BELLIN PSYCHIATRIC CENTER: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BELLIN PSYCHIATRIC CENTER (EIN 39-1657627)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-12
- IRS object ID
- 202132249349301848
- Schema version
- 2019v5.2
- 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 J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-12T12:04:37-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | 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 | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391657627 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN PSYCHIATRIC CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BELL | BusinessNameControlTxt |
| Phone | 9204333630 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 23725 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54305 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHARLA BAENEN | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 9204333630 | PhoneNum |
| Signature | 2021-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2021-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SHARLA BAENEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 23725 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54305 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $27,090,681 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BELLIN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1990 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | BELLIN PSYCHIATRIC CENTER, INC. (BPC) PROVIDES PSYCHIATRIC AND ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BPC, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 268 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,202 | PYContributionsGrantsAmt |
| CY Contributions Grants | $235,381 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,601,552 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,546,716 | CYProgramServiceRevenueAmt |
| PY Investment Income | $300,023 | PYInvestmentIncomeAmt |
| CY Investment Income | $308,584 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $24,913,777 | PYTotalRevenueAmt |
| CY Total Revenue | $27,090,681 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,299,800 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $21,345,600 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,286,167 | PYOtherExpensesAmt |
| CY Other Expenses | $5,983,202 | CYOtherExpensesAmt |
| PY Total Expenses | $26,585,967 | PYTotalExpensesAmt |
| CY Total Expenses | $27,328,802 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,672,190 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$238,121 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,694,855 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,305,611 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,435,664 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,145,192 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,259,191 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,160,419 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | BELLIN PSYCHIATRIC CENTER WILL BE RECOGNIZED AS THE PREFERRED PROVIDER FOR PSYCHIATRIC DISORDERS AND ADDICTIVE DISEASES THROUGH THE DELIVERY OF A CONTINUUM OF CARE AND PREVENTION PROGRAMS BASED ON THE QUALITY CARE DELIVERED AT A REASONABLE COST WITH A MEASURABLE OUTCOME BY:IMPROVING WORK PROCESSES AND SYSTEMSEXCEEDING CUSTOMER NEEDS AND EXPECTATIONSEMPOWERING STAFF TO EXCEL PERSONALLY AND PROFESSIONALLYIN COOPERATION WITH PSYCHIATRISTS, PSYCHOLOGISTS, PRIMARY CARE PHYSICIANS, AGENCIES AND HEALTH PROFESSIONALS, BELLIN PSYCHIATRIC CENTER IS DEDICATED TO THE MULTIDISCIPLINARY TREATMENT OF CHILDREN, ADOLESCENTS, ADULTS AND THEIR FAMILY MEMBERS THROUGHOUT OUR PRIMARY MARKET OF WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,418,113 | ExpenseAmt |
| Revenue | $26,515,497 | RevenueAmt |
| Desc | THE CENTER PROVIDES PSYCHIATRIC AND ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2020 9,552 INPATIENT DAYS WERE PROVIDED (6,206 ADULT, 812 CHILD AND 2,534 ADOLESCENT). THE NUMBER OF OUTPATIENT THERAPY VISITS DURING FISCAL YEAR 2020 WERE 52,948. IN ADDITION THERE WERE 52,893 INPATIENT AND OUTPATIENT MD, APNP AND PHD VISITS. | Desc |
