOY | $4,668,821 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,001,802 | BOYAmt |
| EOY | $700,000 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,328,117 | BOYAmt |
| EOY | $9,873,948 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,907,276 | BOYAmt |
| EOY | $34,679,427 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,869,243 | BOYAmt |
| EOY | $49,922,196 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,902,126 | BOYAmt |
| EOY | $9,602,100 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $773,438 | BOYAmt |
| EOY | $827,479 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,128,688 | BOYAmt |
| EOY | $10,429,579 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,740,555 | BOYAmt |
| EOY | $60,351,775 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $11,504,226 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $54,041 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $739,879 | OtherCostOrOtherBasisAmt |
| Book Value | $739,879 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,747,191 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,220,856 | DepreciationAmt |
| Book Value | $14,526,335 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $171,971 | OtherCostOrOtherBasisAmt |
| Depreciation | $171,971 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,443,906 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,057,429 | DepreciationAmt |
| Book Value | $10,386,477 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,998 | OtherCostOrOtherBasisAmt |
| Book Value | $31,998 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $25,684,689 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN FOUNDATIONS - ALATU | $827,479 |
| RIGHT OF USE ASSETS | $10,404,350 |
| DUE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | $4,951,355 |
| DUE FROM AFFILIATES | $1,713,758 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $17,896,942 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $21,800,000 |
| DUE TO THIRD-PARTY REIMBURSEMENT PROGRAMS | $777,224 |
| OPERATING LEASE LIABILITIES | $10,524,311 |
| FINANCE LEASE LIABILITIES | $1,577,892 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $34,679,427 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 220.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $770,239 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $770,239 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01010 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,881,788 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,655,476 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,226,312 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01600 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,652,027 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,655,476 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,996,551 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02610 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,778 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,847 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,847 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,625 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,674,652 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,655,476 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,019,176 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $879,704 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $9,585,664 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,196,794 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,388,870 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONTO HOSPITAL & MEDICAL CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 820 ARBUTUS AVE | AddressLine1Txt |
