BELLIN PSYCHIATRIC CENTER: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- BELLIN PSYCHIATRIC CENTER (EIN 39-1657627)
- Tax period
- 2023-10-01 to 2024-09-30
- Filed
- 2025-08-13
- IRS object ID
- 202542259349302279
- Schema version
- 2023v6.0
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-08-13T14:24:13-05:00 | ReturnTs |
| Tax Period End | 2024-09-30 | 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 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-10-01 | 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 | JOHN CEELEN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9204333630 | PhoneNum |
| Signature | 2025-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2025-08-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | JOHN CEELEN | 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 | $33,572,208 | 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 | 2 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 312 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $34,138 | PYContributionsGrantsAmt |
| CY Contributions Grants | $102,291 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,663,221 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $31,730,176 | CYProgramServiceRevenueAmt |
| PY Investment Income | $457,081 | PYInvestmentIncomeAmt |
| CY Investment Income | $522,267 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,148,987 | PYOtherRevenueAmt |
| CY Other Revenue | $1,217,474 | CYOtherRevenueAmt |
| PY Total Revenue | $31,303,427 | PYTotalRevenueAmt |
| CY Total Revenue | $33,572,208 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $15,267 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $28,831 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $26,253,747 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,695,189 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,671,489 | PYOtherExpensesAmt |
| CY Other Expenses | $7,060,957 | CYOtherExpensesAmt |
| PY Total Expenses | $32,940,503 | PYTotalExpensesAmt |
| CY Total Expenses | $35,784,977 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,637,076 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,212,769 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,239,238 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,428,979 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,871,411 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,553,510 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,367,827 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,875,469 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $31,425,456 | ExpenseAmt |
| Grant | $28,831 | GrantAmt |
| Revenue | $32,947,650 | RevenueAmt |
| Desc | THE CENTER PROVIDES PSYCHIATRIC AND ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2024, 9,189 INPATIENT DAYS WERE PROVIDED (4,789 ADULT, 2,075 CHILD AND 2,325 ADOLESCENT). THE NUMBER OF OUTPATIENT THERAPY VISITS DURING FISCAL YEAR 2024 WERE 30,582. IN ADDITION, THERE WERE 71,829 INPATIENT AND OUTPATIENT MD, APNP AND PHD VISITS. | Desc |
| Total Program Service Expenses | $31,425,456 | 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 | 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 | 312 | 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 | 2 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | 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 | JOHN CEELEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204333630 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 744 S WEBSTER AVENUE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CHRISTINE WOLESKE | ||||||||||
| MEMBER/BMH CEO | 2.00 | 48.00 | Yes (X) | $0 | $1,775,439 | $238,231 | ||||
| SHARLA BAENEN | ||||||||||
| MEMBER/BMH COO | 2.00 | 48.00 | Yes (X) | $0 | $500,435 | $86,399 | ||||
| SCOTT RATHGABER MD | ||||||||||
| BGHS CEO | 2.00 | 48.00 | $0 | $1,644,221 | $68,728 | Yes (X) | ||||
| STEVE LITTLE | ||||||||||
| BMH CFO (THRU 02/2024) | 2.00 | 48.00 | $0 | $333,317 | $0 | Yes (X) | ||||
| JOHN CEELEN | ||||||||||
| BMH CFO (BEG. 02/2024) | 2.00 | 48.00 | $0 | $0 | $0 | Yes (X) | ||||
| DEBRA PATZ | ||||||||||
| VICE PRESIDENT | 40.00 | $154,268 | $0 | $11,736 | Yes (X) | |||||
| DEREK CARLSON MD | ||||||||||
| PHYSICIAN | 50.00 | $414,680 | $0 | $42,790 | Yes (X) | |||||
| REKHA VIJAYAN | ||||||||||