| Total Program Service Expenses | $23,418,113 | 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 | 0 | 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 | 0 | 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 | Yes (1) | 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 | 268 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | 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 | JULIE GRACEFFA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204333630 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 23400 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54305 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| CHRISTINE WOLESKE | ||||||||
| MEMBER/BELLIN CEO | 0.50 | 50.00 | Yes (X) | $0 | $1,028,581 | $170,215 | ||
| DEREK CARLSON MD | ||||||||
| PHYSICIAN | 40.00 | $412,868 | $0 | $35,500 | Yes (X) | |||
| DHANVENDRAN RAMAR MD | ||||||||
| PHYSICIAN | 40.00 | $397,874 | $0 | $39,808 | Yes (X) | |||
| NACIYE KALAFAT MD | ||||||||
| MEMBER | 45.00 | Yes (X) | $399,079 | $0 | $36,168 | |||
| REKHA VIJAYAN | ||||||||
| PHYSICIAN | 40.00 | $419,879 | $0 | $12,955 | Yes (X) | |||
| EMILY RADEMACHER MD | ||||||||
| MEMBER/PRESIDENT MEDICAL STAFF | 45.00 | Yes (X) | $353,788 | $0 | $35,942 | |||
| JOHN CHARLES MD | ||||||||
| PHYSICIAN | 40.00 | $344,778 | $0 | $42,888 | Yes (X) | |||
| ANTHONY MARCHLEWSKI MD | ||||||||
| PHYSICIAN | 40.00 | $341,310 | $0 | $42,166 | Yes (X) | |||
| MICHAEL HOFFMAN MD | ||||||||
| MEMBER/PHYSICIAN | 0.50 | 35.00 | Yes (X) | $0 | $286,639 | $34,167 | ||
| SHARLA BAENEN | ||||||||
| BPC PRESIDENT | 45.00 | Yes (X) | $202,367 | $0 | $53,850 | Yes (X) | ||
| TARA ROBERTSON PSYD | ||||||||
| MEMBER/PHYSICIAN | 40.00 | Yes (X) | $139,565 | $0 | $8,888 | |||
| BARBARA GILLING | ||||||||
| INTERIM CHAIRPERSON | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| WILLIAM MCKINLEY | ||||||||
| MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| DAVID VANDERPLOEG | ||||||||
| MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| SUSAN GALLAGHER-LEPAK - TERMED | ||||||||
| MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| WILLIAM LAAKSO PSYD | ||||||||
| MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| JOHN PAUL | ||||||||
| MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,011,508 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,315,220 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $512,547 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 40 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BELLIN MEMORIAL HOSPITAL | |||||
| 744 S WEBSTER AVE | GREEN BAY | WI | 54305 | ADMINISTRATIVE SERVICES | $2,377,189 |
| AMN HEALTHCARE INC | |||||
| 12400 HIGH BLUFF DR | SAN DIEGO | CA | 92130 | AGENCY NURSES | $165,442 |
| MEDICAL COLLEGE OF WI | |||||
| 8701 WATERTOWN PLANK RD | MILWAUKEE | WI | 53226 | RESIDENCY PROGRAMS | $141,626 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $230,646 | GovernmentGrantsAmt |
| All Other Contributions | $4,735 | AllOtherContributionsAmt |
| Total Contributions | $235,381 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $25,820,974 | $25,820,974 | |
| INCENTIVE PAYMENTS | 621300 | $669,495 | $669,495 | |
| MISCELLANEOUS | 621300 | $31,219 | $31,219 | |
| CONTRACTED SERVICES | 621110 | $25,028 | $25,028 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,546,716 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,908 | TotalRevenueColumnAmt |
| Exclusion | $153,908 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $154,676 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $154,676 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $154,676 | TotalRevenueColumnAmt |
| Exclusion | $154,676 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,090,681 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,515,497 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $339,803 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,210,676 | TotalAmt |
| Program Services | $1,150,143 | ProgramServicesAmt |
| Management And General | $60,533 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,434,932 | TotalAmt |
| Program Services | $15,574,220 | ProgramServicesAmt |
| Management And General | $860,712 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $700,697 | TotalAmt |
| Program Services | $671,695 | ProgramServicesAmt |
| Management And General | $29,002 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,891,350 | TotalAmt |
| Program Services | $1,796,571 | ProgramServicesAmt |
| Management And General | $94,779 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,107,945 | TotalAmt |
| Program Services | $1,061,584 | ProgramServicesAmt |
| Management And General | $46,361 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,510 | TotalAmt |
| Management And General | $14,510 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $894,653 | TotalAmt |