| City | OCONTO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54153 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.OCONTOHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 1061 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONTO HOSPITAL & MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 20 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C, LINE 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C, LINE 7D | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 220.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.BELLIN.ORG/PATIENTS_VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.BELLIN.ORG/IMAGES/UPLOADS/COMMUNITY_CARE_APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.BELLIN.ORG/IMAGES/UPLOADS/PLAIN_LANGUAGE_SUMMARY_-_FINANCIAL_ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 5: THIS YEAR'S ASSESSMENT BUILT ON COLLABORATION, ACTIVELY SEEKING INPUT FROM A BROAD CROSS SECTION OF COMMUNITY STAKEHOLDERS WITH THE GOAL OF REACHING CONSENSUS ON PRIORITIES TO MUTUALLY FOCUS HUMAN, MATERIAL AND FINANCIAL RESOURCES. BELOW IS A LISTING OF PARTICIPANTS IN A CHNA SUMMIT IN WHICH HEALTH PRIORITIES WERE DETERMINED: BELLIN HEALTH OCONTO HOSPITAL* OCONTO COUNTY PUBLIC HEALTH* HSHS ST. CLARE MEMORIAL HOSPITAL* CESA 8 DARJUNE FOUNDATION, INC* LIBERTAS OF MARINETTE* NORTHLAKES COMMUNITY CLINIC* OCONTO COUNTY BOARD OF DIRECTORS OCONTO COUNTY ECONOMIC DEVELOPMENT CORPORATION OCONTO COUNTY PUBLIC HEALTH* OCONTO COUNTY LAW ENFORCEMENT* OCONTO ELECTRIC COOPERATIVE* OCONTO UNIFIED SCHOOL DISTRICT* PREVEA* TRI-COUNTY UNITED WAY* UNITY* U W EXTENSION WI DEPT OF CORRECTIONS-UNIT 616 OCONTO COUNTY**DENOTES GROUPS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THESE ORGANIZATIONS SERVE THE UNDER-RESOURCED IN OUR COMMUNITY, INCLUDING LOW-INCOME SENIORS, CHILDREN LIVING IN POVERTY, FAMILIES WHO STRUGGLE WITH SHELTER AND FOOD INSECURITY, VETERANS, AND VICTIMS OF DOMESTIC VIOLENCE. |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 6A: HSHS ST. CLARE MEMORIAL HOSPITAL |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 6B: -CESA 8-HSHS ST. CLARE MEMORIAL HOSPITAL-OCONTO COUNTY ECONOMIC DEVELOPMENT CORPORATION-OCONTO COUNTY PUBLIC HEALTH-OCONTO COUNTY LAW ENFORCEMENT-OCONTO COUNTY VETERAN SERVICES-NORTHLAKES COMMUNITY CLINICS-TRI-COUNTY UNITED WAY |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/PDF/BELLIN_CHNA_2021_FINAL__1_.PDFFULL URL FOR PART V, SECTION B, LINE 10A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/CHNA_IMPLEMENTATION_STRATEGY_2021.PDF |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2021 THROUGH 2023. THE NEEDS IDENTIFIED ARE: MENTAL HEALTH, NUTRITION AND PHYSICAL ACTIVITY AND ALCOHOL AND OTHER DRUG ABUSE (AODA). A SUMMARY OF HOW THE HOSPITAL HAS BEEN ADDRESSING SOME OF THE NEEDS IDENTIFIED IN THE CHNA IS AS FOLLOWS:1. MENTAL HEALTH -GRIEF SUPPORT FLYER CREATED BY OCONTO COUNTY LEADERSHIP TEAM - OUT OF THE DARKNESS WALK - EVALUATING THE PHQ-9 SCREENING RELATED TO HEALTHCARE ORGANIZATIONS - WORKING WITH SCHOOL DISTRICTS TO INCORPORATE MENTAL HEALTH FIRST AID INTO THE CURRICULUM2. NUTRITION AND PHYSICAL ACTIVITY -OCONTO COUNTY FARMERS MARKET -BELLIN HEART RUN/WALK 5K - MARINETTE, WI -MILES 4 MADYSON3. ALCOHOL AND OTHER DRUG ABUSE (AODA) -AODA MISUSE TEAM -DRUG DROP BOXES IN CLINICS AND PHARMACIES - PRESCRIPTION DRUG TAKE BACK EVENT |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - BELLIN HEALTH MARINETTE | ||||
| 2820 ROOSEVELT ROAD | MARINETTE | WI | 54143 | RURAL HEALTH CLINIC, ASC |
| 2 - BELLIN HEALTH OCONTO FALLS | ||||
| 107 E HIGHLAND DRIVE | OCONTO FALLS | WI | 54154 | RURAL HEALTH CLINIC |