| PHYSICIAN | 50.00 | $399,473 | $0 | $17,812 | Yes (X) | |||||
| KIM LASECKI | ||||||||||
| PHYSICIAN | 50.00 | $420,392 | $0 | $44,879 | Yes (X) | |||||
| DHANVENDRAN RAMAR MD | ||||||||||
| PHYSICIAN | 50.00 | $464,381 | $0 | $46,957 | Yes (X) | |||||
| ALEXANDRA RUSH | ||||||||||
| PHYSICIAN | 50.00 | $355,187 | $0 | $19,223 | Yes (X) | |||||
| NACIYE KALAFAT MD | ||||||||||
| FORMBER B.M./FORMER PSYCH. DEPT. CHAIR | 50.00 | $383,090 | $0 | $45,601 | Yes (X) | |||||
| EMILY RADEMACHER MD | ||||||||||
| FORMER B.M./PRESIDENT MEDICAL STAFF | 50.00 | $370,781 | $0 | $51,903 | Yes (X) | |||||
| TARA ROBERTSON PSYD | ||||||||||
| FORMER B.M./PSYCHIATRY DEPT. CHAIR | 50.00 | $233,700 | $0 | $13,832 | Yes (X) | |||||
| MICHAEL HOFFMAN MD | ||||||||||
| FORMER B.M./PHYSICIAN | 20.00 | 35.00 | $0 | $282,838 | $46,722 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,195,952 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,536,250 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $734,813 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 41 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 | 543043400 | INTERCOMPANY SERVICES | $2,783,478 |
| IRIS TELEHEALTH MEDICAL GROUP | |||||
| 114 W 7TH ST STE 900 | AUSTIN | TX | 78701 | CONTRACTED VIRTUAL CARE | $1,117,615 |
| STAFFENCY LLC | |||||
| 221 W COLLEGE AVE FL 2 | APPLETON | WI | 54911 | CONTRACTED STAFFING | $996,175 |
| BAY TOWEL LINEN & UNIFORM RENT | |||||
| 2580 S BROADWAY | GREEN BAY | WI | 54304 | CONTRACTED LINEN SERVICES | $126,912 |
| STEVEN R MILJOUR MD | |||||
| W223 LUCHARY RD | BARK RIVER | MI | 49807 | CONTRACTED SERVICES | $110,208 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,735 | RelatedOrganizationsAmt |
| All Other Contributions | $100,556 | AllOtherContributionsAmt |
| Total Contributions | $102,291 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $31,680,005 | $31,680,005 |
| CONTRACTED SERVICES | 621110 | $50,171 | $50,171 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $31,730,176 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $204,489 | TotalRevenueColumnAmt |
| Exclusion | $204,489 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $317,778 | 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 | $317,778 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $317,778 | TotalRevenueColumnAmt |
| Exclusion | $317,778 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCENTIVE PAYMENTS | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $1,200,582 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,200,582 | RelatedOrExemptFuncIncomeAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,892 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,892 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,217,474 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,572,208 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,947,650 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $522,267 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,831 | TotalAmt |
| Program Services | $28,831 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,644 | TotalAmt |
| Program Services | $161,161 | ProgramServicesAmt |
| Management And General | $8,483 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,544,739 | TotalAmt |
| Program Services | $22,594,617 | ProgramServicesAmt |
| Management And General | $950,122 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,141,953 | TotalAmt |
| Program Services | $1,079,233 | ProgramServicesAmt |
| Management And General | $62,720 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,381,917 | TotalAmt |
| Program Services | $2,251,675 | ProgramServicesAmt |
| Management And General | $130,242 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,456,936 | TotalAmt |
| Program Services | $1,388,529 | ProgramServicesAmt |
| Management And General | $68,407 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,339 | TotalAmt |
| Management And General | $20,339 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,006,941 | TotalAmt |
| Program Services | $607,733 | ProgramServicesAmt |
| Management And General | $399,208 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380 | TotalAmt |
| Management And General | $380 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,918 | TotalAmt |
| Program Services | $84,157 | ProgramServicesAmt |