| Program Services | $618,981 | ProgramServicesAmt |
| Management And General | $275,672 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,472 | TotalAmt |
| Program Services | $1,627 | ProgramServicesAmt |
| Management And General | $14,845 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,863 | TotalAmt |
| Program Services | $162,836 | ProgramServicesAmt |
| Management And General | $38,027 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,353 | TotalAmt |
| Program Services | $48,353 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $324,700 | TotalAmt |
| Program Services | $313,438 | ProgramServicesAmt |
| Management And General | $11,262 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,033 | TotalAmt |
| Program Services | $5,818 | ProgramServicesAmt |
| Management And General | $4,215 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,737 | TotalAmt |
| Program Services | $67,257 | ProgramServicesAmt |
| Management And General | $51,480 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,505 | TotalAmt |
| Management And General | $156,505 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $484,860 | TotalAmt |
| Management And General | $484,860 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,262 | TotalAmt |
| Program Services | $13,643 | ProgramServicesAmt |
| Management And General | $36,619 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $2,350,843 | $707,678 | $1,643,165 |
| BAD DEBT EXPENSE | $867,207 | $867,207 | |
| DUES & SUBSCRIPTIONS | $87,371 | $52,653 | $34,718 |
| EQUIPMENT RENT/MAINT | $85,666 | $74,762 | $10,904 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,167 | TotalAmt |
| Program Services | $229,647 | ProgramServicesAmt |
| Management And General | $42,520 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,328,802 | TotalAmt |
| Program Services | $23,418,113 | ProgramServicesAmt |
| Management And General | $3,910,689 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,135,735 | BOYAmt |
| EOY | $2,601,048 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,016,120 | BOYAmt |
| EOY | $2,033,764 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,361,879 | BOYAmt |
| EOY | $3,180,143 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,846 | BOYAmt |
| EOY | $3,846 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,969,678 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,889,704 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,165,431 | BOYAmt |
| EOY | $7,079,974 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,991,844 | BOYAmt |
| EOY | $6,406,836 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,694,855 | BOYAmt |
| EOY | $21,305,611 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,876,765 | BOYAmt |
| EOY | $2,703,349 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,246,872 | BOYAmt |
| EOY | $1,922,699 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,312,027 | BOYAmt |
| EOY | $10,519,144 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,435,664 | BOYAmt |
| EOY | $15,145,192 | 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 | $6,259,191 | BOYAmt |
| EOY | $6,160,419 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,259,191 | BOYAmt |
| EOY | $6,160,419 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,694,855 | BOYAmt |
| EOY | $21,305,611 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$238,121 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $139,349 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | 0 | FederalGrantAuditRequiredInd |
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 | $2,747,765 | OtherCostOrOtherBasisAmt |
| Book Value | $2,747,765 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,122,982 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,284,169 | DepreciationAmt |
| Book Value | $2,838,813 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $373,774 | OtherCostOrOtherBasisAmt |
| Depreciation | $320,972 | DepreciationAmt |
| Book Value | $52,802 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,684,116 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,284,563 | DepreciationAmt |
| Book Value | $1,399,553 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,041 | OtherCostOrOtherBasisAmt |
| Book Value | $41,041 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,079,974 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $10,519,144 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,519,144 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $26,348,313 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $139,349 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$867,207 | OtherRevenueAmt |