| 3 - BELLIN HEALTH CRIVITZ | ||||
| 218 S US HWY 141 SUITE 100 | CRIVITZ | WI | 54114 | RURAL HEALTH CLINIC |
| 4 - BELLIN HEALTH OCONTO | ||||
| 820 ARBUTUS AVE SUITE 102 | OCONTO | WI | 54153 | RURAL HEALTH CLINIC |
| 5 - BELLIN HEALTH PESHTIGO | ||||
| 441 FRENCH STREET | PESHTIGO | WI | 54162 | RURAL HEALTH CLINIC |
| 6 - BELLIN HEALTH MENOMINEE | ||||
| 1100 10TH STREET | MENOMINEE | MI | 49858 | RURAL HEALTH CLINIC |
| 7 - BELLIN HEALTH DAGGETT | ||||
| 106 S SCHOOL ROAD | DAGGETT | MI | 49821 | RURAL HEALTH CLINIC |
| 8 - BELLIN HEALTH LAKEWOOD | ||||
| 15481 COMMERCIAL ROAD SUITE E | LAKEWOOD | WI | 54138 | RURAL HEALTH CLINIC |
| 9 - BELLIN HEALTH SURING | ||||
| 307 MANOR DRIVE | SURING | WI | 54174 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | OCONTO HOSPITAL AND MEDICAL CENTER IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. |
| PART I, LINE 7: | AMOUNTS ARE CALCULATED BASED ON THE COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE OF $1,927,327 INCLUDED ON FORM 990, PART IX, LINE 24 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | - PARTICIPATED IN COMMUNITY EDUCATION RELATED TO OPIOID OVERDOSE RISK AND PREVENTION FOR THE SAFEGUARDING OUR COMMUNITIES OPIOID HARM REDUCTION PROGRAM LEAD M&M COMMUNITY FOUNDATION- EVENT SPONSOR OF LEOWSTRONG BIKE RIDE. PROVIDED CLINICAL STAFF FOR MEDICAL TENT. CHRIS WOLESKE WAS A KEYNOTE SPEAKER- PROVIDED COMMUNITY EDUCATION ON SUICIDE PREVENTION AT CITY OF OCONTO NATIONAL NIGHT OUT - DELIVERED OF MEALS 1X MONTH TO THE HOMEBOUND BY OCONTO LEADERSHIP FOR OCONTO COUNTY COMMISSION ON AGING- OCONTO COUNTY COMMUNITY COVID MEETINGS WITH OCONTO COUNTY PUBLIC HEALTH, CESA 8 AND HSHS- MARINETTE COUNTY COMMUNITY COVID MEETINGS WITH MARINETTE COUNTY PUBLIC HEALTH- OCONTO LEADERSHIP VOLUNTEERING AT OCONTO COUNTY VETERANS SERVICE |
| PART III, LINE 2: | THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS. |
| 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 2021 AND 2020. |
| PART III, LINE 8: | THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SURPLUS SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RUL 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT EXEMPT HOSPITALS, CMS WOULD NEED TO PROVIDE THESE 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: | BELLIN HEALTH OCONTO HOSPITAL (BHOH) CREATES TRUSTED RELATIONSHIPS BY LISTENING WITH INTENT, COMMUNICATING CLEARLY, AND VIEWING ALL WE DO THROUGH THE EYES OF THE PEOPLE WE SERVE. OUR SERVICES WILL BE EASY TO ACCESS AND EASY TO NAVIGATE. OUR PRICES AND OUTCOMES WILL BE READILY AVAILABLE AND EASY TO UNDERSTAND. WE DELIVER THE BELLIN PROMISE TO ALL "I WILL KNOW YOU. I WILL SHOW YOU RESPECT. I WILL GO WITH YOU ON YOUR JOURNEY. I AM HERE TO HELP YOU."BHOH AIMS TO INCREASE YEARS OF QUALITY LIFE BY PROVIDING THE HIGHEST QUALITY, RELIABLE CARE THAT IS INNOVATIVE, EQUITABLE, COORDINATED, AND AFFORDABLE FOR EVERYONE. THROUGH COLLABORATIVE RELATIONSHIPS, WE WILL ADDRESS THE SOCIAL DETERMINANTS OF HEALTH TO POSITIVELY IMPACT THE HEALTH AND WELL-BEING OF OUR PATIENTS AND COMMUNITIES.BHOH CONTINUES TO GROW RELATIONSHIPS WITH INDIVIDUALS, EMPLOYERS, SCHOOLS, AND COMMUNITIES TO INCREASE THE NUMBER OF PEOPLE WHO CHOOSE BELLIN HEALTH AS THEIR HEALTHCARE PARTNER. OUR PARTNERSHIPS, STEWARDSHIP AND POSITIVE FINANCIAL PERFORMANCE WILL DRIVE BETTER HEALTH, BETTER COMMUNITIES, AND LOWER TOTAL COST OF CARE. TOGETHER, WE WILL DESIGN SERVICES AND SUPPORT POLICIES THAT SOCIALLY, ECONOMICALLY, AND ENVIRONMENTALLY SHAPE A BETTER FUTURE. |