| Management And General | $14,761 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,206 | TotalAmt |
| Program Services | $3,728 | ProgramServicesAmt |
| Management And General | $4,478 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $526,867 | TotalAmt |
| Program Services | $476,110 | ProgramServicesAmt |
| Management And General | $50,757 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,827 | TotalAmt |
| Program Services | $6,354 | ProgramServicesAmt |
| Management And General | $8,473 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,844 | TotalAmt |
| Program Services | $72,947 | ProgramServicesAmt |
| Management And General | $22,897 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,824 | TotalAmt |
| Management And General | $53,824 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $503,865 | TotalAmt |
| Program Services | $215,669 | ProgramServicesAmt |
| Management And General | $288,196 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,437 | TotalAmt |
| Program Services | $6,827 | ProgramServicesAmt |
| Management And General | $31,610 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,707,432 | $563,019 | $2,144,413 |
| BAD DEBT EXPENSE | $1,351,633 | $1,351,633 | |
| FOOD | $269,740 | $269,740 | |
| DUES & SUBSCRIPTIONS | $100,671 | $59,579 | $41,092 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $263,033 | TotalAmt |
| Program Services | $203,914 | ProgramServicesAmt |
| Management And General | $59,119 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,784,977 | TotalAmt |
| Program Services | $31,425,456 | ProgramServicesAmt |
| Management And General | $4,359,521 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,512,914 | BOYAmt |
| EOY | $1,807,238 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,077,244 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,701,822 | BOYAmt |
| EOY | $3,012,145 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,805,139 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,611,220 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,747,137 | BOYAmt |
| EOY | $7,193,919 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,200,121 | BOYAmt |
| EOY | $8,415,677 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,239,238 | BOYAmt |
| EOY | $20,428,979 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,071,318 | BOYAmt |
| EOY | $2,375,041 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,416,811 | BOYAmt |
| EOY | $1,499,079 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,383,282 | BOYAmt |
| EOY | $14,679,390 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,871,411 | BOYAmt |
| EOY | $18,553,510 | 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 | $3,367,827 | BOYAmt |
| EOY | $1,875,469 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,367,827 | BOYAmt |
| EOY | $1,875,469 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,239,238 | BOYAmt |
| EOY | $20,428,979 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,212,769 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $720,411 | 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 | $6,786,265 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,544,892 | DepreciationAmt |
| Book Value | $3,241,373 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,259,499 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,066,328 | DepreciationAmt |
| Book Value | $1,193,171 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,610 | OtherCostOrOtherBasisAmt |
| Book Value | $11,610 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,193,919 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $14,679,390 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $14,679,390 | 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 | $555,723 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $555,723 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01610 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,614,369 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $728,456 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,885,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.28710 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,170,092 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $728,456 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,441,636 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.30320 