| Revenue Not Reported | -$727,858 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,076,171 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $14,510 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $14,510 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $27,090,681 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,447,085 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,447,085 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $14,510 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $867,207 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $881,717 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,328,802 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -867,207. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 867,207. |
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 | $409,371 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $409,371 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01550 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,258,128 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,596,825 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,661,303 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10060 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,667,499 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,596,825 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,070,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11610 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Direct Offsetting Revenue | $4,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $162,540 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $162,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,473 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,473 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $165,013 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $165,013 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,832,512 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,601,560 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,235,687 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12230 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $434,985 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,102,086 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,345,268 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,243,182 | 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 | BELLIN PSYCHIATRIC CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 E ST JOSEPH STREET | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543053725 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BELLIN.ORG | WebsiteAddressTxt |
| State License | 263 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN PSYCHIATRIC 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 | 17 | 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 B, 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 | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION B, 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 | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BUSOF.001_-_FINANCIAL_ASSISTANCE.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/COMMUNITY_CARE_APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/PLAIN_LANGUAGE_SUMMARY_-_FINANCIAL_AS | 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 |
|---|---|
| BELLIN PSYCHIATRIC 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 ON. BELOW IS A LISTING OF PARTICIPANTS IN A CHNA SUMMIT IN WHICH HEALTH PRIORITIES WERE DETERMINED.-CITY OF GREEN BAY - PARKS & RECREATION-NORTHEASTERN WISCONSIN TECHNICAL COLLEGE-CITY OF DE PERE - HEALTH DEPARTMENT-BELLIN HEALTH-BROWN COUNTY PUBLIC HEALTH-ASHWAUBENON SCHOOLS-INTERN SCHOOL SOCIAL WORKER (HSSD)-WILLOW CREEK BEHAVIORAL HEALTH-HSHS ST VINCENT HOSPITAL/ ST MARY'S HOSPITAL-LIVE 54218-BELLIN PSYCHIATRIC CENTER-BROWN COUNTY BOARD-WIC-FAMILY & CHILDCARE RESOURCES OF NEW-AGING AND DISABILITY RESOURCE CENTER-BROWN COUNTY BOARD OF HEALTH-WI DHS DIVISION OF PUBLIC HEALTH-HOWARD SUAMICO SCHOOLS-CONNECTIONS FOR MENTAL WELLNESS-PULASKI COMMUNITY SCHOOLS-ST NORBERT COLLEGE-HSHS LIBERTAS TREATMENT CENTER-SHERMAN COUNSELING-UW EXTENSIONS-AIDS RESOURCE CENTER OF WISCONSIN (ARCW)-FOUNDATIONS-BOCE/ETC.