| PART VI, LINE 3: | THE NO SURPRISE BILLING ACT WENT INTO EFFECT ON JANUARY 1, 2022. THE ACT REQUIRES HEALTHCARE PROVIDERS TO PROVIDE NOTICE OF THE ACT TO ALL PATIENTS, NOTIFY, PATIENTS IF THEIR INSURANCE IS OUT-OF-NETWORK AND OBTAIN CONSENT TO BALANCE BILL, AS WELL AS PROVIDE AN ESTIMATE OF CHARGES TO UNINSURED PATIENTS. |
| PART VI, LINE 4: | - OCONTO COUNTY MARKET IS DEFINED BY THE BORDER OF BROWN AND MARINETTE COUNTY.- THE POPULATION IS JUST OVER 37,863, OF WHICH 11,106 HAVE A PRIMARY CARE PROVIDER ALIGNMENT WITH BELLIN HEALTH. - OCONTO COUNTY FALLS IN THE NATIONAL AVERAGE FOR DEPRIVATION SITTING AT 98%. THE COUNTY HAS TWO SPECIFIC AREAS; ONE THAT CIRCLES AROUND OCONTO AND THEN ANOTHER THAT STARTS NORTHWEST OF SURING AND CONTINUES TO THE LAKEWOOD AREA. BROADBAND ACCESS FOLLOWS THE PATTERN AS WELL.- BELLIN HEALTH OCONTO HOSPITAL (BHOH) IS ONE OF THE MAJOR PLAYERS IN THIS MARKET. NORTHLAKES COMMUNITY CLINIC IS LOCATED IN LAKEWOOD AND THEIR DENTAL PRACTICE IS HOUSED WITHIN BHOH CAMPUS. - 20% OF OCONTO COUNTY ARE SENIORS OVER AGE 65. - 21% OF OUR COMMUNITY IS 18 AND YOUNGER.- OVER 55% OF OCONTO COUNTY HAS MEDICARE OR MEDICAID-16% OF PEOPLE IN OCONTO COUNTY ARE LOW INCOME |
| PART VI, LINE 5: | THE ORGANIZATION IS A STEERING TEAM MEMBER OF THE HEALTHY OCONTO COUNTY IMPROVEMENT WORK ALONG WITH HSHS ST. CLARE HOSPITAL AND OCONTO COUNTY PUBLIC HEALTH. THE ORGANIZATION PARTICIPATED IN THE MILES 4 MADYSON 5K/HALF MARATHON COMMUNITY EVENT, THE OCONTO COUNTY FARMERS MARKET, HOST FAMILY NIGHT TO ENCOURAGE HEALTHY ACTIVITIES. THE ORGANIZATION HAS A 24/7 EMERGENCY ROOM AVAILABILITY TO THE COMMUNITY. |
| PART VI, LINE 6: | THE ORGANIZATION, IN PARTNERSHIP WITH BELLIN HEALTH SYSTEMS, INC., CONTINUES TO SERVE ITS COMMUNITY. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE I, PART II | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION DID NOT HAVE ANY GRANTS TO ANY ORGANIZATION OVER $5,000. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES DIETSCHE | ||||||||||||||
| COO/CFO | $0 | $470,692 | $0 | $170,055 | $0 | $24,741 | $0 | $60,714 | $0 | $7,397 | $0 | $733,599 | $0 | $0 |
| DAVID HOYER MD | ||||||||||||||
| PHYSICIAN | $495,877 | $0 | $1,040 | $0 | $270 | $0 | $4,004 | $0 | $22,672 | $0 | $523,863 | $0 | $0 | $0 |
| PAWNEET SINGH MD | ||||||||||||||
| PHYSICIAN | $431,190 | $0 | $56,792 | $0 | $180 | $0 | $14,399 | $0 | $9,195 | $0 | $511,756 | $0 | $0 | $0 |
| CHARLES HEYKA MD | ||||||||||||||
| PRESIDENT OF MEDICAL STAFF | $376,523 | $0 | $1,040 | $0 | $1,188 | $0 | $18,781 | $0 | $27,947 | $0 | $425,479 | $0 | $0 | $0 |
| MICHAEL BRENNER MD | ||||||||||||||
| PHYSICIAN | $367,690 | $0 | $1,040 | $0 | $180 | $0 | $15,728 | $0 | $25,347 | $0 | $409,985 | $0 | $0 | $0 |
| LAURA HIEB | ||||||||||||||
| BOARD MEMBER | $0 | $266,873 | $0 | $35,890 | $0 | $13,337 | $0 | $45,926 | $0 | $11,130 | $0 | $373,156 | $0 | $0 |
| JON SIMMONS MD | ||||||||||||||
| PHYSICIAN | $209,141 | $0 | $136,261 | $0 | $414 | $0 | $15,290 | $0 | $10,239 | $0 | $371,345 | $0 | $0 | $0 |
| NICOLE HINIKER MD | ||||||||||||||
| PHYSICIAN | $183,962 | $0 | $120,131 | $0 | $414 | $0 | $16,322 | $0 | $22,407 | $0 | $343,236 | $0 | $0 | $0 |
| SHARLA BAENEN | ||||||||||||||
| PRESIDENT & COO | $0 | $216,525 | $0 | $25,040 | $0 | $16,500 | $0 | $42,248 | $0 | $22,646 | $0 | $322,959 | $0 | $0 |
| JULIE BIEBER | ||||||||||||||
| VP | $129,705 | $0 | $10,040 | $0 | $5,537 | $0 | $10,438 | $0 | $11,419 | $0 | $167,139 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. JAMES DIETSCHE, SHARLA BAENEN, AND LAURA HIEB PARTICIPATED IN THE 457(F) PLAN. THERE WERE NO DISTRIBUTIONS DURING CALENDAR YEAR 2020. THE FOLLOWING AMOUNTS WERE ACCRUED DURING CALENDAR YEAR 2020: JAMES DIETSCHE $46,179 SHARLA BAENEN $26,739 LAURA HIEB $26,739 | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2011-08-18 | BondIssuedDt |