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Direct Offsetting Revenue | $38,129 | 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 | $333,625 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $333,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00970 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $335,625 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $38,129 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $335,625 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00980 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,505,717 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $766,585 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,777,261 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.31300 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $711,079 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,522,927 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,069,517 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,546,590 | 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 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 |
| Other | PSYCHIATRIC | OtherDesc |
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 | 23 | 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 | 23 | 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 | SEE PART V, SECTION C, LINES 16A-C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C, LINES 16A-C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 10 | 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 5: IN THE 2023-2024 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE KEY IDENTIFIED PRIORITIES FOCUS ON MENTAL AND EMOTIONAL WELL-BEING, SUBSTANCE MISUSE, EQUITABLE ACCESS TO HEALTHCARE, AND SAFE AND ACCESSIBLE HOUSING. RECOGNIZING THE NEED TO UNDERSTAND THE UNDERLYING REASONS FOR HEALTH DISPARITIES, COMMUNITY FEEDBACK WAS GATHERED THROUGH THE COMMUNITY MEMBER CHNA SURVEY.FEEDBACK WAS GATHERED THROUGH VARIOUS METHODS, INCLUDING:- ONGOING CHNA/CHIP SURVEY: AVAILABLE ON THE BCHP WEBSITE, THIS SURVEY SOLICITS INPUT IN ENGLISH, HMONG, AND SPANISH. IT HAS BEEN PROMOTED VIA SOCIAL MEDIA AND THROUGH COMMUNITY PARTNERS AND STEERING COMMITTEE MEMBERS, YIELDING APPROXIMATELY 60 RESPONSES FROM THE GENERAL PUBLIC.- DOOR-TO-DOOR SURVEY: IN LATE 2023, BROWN COUNTY PUBLIC HEALTH CONDUCTED A DOOR-TO-DOOR SURVEY TO ASSESS COMMUNITY EMERGENCY PREPAREDNESS NEEDS USING THE CDC'S CASPER TOOL. THIS INVOLVED RANDOMLY SELECTING 30 CLUSTERS OF HOUSES, RESULTING IN VISITS TO 490 HOMES AND THE COMPLETION OF 142 SURVEYS. THIS EFFORT WAS SUPPORTED BY PARTNERS SUCH AS THE DE PERE HEALTH DEPARTMENT, GREEN BAY METRO FIRE DEPARTMENT, AND HOWARD FIRE DEPARTMENT.- DIVERSE ENGAGEMENT INITIATIVES: TO CAPTURE A BROADER RANGE OF PERSPECTIVES, WE PARTNERED WITH COMMUNITY ORGANIZATIONS TO ENGAGE AGING INDIVIDUALS, RURAL RESIDENTS, BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC), AS WELL AS THOSE EXPERIENCING HOMELESSNESS. THIS INITIATIVE INCLUDED A TWO-PART SERIES WHERE CONSULTANTS SHARED THEIR HEALTH EXPERIENCES AS MEMBERS OF THE BROWN COUNTY COMMUNITY, WITH APPROXIMATELY 45 PARTICIPANTS INVOLVED.GUIDED BY BROWN COUNTY'S 2022-2024 CHIP AND DATA FROM THE MOST RECENT CHNA, THE BEYOND HEALTH STEERING COMMITTEE RANKED THE WISCONSIN STATE HEALTH IMPROVEMENT PLAN'S PRIORITY AREAS. THIS RANKING ESTABLISHED THE THREE FOCUS AREAS FOR BROWN COUNTY'S 2025-2027 CHIP. WHILE THE SELECTED FOCUS AREAS MAY NOT ALIGN EXACTLY WITH THE SHIP'S PRIORITIES, THE STEERING COMMITTEE OPTED TO CONCENTRATE ON MORE SPECIFIC ISSUES WITHIN THOSE AREAS. THEY ALSO CHOSE NAMES FOR THE FOCUS AREAS THAT ARE STRAIGHTFORWARD AND RESONATE WITH THE BROWN COUNTY COMMUNITY.THE 2025-2027 CHIP REPRESENTS A COLLABORATIVE EFFORT, INVOLVING PARTNERSHIPS ACROSS MULTIPLE SECTORS, INCLUDING GOVERNMENT, HEALTHCARE, AND NON-PROFIT ORGANIZATIONS.BEYOND HEALTH STEERING COMMITTEE, WHICH INCLUDES REPRESENTATION FROM LOCAL PUBLIC HEALTH AGENCIES, AREA HEALTH SYSTEMS, AND COMMUNITY AGENCIES. THE FOLLOWING ARE REPRESENTED ON THE BEYOND HEALTH STEERING COMMITTEE:- BROWN COUNTY PUBLIC HEALTH- DE PERE HEALTH DEPARTMENT- WI DEPARTMENT OF HEALTH SERVICES, DIVISION OF PUBLIC HEALTH- BROWN COUNTY UNITED WAY- ONEIDA COMMUNITY HEALTH SERVICES DEPARTMENT- N.E.W. COMMUNITY CLINIC- PREVEA HEALTH- HOSPITAL SISTERS HEALTH SYSTEM- AURORA BAYCARE MEDICAL CENTER- EMPLIFY HEALTH BY BELLINBEYOND HEALTH STRATEGY LEADS REPRESENTATION: - BROWN COUNTY UNITED WAY - BROWN COUNTY PUBLIC HEALTH - EMPLIFY HEALTH BY BELLIN - GREATER GREEN BAY BLUEPRINT TO PREVENT AND END HOMELESSNESS - NEIGHBORWORKS GREEN BAY - UW MADISON - EXTENSION, BROWN COUNTY - WELLO - WI DEPARTMENT OF HEALTH SERVICES - DIVISION OF PUBLIC HEALTHCOMMUNITY ORGANIZATIONS/COMMUNITIES REPRESENTED THROUGH COMMUNITY CONSULTANTS MEETINGS:- DENMARK COMMUNITY MEMBERS- HOUSE OF HOPE- PULASKI COMMUNITY MEMBERS- WE ALL RISE- WRIGHTSTOWN COMMUNITY MEMBERS |