-AURORA BEHAVIORAL HEALTH - UWGB-UNITED WAY - BROWN COUNTY-EX PRISONER OPPORTUNITIES-INTEGRATED COMMUNITY SOLUTIONS-OCONTO COUNTY PUBLIC HEALTH-RETIRED LAW ENFORCEMENT - DE PERE-BELLIN COLLEGE-BROWN COUNTY - CTC-UW GREEN BAY-ONEIDA NATION-BROWN COUNTY CHILD AND ADOLESCENT BEHAVIORAL HEALTH-PREVEA HEALTH-BROWN COUNTY HEALTH & HUMAN SERVICES-NEW COMMUNITY CLINIC-NEW COMMUNITY CLINIC & BROWN COUNTY BOARD OF HEALTH-GREEN BAY AREA PUBLIC SCHOOLS-CITY OF GREEN BAY - MAYOR-AURORA BAYCARE MEDICAL CENTER (ABMC)-ORAL HEALTH PARTNERSHIP-COMMUNITY VOLUNTEER-CITY OF DE PERE-JOSHUA - BC MENTAL HEALTH TASK FORCE - CONNECTIONS FOR MENTAL WELLNESS-DIOCESE OF GB CATHOLIC CHARITIES-BAY AREA COMMUNITY COUNCIL (BACC)-DARJUNE/EXPOTO ENSURE THAT THE NEEDS OF THESE GROUPS WERE ADEQUATELY REPRESENTED, WE INCLUDED REPRESENTATIVES FROM BROWN COUNTY HEALTH AND HUMAN SERVICES (PUBLIC HEALTH, AGING & DISABILITY RESOURCE CENTER, AND CHILD & FAMILY SERVICES); VARIOUS BROWN COUNTY DEPARTMENTS INCLUDING HEAD START, PROBATION & PAROLE, VICTIM/WITNESS SERVICES, VETERANS SERVICES; LOVE, INC.; BROWN COUNTY INTERFAITH ORGANIZATION; LOCAL SCHOOL DISTRICTS; BROWN COUNTY INTERFAITH; PARTNERS FOR COMMUNITY DEVELOPMENT; FAMILY RESOURCE CENTER OF BROWN COUNTY; SAFE HARBOR. 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. |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 6A: AURORA BAYCARE MEDICAL CENTER (GREEN BAY) AND ST. MARY'S AND ST. VINCENT HOSPITALS (HSHS, GREEN BAY) |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 6B: BROWN COUNTY HEALTH DEPARTMENT, CITY OF DE PERE HEALTH DEPARTMENT, AND BROWN COUNTY UNITED WAY |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BROWN_COUNTY-FY2018_CHNA_EDITS_04_10_FULL URL FOR PART V, SECTION B, LINE 10A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BROWN_COUNTY_FY2018_IMPLEMENTATION_PL |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2018 THROUGH 2020. THE NEEDS IDENTIFIED ARE: MENTAL HEALTH, PHYSICAL ACTIVITY, OBESITY, AND NUTRITION, AND HEALTH INEQUALITY. BELLIN REPRESENTATIVES LEAD THE INITIATIVES. A SUMMARY OF HOW BELLIN HAS BEEN ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA IS AS FOLLOWS:MENTAL HEALTH: LONG-TERM PERFORMANCE INDICATORS: BY JULY 2020, THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS PER 30 DAYS, AS REPORTED BY COUNTY RESIDENTS, WILL DECREASE FROM 3.4 TO 3.2. STRATEGY ONE: SCREENING TOOL ASSESSMENT AND BEST PRACTICE IDENTIFICATION BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT AND MENTAL HEALTH TASK FORCE TO: -ASSIST IN COMPLETING AN INVENTORY OF CURRENT BEHAVIORAL HEALTH SCREENING TOOLS USED ACROSS SETTINGS. -ASSIST IN COMPLETING AN INVENTORY OF CURRENT SUICIDE RISK SCREENING TOOLS USED ACROSS SETTINGS (CONSIDER COLLABORATION WITH THE BROWN COUNTY COALITION FOR SUICIDE PREVENTION ON THIS ACTIVITY). -IDENTIFY BEST PRACTICE BEHAVIORAL HEALTH SCREENING TOOLS AND DEVELOP RECOMMENDATIONS FOR TOOLS USED IN VARIOUS COMMUNITY SETTINGS. -IDENTIFY BEST PRACTICE SUICIDE RISK SCREENING TOOLS AND DEVELOP RECOMMENDATIONS FOR TOOLS USED IN VARIOUS COMMUNITY SETTINGS. STRATEGY TWO: "NO WRONG DOOR" ACCESS PLATFORM FOR MENTAL HEALTH TREATMENT AND PROVIDERS BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT AND MENTAL HEALTH TASK FORCE TO: -IMPLEMENT TRILOGY NETWORK OF CARE IN COLLABORATION WITH NEW CONNECTIONS -WORK WITH PRIMARY CARE PROVIDERS TO IDENTIFY EDUCATION NEEDS AND STRENGTHEN PRIMARY CARE AS THE ENTRY POINT TO "RIGHT CARE, RIGHT PERSON, RIGHT TIME" MENTAL HEALTH TREATMENT. -INVESTIGATE AND IMPLEMENT A "NO WRONG DOOR" REFERRAL PROCESS BETWEEN COMMUNITY AGENCIES TO GUARANTEE THE RIGHT ACCESS AT THE RIGHT TIME. STRATEGY THREE: DEVELOP A NETWORK OF PEER SUPPORT, INCREASING AVAILABILITY OF IMMEDIATE RESOURCES TO COMMUNITY BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT AND MENTAL HEALTH TASK FORCE TO: -COMPLETE AN INVENTORY OF CURRENT MENTAL HEALTH PEER SUPPORT RESOURCES AVAILABLE IN THE COMMUNITY. -IDENTIFY EDUCATIONAL/TRAINING PROGRAMS AVAILABLE TO THOSE INTERESTED IN PROVIDING PEER SUPPORT IN THE COMMUNITY (E.G. QPR, MENTAL HEALTH FIRST AID, ETC.). -DEVELOP A PEER SUPPORT NETWORK, IMPLEMENT SERVICES AND PROVIDE RESOURCE CONTACTS TO COMMUNITY ORGANIZATIONS AND AGENCIES. PHYSICAL ACTIVITY, OBESITY, AND NUTRITION:LONG-TERM PERFORMANCE INDICATORS: BY 2020, INCREASE NUMBER OF INDIVIDUALS WITH A HEALTHY WEIGHT BY THREE PERCENT, AS EVIDENCED BY AN INCREASE IN THE NUMBER OF COMMUNITY MEMBERS WITH A BMI UNDER 30. (BASELINE MEASURE: 72 PERCENT AT HEALTHY WEIGHT, BASED ON COUNTY HEALTH RANKINGS 2017- 2013 DATA).STRATEGY ONE: FOOD AS MEDICINE BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT TO IMPROVE EQUITABLE ACCESS TO