2025-08-13T14:24:13-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 391657627 BELLIN PSYCHIATRIC CENTER BELL 9204333630 PO BOX 23725 GREEN BAY WI 54305 JOHN CEELEN CFO 9204333630 2025-08-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-13 2023 2025-03-06 01:10:19Z X JOHN CEELEN PO BOX 23725 GREEN BAY WI 54305 33572208 0 X WWW.BELLIN.ORG X 1990 WI 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. 2 0 312 11 0 0 34138 102291 29663221 31730176 457081 522267 1148987 1217474 31303427 33572208 15267 28831 0 0 26253747 28695189 0 0 0 6671489 7060957 32940503 35784977 -1637076 -2212769 20239238 20428979 16871411 18553510 3367827 1875469 X 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. 0 0 31425456 28831 32947650 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. 31425456 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 312 1 0 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOHN CEELEN 9204333630 744 S WEBSTER AVENUE GREEN BAY WI 54301 CHRISTINE WOLESKE MEMBER/BMH CEO 2.00 48.00 X 0 1775439 238231 SHARLA BAENEN MEMBER/BMH COO 2.00 48.00 X 0 500435 86399 SCOTT RATHGABER MD BGHS CEO 2.00 48.00 X 0 1644221 68728 STEVE LITTLE BMH CFO (THRU 02/2024) 2.00 48.00 X 0 333317 0 JOHN CEELEN BMH CFO (BEG. 02/2024) 2.00 48.00 X 0 0 0 DEBRA PATZ VICE PRESIDENT 40.00 X 154268 0 11736 DEREK CARLSON MD PHYSICIAN 50.00 X 414680 0 42790 REKHA VIJAYAN PHYSICIAN 50.00 X 399473 0 17812 KIM LASECKI PHYSICIAN 50.00 X 420392 0 44879 DHANVENDRAN RAMAR MD PHYSICIAN 50.00 X 464381 0 46957 ALEXANDRA RUSH PHYSICIAN 50.00 X 355187 0 19223 NACIYE KALAFAT MD FORMBER B.M./FORMER PSYCH. DEPT. CHAIR 50.00 X 383090 0 45601 EMILY RADEMACHER MD FORMER B.M./PRESIDENT MEDICAL STAFF 50.00 X 370781 0 51903 TARA ROBERTSON PSYD FORMER B.M./PSYCHIATRY DEPT. CHAIR 50.00 X 233700 0 13832 MICHAEL HOFFMAN MD FORMER B.M./PHYSICIAN 20.00 35.00 X 0 282838 46722 3195952 4536250 734813 41 1 1 0 BELLIN MEMORIAL HOSPITAL INC 744 S WEBSTER AVE GREEN BAY WI 543043400 INTERCOMPANY SERVICES 2783478 IRIS TELEHEALTH MEDICAL GROUP 114 W 7TH ST STE 900 AUSTIN TX 78701 CONTRACTED VIRTUAL CARE 1117615 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 CONTRACTED STAFFING 996175 BAY TOWEL LINEN & UNIFORM RENT 2580 S BROADWAY GREEN BAY WI 54304 CONTRACTED LINEN SERVICES 126912 STEVEN R MILJOUR MD W223 LUCHARY RD BARK RIVER MI 49807 CONTRACTED SERVICES 110208 5 1735 100556 102291 NET PATIENT SERVICE REVENUE 621300 31680005 31680005 CONTRACTED SERVICES 621110 50171 50171 31730176 204489 204489 317778 0 317778 317778 317778 INCENTIVE PAYMENTS 621300 1200582 1200582 16892 16892 1217474 33572208 32947650 0 522267 28831 28831 169644 161161 8483 23544739 22594617 950122 1141953 1079233 62720 2381917 2251675 130242 1456936 1388529 68407 20339 20339 1006941 607733 399208 380 380 98918 84157 14761 8206 3728 4478 526867 476110 50757 14827 6354 8473 95844 72947 22897 53824 53824 503865 215669 288196 38437 6827 31610 MEDICAL SUPPLIES 2707432 563019 2144413 BAD DEBT EXPENSE 1351633 1351633 FOOD 269740 269740 DUES & SUBSCRIPTIONS 100671 59579 41092 263033 203914 59119 35784977 31425456 4359521 0 1512914 1807238 2077244 0 2701822 3012145 13805139 6611220 6747137 7193919 7200121 8415677 20239238 20428979 2071318 2375041 1416811 1499079 13383282 14679390 16871411 18553510 X 3367827 1875469 3367827 1875469 20239238 20428979 -2212769 720411 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2747765 2747765 6786265 3544892 3241373 4259499 3066328 1193171 11610 11610 7193919 DUE TO AFFILIATES 14679390 14679390 1 1 X 1 X 220.000000000000 1 X 1 1 1 0 1 1 555723 555723 0.01610 10614369 728456 9885913 0.28710 11170092 728456 10441636 0.30320 38129 0 0.00000 333625 333625 0.00970 2000 2000 0.00010 335625 38129 335625 0.00980 11505717 766585 10777261 0.31300 1 711079 0 3522927 5069517 -1546590 X 1 1 1 1 BELLIN PSYCHIATRIC CENTER INC 301 E JOSEPH STREET GREEN BAY WI 543053725 WWW.BELLIN.ORG 263 X PSYCHIATRIC BELLIN PSYCHIATRIC CENTER INC 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 23 1 SEE PART V, SECTION C, LINE 7D 0 1 X 220.