| 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: BEYOND HEALTH IS A STEERING COMMITTEE COMPOSED OF LEADERS FROM BOTH THE PUBLIC AND PRIVATE SECTORS, INCLUDING HEALTHCARE PARTNERS, PUBLIC HEALTH AGENCIES, AND NON-PROFIT ORGANIZATIONS. THIS COLLABORATIVE GROUP WORKS TOGETHER TO IDENTIFY ACTIONABLE PRIORITIES, REDUCE HEALTH DISPARITIES, AND ADAPT TO NEW AND EMERGING HEALTH CONCERNS AS THEY ARISE. BY LEVERAGING DIVERSE EXPERTISE AND RESOURCES, BEYOND HEALTH STRIVES TO CULTIVATE A MORE EQUITABLE AND RESPONSIVE COMMUNITY HEALTH LANDSCAPE FOR THE POPULATIONS WE SERVE. |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A & 10A:HTTPS://BELLIN.ORG/ABOUT-BELLIN-HEALTH/COMMUNITY-HEALTH-INITIATIVES |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2025 THROUGH 2027.AS DETAILED IN THE CHNA REPORT, BELLIN MEMORIAL HOSPITAL, IN COLLABORATION WITH COMMUNITY PARTNERS, IDENTIFIED THE FOLLOWING HEALTH PRIORITIES IN BROWN COUNTY: MENTAL AND EMOTIONAL WELL-BEING SUBSTANCE MISUSE EQUITABLE ACCESS TO HEALTHCARE SAFE AND ACCESSIBLE HOUSINGUNDER THE BROAD UMBRELLAS OF THESE PRIORITIES, BASED ON THE HEALTH OUTCOME DATA AND OBSERVED COMMUNITY NEEDS, BELLIN MEMORIAL HOSPITAL HAS CHOSEN TO FOCUS SPECIFICALLY ON THE AREAS OUTLINED IN THE ACTION PLAN.IDENTIFIED PRIORITY: MENTAL AND EMOTIONAL WELL-BEINGTACTIC: ROUTINE SCREENING FOR DEPRESSION/RISK FOR DEPRESSION FOR ADULT AND YOUTH POPULATION. TACTIC: MONITOR AND IMPROVE COMMUNITY RESOURCES CONNECTOR REFERRALS FOR PATIENTS EXPERIENCING STRESS/TOXIC STRESS (INITIATED WITH THE SOCIAL DETERMINANTS OF HEALTH SURVEY)TACTIC: INCREASE THE NUMBER OF CAREGIVERS AND STAFF TRAIN IN MENTAL HEALTH FIRST AID.TACTIC: BEHAVIORAL HEALTH CONSULTANTS (BHCS) IN PRIMARY CARETACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMSIDENTIFIED PRIORITY: SUBSTANCE MISUSETACTIC: DEVELOP AND PROMOTE REFERRAL FOR WELLNESS COACHING PROCESSES FOR PATIENTS WHO USE NICOTINE PRODUCTSTACTIC: PARTICIPATE IN DRUG TAKE-BACK EVENTSTACTIC: REGIONAL SUSPECTED OPIOID-RELATED OVERDOSES.TACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMSIDENTIFIED PRIORITY: EQUITABLE ACCESS TO HEALTHCARETACTIC: EPIC CAMPAIGNS TO HELP ADDRESS GAPS IN CARE.TACTIC: TARGETED OUTREACH TO ALL MEDICAID PATIENTS OVERDUE FOR MAMMOGRAPHY, COLORECTAL CANCER SCREENING, WELL CHILD VISITS, AND BLOOD PRESSURE FOLLOW UP. TACTIC: IDENTIFY BARRIERS TO HEALTHCARE ACCESS THROUGH SDOH SCREENING AND INTERVENING.TACTIC: LEVERAGE COMMUNITY EDUCATION/EVENT OPPORTUNITIES TO INCREASE AWARENESS AND ALIGN TO RESOURCES. IDENTIFIED PRIORITY: SAFE AND ACCESSIBLE HOUSINGTACTIC: MONITOR AND IMPROVE SOCIAL DETERMINANTS OF HEALTH SCREENING AND REFERRALS FOR PATIENTS AND FAMILIES. TACTIC: PARTICIPATE BIANNUALLY IN POINT IN TIME COUNT. PARTNER WITH COMMUNITY BASED ORGANIZATIONS TO ADDRESS NEEDS AND IMPLEMENT STRATEGIES. TACTIC: CONTINUE SUPPORT OF COMMUNITY INITIATIVES AND POLICIES THAT IMPROVE AFFORDABLE HOUSING AND ACCESS TO HOUSING RESOURCES FOR ALL POPULATIONS.HEALTH NEEDS THAT WILL NOT BE ADDRESSED AT THIS TIME:IN ADDITION TO THE HEALTH NEEDS BELLIN SELECTED AS TOP PRIORITIES, THE CHNA IDENTIFIED OTHER SIGNIFICANT HEALTH NEEDS IN BROWN COUNTY. STRATEGY OWNERS/ORGANIZATIONS ARE ASSIGNED TO LEAD WORK WITHIN THIS SPACE AND CAPITALIZE ON COMMUNITY RESOURCES AND PARTNERS COLLABORATING TO ADDRESS THE NEEDS. |
| BELLIN PSYCHIATRIC CENTER, INC. | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY INCLUDES FACTORS SUCH AS: HOMELESSNESS, DECEASED WITH NO KNOWN ESTATE, APPROVED COURT BANKRUPTCY, PAYMENT ASSISTANCE RANK ORDER SCORE, ELIGIBLE FOR STATE OF WI FOOD SHARE PROGRAM. |
| PART V, SECTION B, LINES 16A-C: | LINE 16A:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONSLINE 16B:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONSLINE 16C:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 22 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (22 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 CLINIC | ||||