HEALTHY FOOD, AND INCREASE THE PROPORTION OF BROWN COUNTY RESIDENTS WHO CONSUME THE RECOMMENDED NUMBER OF SERVINGS OF FRUITS AND VEGETABLES BY AT LEAST TWO PERCENT (SHORT TERM) AND FOUR PERCENT (LONG TERM) BY: -ESTABLISHING RELATIONSHIPS WITH VARIOUS COMMUNITY GROUPS AND OFFERING ASSISTANCE TO FACILITATE CHANGE OR MAINTENANCE FOR PROGRAMS THAT FOCUS ON CONSUMPTION OF HEALTHY FOODS -MONITORING HEALTHY FOOD DONATIONS AT SCOUTING FOR FOODS DRIVE -MAINTAINING AND PROMOTING FOOD DRIVE 5 TOOLKIT -MONITORING AND ENCOURAGING FOOD PANTRY INFRASTRUCTURE THAT PROMOTES HEALTHY FOOD CHOICES -INSTITUTE A PLATFORM OF HEALTHY SNACKS IN THE SCHOOL SYSTEM BY ELIMINATING CANDY, HIGH FAT SNACKS AND SODA FROM VENDING MACHINES AND CAFETERIAS -TRACKING THE RATIO OF ELIGIBILITY FOR EBT PROGRAM TO THOSE WHO USE THE DOUBLE YOUR BUCKS PROGRAM AT THE FARMER'S MARKET -BEN'S WISH PROGRAM THAT ASSISTS LOCAL COMMUNITIES IN FIGHTING FOOD INSECURITY ISSUES THROUGH FOOD DRIVE COLLECTION, WEEKEND BACKPACK PROGRAM AND EDUCATIONAL ACTIVITIES. STRATEGY TWO: MOVEMENT AS MEDICINE BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT TO DECREASE PHYSICAL INACTIVITY (SHORT-TERM BY TWO PERCENT, LONG-TERM BY FOUR PERCENT) THROUGH EMPOWERING COMMUNITY MEMBERS TO USE ACTIVE MEANS OF TRANSPORT/MOVEMENT BY PARTNERING WITH THE GREATER GREEN BAY ACTIVE COMMUNITY ALLIANCE. ENCOURAGE BROWN COUNTY RESIDENTS TO UTILIZE COMMUNITY RESOURCES (E.G. WALKING/BIKING TRAILS, FITNESS CENTERS, ETC) AND FACILITATE CAMPAIGN(S) THAT PROMOTE(S) HEALTHY LIFESTYLES THROUGH SAFE AND AFFORDABLE MODES OF PHYSICAL ACTIVITY (AS MEASURED BY A DECREASE IN PHYSICAL INACTIVITY) BY STRUCTURING THE WORK AROUND THE THREE ES (ENGINEERING, EDUCATION, ENFORCEMENT). TOGETHER, WE WILL ACCOMPLISH THIS BY: -INVENTORYING EXISTING INITIATIVES THAT ARE IN ALIGNMENT WITH THIS OBJECTIVE. -PARTNERING WITH THE GREATER GREEN BAY ACTIVE COMMUNITY ALLIANCE TO CREATE A MORE ACTIVE AND CONNECTED COMMUNITY. -DEVELOPING AN EDUCATIONAL STRATEGY USING THE THREE ES IN PARTNERSHIP WITH THE GREATER GREEN BAY ACTIVE COMMUNITY ALLIANCE. -MONITORING UTILIZATION TRENDS OF ACTIVE DESIGN AND INFRASTRUCTURE TO IDENTIFY GAPS AND OPPORTUNITIES TO IMPROVE. STRATEGY THREE: CULTURE CHANGE: BELLIN HEALTH WILL WORK COLLABORATIVELY WITH THE BROWN COUNTY HEALTH DEPARTMENT TO LINK LIFE STUDY DATA, CHIP AND THE GROW PROJECT TOGETHER TO COLLABORATE ON COMMUNITY INITIATIVES. TOGETHER WE WILL CREATE A COMMUNITY DRIVEN BY MULTI-SECTORED PARTNERSHIPS SUPPORTIVE OF CULTURAL WELL-BEING THAT IMPROVES THE HEALTH OF BROWN COUNTY BY: -CONVENING MEETINGS WITH LEADERSHIP FROM LIFE STUDY, CHIP AND THE GROW PROJECT. -TESTING A COMMUNITY EDUCATION PLATFORM SUPPORTING THE CONNECTION BETWEEN NUTRITION, MOVEMENT AND HEALTH STATUS. -ENGAGING AND EMPOWERING THE GROWTH AND DEVELOPMENT OF RELATIONSHIPS BETWEEN AGENCIES IN THE FOOD-RELATED AND WELL-BEING SECTORS. -ADOPTING HEALTHFUL HOSPITAL FOOD AMERICAN MEDICAL ASSOCIATION RESOLUTION 406.HEALTH EQUALITY:IN ADDITION TO THE THREE COMMUNITY TEAMS, BELLIN IS HAS AN INTERNAL TEAM FOCUSED ON ADDRESSING HEALTH EQUITY. PRIMARY DRIVERS IN THIS WORK INCLUDE: LEADERSHIP AND ADVOCACY AS HEALTHCARE LEADERS FOR HEALTH EQUITY, ORGANIZATION FOCUS TO ADDRESS OPPORTUNITIES FOR HEALTH CARE EQUITY AND PARTNERSHIPS WITH THE KEY STAKEHOLDERS AND COMMUNITIES. ONE OF THE KEY PROJECT THAT THIS TEAM WILL FOCUS ON US THE COLLECTION AND USE OF REAL (RACE, ETHNICITY AND LANGUAGE) DATA. SOME ADDITIONAL PROJECTS THAT THE TEAM HAS PRIORITIZED FALL UNDER THE SECONDARY DRIVERS OF DEVELOPING A RECRUITMENT AND RETENTION STRATEGY TO EVOLVE THE WORKFORCE TO REFLECT THE COMMUNITY WE LIVE IN, AND THE QUALITATIVE AND QUANTITATIVE UNDERSTANDING OF THE POPULATIONS WE SERVE BY ADDRESSING THE SOCIAL DETERMINATES OF HEALTH. NEXT STEPS THE IMPLEMENTATION PLAN OUTLINES A THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PROCESS. ANNUALLY, THE HOSPITAL WILL: -REVIEW THE IMPLEMENTATION PLAN AND UPDATE STRATEGIES FOR THE FOLLOWING FISCAL YEAR -SET AND TRACK ANNUAL PERFORMANCE INDICATORS FOR EACH IMPLEMENTATION STRATEGY -TRACK PROGRESS TOWARD MID TERM PERFORMANCE INDICATORS -REPORT PROGRESS TOWARD THE PERFORMANCE INDICATORS TO THE HOSPITAL BOARD, COMMUNITY BENEFIT ADVISORY COMMITTEE |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 13B: 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 | 20 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (20 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - BELLIN BEHAVIORAL HEALTH CLINIC | ||||
| 301 E ST JOSEPH STREET | GREEN BAY | WI | 54305 | OUTPATIENT MENTAL HEALTH CLINIC |