| Issue Price | $14,000,000 | IssuePriceAmt |
| Purpose | FACILITY AND SERVICE EXPANSION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $466,667 | RetiredAmt |
| Total Proceeds | $14,000,000 | TotalProceedsAmt |
| Capitalized Interest | $36,149 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $132,033 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $13,831,818 | CapitalExpendituresAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION IS WHOLLY OWNED BY BELLIN MEMORIAL HOSPITAL, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF THE ORGANIZATION HAVE THE POWER TO APPOINT/ELECT THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS ALSO HAVE THE POWER TO APPROVE, BUT NOT LIMITED TO, THE PHILOSOPHY, MISSION, AND VALUE OF THE ORGANIZATION, STRATEGIC PLANS, THE ANNUAL OPERATING AND CAPITAL BUDGET, AMENDMENTS OR RESTATEMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS. |
| 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 | THE ORGANIZATION REQUESTS AN ANNUAL UPDATE FROM ALL BOARD MEMBERS WHO SIGN THE POLICY. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. IF THERE IS A CONFLICT OF INTERST, THE CORPORATE COMPLIANCE OFFICER IS NOTIFIED. MEMBERS OF THE BOARD WHO HAVE A CONFLICT OF INTEREST WITH A BOARD DECISION ABSTAIN FROM VOTING ON THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD WITHOUT CONFLICT OF INTEREST AND IS SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANT'S REPORT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION CONSIDERS THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS PROPERTY OF THE ORGANIZATION AND, THEREFORE, ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN OCONTO MEMORIAL HOSPITAL CITIZENS' FOUNDATION, INC. 54,041. |
| FORM 990, PART XI, LINE 2B-2C | THE ORGANIZATION 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C) | LINE 12B, II | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING AND RADIOLOGIC SCIENCE COLLEGE | WI | 501(C) | LINE 2 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C) | LINE 7 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN PSYCHIATRIC CENTER INC | |||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54305 | 391657627 | PSYCHIATRIC HOSPITAL | WI | 501(C) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391900586 | ACUTE CARE HOSPITAL | WI | 501(C) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C) | LINE 12B, II | 0 | N/A | |
| UNITED LIMITY PARTNERSHIP | |||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HOSPICE, PALLIATIVE & BEREAVEMENT SERVICES | WI | 501(C) | LINE 10 | 0 | N/A | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN ORTHOPEDIC SURGERY CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2223 LIME KILN RD | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264677834 | EIN |
| Primary Activities | AMBULATORY ORTHOPEDIC SURGERY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BEL-REGIONAL HOME MEDICAL INC | |||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | Yes (1) |
| BELLIN INVESTMENTS INC | |||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391564939 | OTHER | WI | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BELLIN MEMORIAL HOSPITAL INC | ||
| E | $31,716,655 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| D | $1,713,758 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| K | $2,065,985 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| M | $7,569,473 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| O | $9,008,456 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| P | $49,000,000 | FMV |
| BEL-REGIONAL HOME MEDICAL INC | ||
| J | $120,000 | FMV |
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