| 1325 ANGELS PATH | DE PERE | WI | 54115 | OUTPATIENT MENTAL HEALTH CLINIC |
| 3 - BELLIN BEHAVIORAL HEALTH CLINIC ASHWAUBENO | ||||
| 1630 COMMANCHE AVENUE | GREEN BAY | WI | 54313 | OUTPATIENT MENTAL HEALTH CLINIC |
| 4 - BELLIN BEHAVIORAL HEALTH CLINIC DE PERE | ||||
| 555 REDBIRD CIR | DE PERE | WI | 54115 | OUTPATIENT MENTAL HEALTH CLINIC |
| 5 - BELLIN BEHAVIORAL HEALTH CLINIC THE NEURO | ||||
| 744 S WEBSTER AVENUE | GREEN BAY | WI | 54301 | PSYCHOLOGICAL TESTING |
| 6 - BELLIN BEHAVIORAL HEALTH CLINIC BELLEVUE | ||||
| 3263 EATON ROAD | GREEN BAY | WI | 54311 | OUTPATIENT MENTAL HEALTH CLINIC |
| 7 - BELLIN BEHAVIORAL HEALTH CLINIC IRON MOUNT | ||||
| 440 WOODWARD AVE UNIT 101 | IRON MOUNTAIN | MI | 49801 | OUTPATIENT MENTAL HEALTH CLINIC |
| 8 - BELLIN BEHAVIORAL HEALTH CLINIC MARINETTE | ||||
| 2820 ROOSEVELT RD | MARINETTE | WI | 54143 | OUTPATIENT MENTAL HEALTH CLINIC |
| 9 - BELLIN BEHAVIORAL HEALTH CLINIC ESCANABA | ||||
| 610 S LINCOLN ROAD | ESCANABA | MI | 49829 | OUTPATIENT MENTAL HEALTH CLINIC |
| 10 - BELLIN BEHAVIORAL HEALTH CLINIC PULASKI | ||||
| 723 N WISCONSIN ST | PULASKI | WI | 54162 | OUTPATIENT MENTAL HEALTH CLINIC |
| 11 - BELLIN BEHAVIORAL HEALTH CLINIC HOWARD | ||||
| 2714 RIVERVIEW DR | GREEN BAY | WI | 54313 | OUTPATIENT MENTAL HEALTH CLINIC |
| 12 - BELLIN BEHAVIORAL HEALTH CLINIC WRIGHTSTOW | ||||
| 555 QUALITY CT STE 101 | WRIGHTSTOWN | WI | 54180 | OUTPATIENT MENTAL HEALTH CLINIC |
| 13 - BELLIN BEHAVIORAL HEALTH CLINIC LUXEMBURG | ||||
| 140 SCHOOL CREEK TRAIL | LUXEMBURG | WI | 54217 | OUTPATIENT MENTAL HEALTH CLINIC |
| 14 - BELLIN BEHAVIORAL HEALTH CLINIC MANITOWOC | ||||
| 3415 CUSTER ST STE D | MANITOWOC | WI | 54220 | OUTPATIENT MENTAL HEALTH CLINIC |
| 15 - BELLIN BEHAVIORAL HEALTH CLINIC WEBSTER | ||||
| 704 S WEBSTER AVE STE 300 | GREEN BAY | WI | 54301 | OUTPATIENT MENTAL HEALTH CLINIC |
| 16 - BELLIN BEHAVIORAL HEALTH CLINIC STURGEON B | ||||
| 311 N 3RD AVE | STURGEON BAY | WI | 54235 | OUTPATIENT MENTAL HEALTH CLINIC |
| 17 - BELLIN BEHAVIORAL HEALTH CLINIC OCONTO FAL | ||||
| 107 E HIGHLAND DR | OCONTO FALLS | WI | 54154 | OUTPATIENT MENTAL HEALTH CLINIC |
| 18 - BELLIN BEHAVIORAL HEALTH CLINIC DE PERE | ||||
| 1800 LAWRENCE DRIVE | DE PERE | WI | 54115 | OUTPATIENT MENTAL HEALTH CLINIC |
| 19 - BELLIN BEHAVIORAL HEALTH CLINIC OCONTO | ||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | OUTPATIENT MENTAL HEALTH CLINIC |
| 20 - BELLIN BEHAVIORAL HEALTH CLINIC CANCER TEA | ||||
| 1580 COMMANCHE AVENUE | ASHWAUBENON | WI | 54313 | OUTPATIENT MENTAL HEALTH CLINIC |
| 21 - BELLIN BEHAVIORAL HEALTH CLINIC KEWAUNEE | ||||
| 575 4TH ST | KEWAUNEE | WI | 54216 | OUTPATIENT MENTAL HEALTH CLINIC |
| 22 - BELLIN BEHAVIORAL HEALTH CLINIC BONDUEL | ||||
| 401 W MILL ST | BONDUEL | WI | 54107 | 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 $1,351,633 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 RATIO. |
| 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 21 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 2024 AND 2023. |
| 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 AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. |
| PART III, LINE 9B: | FOR PATIENTS WHO CANNOT MEET THE EXPECTATIONS OF THE DEBT COLLECTION POLICY, THE ORGANIZATION OFFERS FINANCIAL ASSISTANCE. THE ORGANIZATION WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE DETERMINING WHETHER A GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM AS PART OF THE REGISTRATION PROCESS IN ADDITION, ALL STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE AVAILABILITY. |
| PART VI, LINE 2: | BELLIN PSYCHIATRIC CENTER IS INCLUDED IN THE BELLIN MEMORIAL HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT THAT IS POSTED ON BELLIN.ORG. |
| PART VI, LINE 3: | FINANCIAL COUNSELORS PLAY A CRUCIAL ROLE IN GUIDING PATIENTS THROUGH AVAILABLE ASSISTANCE PROGRAMS. ONE VALUABLE SERVICE THEY UTILIZE IS HRS ERASE, WHICH HELPS REVIEW SELF-PAY ACCOUNTS TO IDENTIFY POTENTIAL COVERAGE OPTIONS THROUGH GOVERNMENT PROGRAMS. THIS PROACTIVE APPROACH ENSURES THAT PATIENTS RECEIVE THE FINANCIAL SUPPORT THEY NEED, MAKING HEALTHCARE MORE ACCESSIBLE AND MANAGEABLE. |