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C, LINES 16A-C X SEE PART V, SECTION C, LINES 16A-C X SEE PART V, PAGE 10 X X X X X X 1 X 0 X X X X 1 X 0 0 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 22 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 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 X X 0 1 0 0 0 0 0 0 0 CHRISTINE WOLESKE MEMBER/BMH CEO 0 957900 0 634883 0 182656 0 226898 0 11333 0 2013670 0 175207 SCOTT RATHGABER MD BGHS CEO 0 1274504 0 200000 0 169717 0 45225 0 23503 0 1712949 0 0 SHARLA BAENEN MEMBER/BMH COO 0 387636 0 78025 0 34774 0 59243 0 27156 0 586834 0 34504 DHANVENDRAN RAMAR MD PHYSICIAN 263785 0 200326 0 270 0 16876 0 30081 0 511338 0 0 0 KIM LASECKI PHYSICIAN 234055 0 185563 0 774 0 17099 0 27780 0 465271 0 0 0 DEREK CARLSON MD PHYSICIAN 343519 0 69973 0 1188 0 15510 0 27280 0 457470 0 0 0 NACIYE KALAFAT MD FORMBER B.M./FORMER PSYCH. DEPT. CHA 290465 0 91865 0 760 0 20204 0 25397 0 428691 0 0 0 EMILY RADEMACHER MD FORMER B.M./PRESIDENT MEDICAL STAFF 298455 0 72146 0 180 0 18119 0 33784 0 422684 0 0 0 REKHA VIJAYAN PHYSICIAN 272109 0 127094 0 270 0 16581 0 1231 0 417285 0 0 0 ALEXANDRA RUSH PHYSICIAN 325000 0 25 0 30162 0 17943 0 1280 0 374410 0 0 0 STEVE LITTLE BMH CFO (THRU 02/2024) 0 258317 0 75000 0 0 0 0 0 0 0 333317 0 0 MICHAEL HOFFMAN MD FORMER B.M./PHYSICIAN 0 274849 0 7215 0 774 0 19491 0 27231 0 329560 0 0 TARA ROBERTSON PSYD FORMER B.M./PSYCHIATRY DEPT. CHAIR 97510 0 135930 0 260 0 13089 0 743 0 247532 0 0 0 DEBRA PATZ VICE PRESIDENT 144998 0 9000 0 270 0 10780 0 956 0 166004 0 0 0 PART I, LINE 4B 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 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2024-06-03 1518674 REFUND AND LEGALLY DEFEASE 0 0 0 A 1518674 8613 1510061 2009 0 1 1 1 A 0 1 1 1 0 1 0 1 A 0 1 0 0 0 0 0 0 1 A 1 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. 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 BELLIN GUNDERSEN HEALTH SYSTEM INC 1 LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 12B, II BELLIN HEALTH SYSTEMS INC 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 390884478 ACUTE CARE HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HOSPITAL WI 501(C)(3) LINE 3 BELLIN MEMORIAL HOSPITAL INC 1 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391866425 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II BELLIN GUNDERSEN HEALTH SYSTEM INC 1 GUNDERSEN LUTHERAN MEDICAL CENTER 1910 SOUTH AVENUE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 GUNDERSEN LUTHERAN ADMINISTRATIVE SVC 1910 SOUTH AVENUE LA CROSSE WI 54601 391606449 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) LINE 7 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 TRI-COUNTY MEMORIAL HOSPITAL 1860 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 HARMONY COMMUNITY HEALTHCARE INC 815 MAIN AVENUE SOUTH HARMONY MN 55939 410711606 HEALTHCARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVENUE SE SPRING GROVE MN 55974 411565003 HEALTHCARE MN 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 TRI-STATE AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 TRI-STATE REGIONAL AMBULANCE 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORTATION WI 501(C)(3) LINE 10 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 LUTHERAN REAL ESTATE HOLDING CORP 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) LINE 12C, III-FI GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 COMMUNITY HOUSING OF LA CROSSE 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) LINE 10 LUTHERAN REAL ESTATE HOLDING CORP 1 LUTHERAN HOUSING OF LA CROSSE 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) LINE 10 LUTHERAN REAL ESTATE HOLDING CORP 1 ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVENUE HILLSBORO WI 54634 390929538 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 ST JOSEPH'S MEMORIAL FOUNDATION INC 400 WATER AVENUE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) LINE 12A, I ST JOSEPH'S HEALTH SERVICES INC 1 TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) LINE 12A, I TRI-COUNTY MEMORIAL HOSPITAL 1 MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE IA 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 MOUNDVIEW MEMORIAL HOSPITALS & CLINICS INC 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTHCARE WI 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 MEMORIAL HEALTHCARE FOUNDATION INC PO BOX 40 FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) LINE 12A, I MOUNDVIEW MEMORIAL HOSPITAL 1 SAINT ELIZABETH'S HOSPITAL OF WABASHA INC 1200 5TH GRANT BOULEVARD WEST WABASHA MN 55981 410693877 HEALTHCARE MN 501(C)(3) LINE 3 GUNDERSEN LUTHERAN HEALTH SYSTEMS INC 1 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 20 GENESIS CLOSE PO BOX 30600 GEORGE TOWN GRAND CAYMAN, KY1 CJ SELF INSURANCE CJ N/A C 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 BELLIN MEMORIAL HOSPITAL INC E 16178514 ACTUAL BELLIN MEMORIAL HOSPITAL INC K 58969 ACTUAL BELLIN MEMORIAL HOSPITAL INC M 2869039 ACTUAL BELLIN MEMORIAL HOSPITAL INC P 18834029 ACTUAL