| 2 - BELLIN HEALTH - RIVERSIDE PSYCHIATRIC | ||||
| 1325 ANGELS PATH | DE PERE | WI | 54115 | OUTPATIENT MENTAL HEALTH CLINIC |
| 3 - BELLIN BEHAVIORAL HEALTH CLINIC ASHWAUBE | ||||
| 1630 COMMANCHE AVENUE | GREEN BAY | WI | 54313 | OUTPATIENT MENTAL HEALTH CLINIC |
| 4 - BELLIN BEHAVIORAL HEALTH CLINIC NEURO CA | ||||
| 744 S WEBSTER AVENUE | GREEN BAY | WI | 54301 | PSYCHOLOGICAL TESTING |
| 5 - BELLIN BEHAVIORAL HEALTH CLINIC BELLEVUE | ||||
| 3263 EATON ROAD | GREEN BAY | WI | 54311 | OUTPATIENT MENTAL HEALTH CLINIC |
| 6 - BELLIN BEHAVIORAL HEALTH CLINIC EAST DE | ||||
| 555 REDBIRD CIR | DE PERE | WI | 54115 | OUTPATIENT MENTAL HEALTH CLINIC |
| 7 - BELLIN BEHAVIORAL HEALTH CLINIC MARINETT | ||||
| 2820 ROOSEVELT RD | MARINETTE | WI | 54143 | OUTPATIENT MENTAL HEALTH CLINIC |
| 8 - BELLIN BEHAVIORAL HEALTH CLINIC ESCANABA | ||||
| 610 S LINCOLN ROAD | ESCANABA | MI | 49829 | OUTPATIENT MENTAL HEALTH CLINIC |
| 9 - BELLIN BEHAVIORAL HEALTH CLINIC IRON MOU | ||||
| 440 WOODWARD AVE UNIT 101 | IRON MOUNTAIN | MI | 49801 | OUTPATIENT MENTAL HEALTH CLINIC |
| 10 - BELLIN BEHAVIORAL HEALTH CLINIC OCONTO | ||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | OUTPATIENT MENTAL HEALTH CLINIC |
| 11 - BELLIN BEHAVIORAL HEALTH CLINIC OCONTO F | ||||
| 107 E HIGHLAND DR | OCONTO FALLS | WI | 54154 | OUTPATIENT MENTAL HEALTH CLINIC |
| 12 - BELLIN BEHAVIORAL HEALTH CLINIC HOWARD | ||||
| 2714 RIVERVIEW DR | GREEN BAY | WI | 54313 | OUTPATIENT MENTAL HEALTH CLINIC |
| 13 - BELLIN BEHAVIORAL HEALTH CLINIC WEST DE | ||||
| 1800 LAWRENCE DRIVE | DE PERE | WI | 54115 | OUTPATIENT MENTAL HEALTH CLINIC |
| 14 - BELLIN BEHAVIORAL HEALTH CLINIC PULASKI | ||||
| 723 N WISCONSIN ST | PULASKI | WI | 54162 | OUTPATIENT MENTAL HEALTH CLINIC |
| 15 - BELLIN BEHAVIORAL HEALTH CLINIC STURGEON | ||||
| 311 N 3RD AVE | STURGEON BAY | WI | 54235 | OUTPATIENT MENTAL HEALTH CLINIC |
| 16 - BELLIN BEHAVIORAL HEALTH CLINIC ALGOMA | ||||
| 831 PARKER AVE | ALGOMA | WI | 54201 | OUTPATIENT MENTAL HEALTH CLINIC |
| 17 - BELLIN BEHAVIORAL HEALTH CLINIC KEWAUNEE | ||||
| 575 4TH ST | KEWAUNEE | WI | 54216 | OUTPATIENT MENTAL HEALTH CLINIC |
| 18 - BELLIN BEHAVIORAL HEALTH CLINIC DAGGETT | ||||
| 106 S SCHOOL RD | DAGGETT | MI | 49821 | OUTPATIENT MENTAL HEALTH CLINIC |
| 19 - BELLIN BEHAVIORAL HEALTH CLINIC LUXEMBUR | ||||
| 140 SCHOOL CREEK TRAIL | LUXEMBURG | WI | 54217 | OUTPATIENT MENTAL HEALTH CLINIC |
| 20 - BELLIN BEHAVIORAL HEALTH CLINIC CANCER T | ||||
| 1580 COMMANCHE AVENUE | ASHWAUBENON | WI | 54313 | OUTPATIENT MENTAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | BELLIN PSYCHIATRIC CENTER IS INCLUDED IN THE ANNUAL 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 $867,207 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 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 16 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 2020 AND 2019. |
| 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 RUL 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. 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 ANDEXPERIENCE 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: | BELLIN PSYCHIATRIC CENTER HAS COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IT IS POSTED ON BELLIN.ORG |
| PART VI, LINE 3: | FINANCIAL COUNSELORS ADVISE PATIENTS OF ASSISTANCE PROGRAMS AS WELL AS SERVICE CALLED HRS ERASE IS USED TO REVIEW SELF PAY ACCOUNTS FOR POSSIBLE COVERAGE THROUGH GOVERNMENT PROGRAMS. |
| PART VI, LINE 4: | BELLIN PSYCHIATRIC CENTER SERVES NORTHEAST WISCONSIN INCLUDING CLINICS IN THE CITIES OF GREEN BAY, ASHWAUBENON, BELLEVUE, DE PERE, LEDGEVIEW, MARINETTE, OCONTO, OCONTO FALLS, PESHTIGO, ALGOMA, ESCANABA, AND IRON MOUNTAIN. |
| PART VI, LINE 5: | A MAJORITY OF BELLIN PSYCHIATRIC CENTER'S GOVERNING BODY IS COMPRISED OF PERSON WHO RESIDE IN BELLIN PSYCHIATRIC CENTER'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, BELLIN PSYCHIATRIC CENTER EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. BELLIN PSYCHIATRIC CENTER 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHRISTINE WOLESKE | ||||||||||||||
| MEMBER/BELLIN CEO | $0 | $570,739 | $0 | $422,692 | $0 | $35,150 | $0 | $151,742 | $0 | $18,473 | $0 | $1,198,796 | $0 | $0 |
| DEREK CARLSON MD | ||||||||||||||
| PHYSICIAN | $345,602 | $0 | $66,078 | $0 | $1,188 | $0 | $14,436 | $0 | $21,064 | $0 | $448,368 | $0 | $0 | $0 |
| DHANVENDRAN RAMAR MD | ||||||||||||||
| PHYSICIAN | $263,787 | $0 | $133,907 | $0 | $180 | $0 | $11,039 | $0 | $28,769 | $0 | $437,682 | $0 | $0 | $0 |