| PART VI, LINE 4: | BELLIN PSYCHIATRIC CENTER SERVES NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN, INCLUDING CLINICS IN THE CITIES OF GREEN BAY, ASHWAUBENON, BELLEVUE, DE PERE, LEDGEVIEW, MARINETTE, OCONTO, OCONTO FALLS, PESHTIGO, ALGOMA, ESCANABA, CRIVITZ AND IRON MOUNTAIN. |
| PART VI, LINE 5: | A MAJORITY OF BELLIN PSYCHIATRIC CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS 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 PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL ITS DEPARTMENTS. BELLIN PSYCHIATRIC CENTER APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, EDUCATION, AND FACILITIES. |
| PART VI, LINE 6: | EMPLIFY HEALTH BY BELLIN IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (14 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/BMH CEO | $0 | $957,900 | $0 | $634,883 | $0 | $182,656 | $0 | $226,898 | $0 | $11,333 | $0 | $2,013,670 | $0 | $175,207 |
| SCOTT RATHGABER MD | ||||||||||||||
| BGHS CEO | $0 | $1,274,504 | $0 | $200,000 | $0 | $169,717 | $0 | $45,225 | $0 | $23,503 | $0 | $1,712,949 | $0 | $0 |
| SHARLA BAENEN | ||||||||||||||
| MEMBER/BMH COO | $0 | $387,636 | $0 | $78,025 | $0 | $34,774 | $0 | $59,243 | $0 | $27,156 | $0 | $586,834 | $0 | $34,504 |
| DHANVENDRAN RAMAR MD | ||||||||||||||
| PHYSICIAN | $263,785 | $0 | $200,326 | $0 | $270 | $0 | $16,876 | $0 | $30,081 | $0 | $511,338 | $0 | $0 | $0 |
| KIM LASECKI | ||||||||||||||
| PHYSICIAN | $234,055 | $0 | $185,563 | $0 | $774 | $0 | $17,099 | $0 | $27,780 | $0 | $465,271 | $0 | $0 | $0 |
| DEREK CARLSON MD | ||||||||||||||
| PHYSICIAN | $343,519 | $0 | $69,973 | $0 | $1,188 | $0 | $15,510 | $0 | $27,280 | $0 | $457,470 | $0 | $0 | $0 |
| NACIYE KALAFAT MD | ||||||||||||||
| FORMBER B.M./FORMER PSYCH. DEPT. CHA | $290,465 | $0 | $91,865 | $0 | $760 | $0 | $20,204 | $0 | $25,397 | $0 | $428,691 | $0 | $0 | $0 |
| EMILY RADEMACHER MD | ||||||||||||||
| FORMER B.M./PRESIDENT MEDICAL STAFF | $298,455 | $0 | $72,146 | $0 | $180 | $0 | $18,119 | $0 | $33,784 | $0 | $422,684 | $0 | $0 | $0 |
| REKHA VIJAYAN | ||||||||||||||
| PHYSICIAN | $272,109 | $0 | $127,094 | $0 | $270 | $0 | $16,581 | $0 | $1,231 | $0 | $417,285 | $0 | $0 | $0 |
| ALEXANDRA RUSH | ||||||||||||||
| PHYSICIAN | $325,000 | $0 | $25 | $0 | $30,162 | $0 | $17,943 | $0 | $1,280 | $0 | $374,410 | $0 | $0 | $0 |
| STEVE LITTLE | ||||||||||||||
| BMH CFO (THRU 02/2024) | $0 | $258,317 | $0 | $75,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $333,317 | $0 | $0 |
| MICHAEL HOFFMAN MD | ||||||||||||||
| FORMER B.M./PHYSICIAN | $0 | $274,849 | $0 | $7,215 | $0 | $774 | $0 | $19,491 | $0 | $27,231 | $0 | $329,560 | $0 | $0 |
| TARA ROBERTSON PSYD | ||||||||||||||
| FORMER B.M./PSYCHIATRY DEPT. CHAIR | $97,510 | $0 | $135,930 | $0 | $260 | $0 | $13,089 | $0 | $743 | $0 | $247,532 | $0 | $0 | $0 |
| DEBRA PATZ | ||||||||||||||
| VICE PRESIDENT | $144,998 | $0 | $9,000 | $0 | $270 | $0 | $10,780 | $0 | $956 | $0 | $166,004 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | BELLIN MEMORIAL HOSPITAL, A RELATED PARTY, HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. SHARLA BAENEN AND CHRISTINE WOLESKE PARTICIPATED IN THE 457(F) PLAN. THE FOLLOWING DISTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2023: CHRISTINE WOLESKE $175,207 SHARLA BAENEN $34,504 | 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 |
| Bond Issued | 2024-06-03 | BondIssuedDt |
| Issue Price | $1,518,674 | 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 |
| Total Proceeds | $1,518,674 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $8,613 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $1,510,061 | 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 | 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 |
| 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 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 IS 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: THE CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA FOR 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 | BELLIN PSYCHIATRIC CENTER, INC. 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 (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BELLIN GUNDERSEN HEALTH SYSTEM INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 920504278 | PARENT | WI | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | LINE 12B, II | Yes (1) | BELLIN GUNDERSEN HEALTH SYSTEM INC | |
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C)(3) | LINE 12B, II | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING COLLEGE | WI | 501(C)(3) | LINE 2 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 390884478 | ACUTE CARE HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | BELLIN HEALTH SYSTEMS INC | |
| OCONTO HOSPITAL & MEDICAL CENTER INC | |||||||||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | 061745397 | HOSPITAL | WI | 501(C)(3) | LINE 3 | Yes (1) | BELLIN MEMORIAL HOSPITAL INC | |
| GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391866425 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | Yes (1) | BELLIN GUNDERSEN HEALTH SYSTEM INC | |
| GUNDERSEN LUTHERAN MEDICAL CENTER | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| GUNDERSEN CLINIC LTD | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SVC | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391606449 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | |||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| TRI-COUNTY MEMORIAL HOSPITAL | |||||||||||
| 1860 LINCOLN STREET | WHITEHALL | WI | 54773 | 390704510 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| HARMONY COMMUNITY HEALTHCARE INC | |||||||||||
| 815 MAIN AVENUE | SOUTH HARMONY | MN | 55939 | 410711606 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | |||||||||||
| 125 FIFTH AVENUE | SE SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | MN | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| TRI-STATE AMBULANCE INC | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| TRI-STATE REGIONAL AMBULANCE | |||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORTATION | WI | 501(C)(3) | LINE 10 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| LUTHERAN REAL ESTATE HOLDING CORP | |||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | LINE 12C, III-FI | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| COMMUNITY HOUSING OF LA CROSSE | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | Yes (1) | LUTHERAN REAL ESTATE HOLDING CORP | |
| LUTHERAN HOUSING OF LA CROSSE | |||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | LINE 10 | Yes (1) | LUTHERAN REAL ESTATE HOLDING CORP | |
| ST JOSEPH'S HEALTH SERVICES INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| ST JOSEPH'S MEMORIAL FOUNDATION INC | |||||||||||
| 400 WATER AVENUE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | ST JOSEPH'S HEALTH SERVICES INC | |
| TRI-COUNTY MEMORIAL FOUNDATION INC | |||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | TRI-COUNTY MEMORIAL HOSPITAL | |
| MEMORIAL HOSPITAL OF BOSCOBEL | |||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| PALMER LUTHERAN HEALTH CENTER INC | |||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| MOUNDVIEW MEMORIAL HOSPITALS & CLINICS INC | |||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
| MEMORIAL HEALTHCARE FOUNDATION INC | |||||||||||
| PO BOX 40 | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | LINE 12A, I | Yes (1) | MOUNDVIEW MEMORIAL HOSPITAL | |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | |||||||||||
| 1200 5TH GRANT BOULEVARD | WEST WABASHA | MN | 55981 | 410693877 | HEALTHCARE | MN | 501(C)(3) | LINE 3 | Yes (1) | GUNDERSEN LUTHERAN HEALTH SYSTEMS INC | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BEL-REGIONAL HOME MEDICAL INC | ||||||||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | 0 | |||||
| GUNDERSEN LUTHERAN ENVISION LLC | ||||||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 264706546 | RENEWABLE ENERGY | WI | N/A | C | 0 | |||||
| GUNDERSEN EDGE LLC | ||||||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54301 | 921783811 | INNOVATION | WI | N/A | C | 0 | |||||
| BG ASSURANCE COMPANY | ||||||||||||||
| SELF INSURANCE | N/A | C | 0 | 20 GENESIS CLOSE PO BOX 30600 | GEORGE TOWN | GRAND CAYMAN, KY1 | CJ | CJ | ||||||
| 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 | Yes (1) | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BELLIN MEMORIAL HOSPITAL INC | ||
| E | $16,178,514 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL INC | ||
| K | $58,969 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL INC | ||
| M | $2,869,039 | ACTUAL |
| BELLIN MEMORIAL HOSPITAL INC | ||
| P | $18,834,029 | ACTUAL |
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