| NACIYE KALAFAT MD | ||||||||||||||
| MEMBER | $256,894 | $0 | $141,203 | $0 | $982 | $0 | $12,324 | $0 | $23,844 | $0 | $435,247 | $0 | $0 | $0 |
| REKHA VIJAYAN | ||||||||||||||
| PHYSICIAN | $275,018 | $0 | $144,681 | $0 | $180 | $0 | $11,675 | $0 | $1,280 | $0 | $432,834 | $0 | $0 | $0 |
| EMILY RADEMACHER MD | ||||||||||||||
| MEMBER/PRESIDENT MEDICAL STAFF | $345,573 | $0 | $8,053 | $0 | $162 | $0 | $12,173 | $0 | $23,769 | $0 | $389,730 | $0 | $0 | $0 |
| JOHN CHARLES MD | ||||||||||||||
| PHYSICIAN | $192,179 | $0 | $152,185 | $0 | $414 | $0 | $21,719 | $0 | $21,169 | $0 | $387,666 | $0 | $0 | $0 |
| ANTHONY MARCHLEWSKI MD | ||||||||||||||
| PHYSICIAN | $271,863 | $0 | $68,673 | $0 | $774 | $0 | $18,397 | $0 | $23,769 | $0 | $383,476 | $0 | $0 | $0 |
| MICHAEL HOFFMAN MD | ||||||||||||||
| MEMBER/PHYSICIAN | $0 | $234,461 | $0 | $51,764 | $0 | $414 | $0 | $16,548 | $0 | $17,619 | $0 | $320,806 | $0 | $0 |
| SHARLA BAENEN | ||||||||||||||
| BPC PRESIDENT | $187,017 | $0 | $15,080 | $0 | $270 | $0 | $32,731 | $0 | $21,119 | $0 | $256,217 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | THE PSYCHIARTRIC CENTER HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. THE PARTICIPANT IS SHARLA BAENEN. | 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 AND EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| CUSIP | 97712DLH7 | CUSIPNum |
| Bond Issued | 2015-04-09 | BondIssuedDt |
| Issue Price | $2,468,852 | IssuePriceAmt |
| Purpose | REFUND AND LEGALLY DEFEASE | 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 | $139,666 | RetiredAmt |
| Total Proceeds | $2,468,852 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $28,985 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $2,439,867 | OtherSpentProceedsAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | Yes (1) | 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 | Yes (1) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | Yes (1) | 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 | Yes (1) | Form8038TFiledInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NACIYE KALAFAT MD | PersonNm |
| Relationship With Org | PRESIDENT MEDICAL STAFF/BOD | RelationshipWithOrgTxt |
| Loan Purpose | SALARY ADVANCE | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $40,000 | OriginalPrincipalAmt |
| Balance Due | $3,846 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $3,846 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 AND REMOVE 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. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. SHOULD THERE BE A CONFLICT OF INTEREST WHICH ARISES AT A BOARD MEETING, THE INDIVIDUAL WITH A CONFLICT WILL BE ASKED TO LEAVE THE MEETING DURING A VOTE ON THE MATTER AND IS REQUIRED TO ABSTAIN FROM VOTING. |
| 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 CONSULTANTS 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 XII, 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 | 54305 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C)(3) | 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)(3) | LINE 2 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 391809171 | FOUNDATION | WI | 501(C)(3) | LINE 7 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 390884478 | ACUTE CARE HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| OCONTO HOSPITAL & MEDICAL CENTER INC | |||||||||||
| PO BOX 357 | OCONTO | WI | 54153 | 061745397 | HOSPITAL | WI | 501(C)(3) | LINE 3 | BELLIN MEMORIAL HOSPITAL INC | Yes (1) | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54305 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| UNITY LIMITED PARTNERSHIP | |||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HOSPICE, PALLIATIVE, AND BEREAVEMENT SERVICES | WI | 501(C)(3) | 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 |
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 | |||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 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 | 0 | 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 | 0 | 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 | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BELLIN MEMORIAL HOSPITAL | ||
| E | $1,922,699 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL | ||
| M | $2,165,579 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL | ||
| E | $10,519,143 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL | ||
| K | $56,012 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL | ||
| P | $15,500,000 | ACTUAL |