OCONTO HOSPITAL & MEDICAL CENTER INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- OCONTO HOSPITAL & MEDICAL CENTER INC (EIN 06-1745397)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-08-14
- IRS object ID
- 202012279349300006
- Schema version
- 2018v3.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-08-14T07:24:10-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061745397 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONTO HOSPITAL AND MEDICAL CENTER | BusinessNameLine1Txt |
| Business Name Line2 | BELLIN HEALTH OCONTO HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OCON | BusinessNameControlTxt |
| Phone | 9208351100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 357 | AddressLine1Txt |
| City | OCONTO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54153 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES DIETSCHE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9208351100 | PhoneNum |
| Signature | 2020-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2020-08-13 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 184.97.211.65 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-08-13 | IPDt |
| IP Tm | 10:02:18 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 7D2FE2EA17AC540A2D29D4112E82844D375299C1 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-09-22 18:59:49Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN HEALTH OCONTO HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LAURA CORMIER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 357 | AddressLine1Txt |
| City | OCONTO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54153 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $57,016,078 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.OCONTOHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | OCONTO HOSPITAL & MEDICAL CENTER, INC. (THE ORGANIZATION) IS YOUR HOME TOWN HEALTHCARE SERVICE PROVIDER, CREATED TO MAKE OUTSTANDING HEALTHCARE CONVENIENT. BACKED BY THE RESOURCES OF BELLIN HEALTH, THE ORGANIZATION OFFERS OUTSTANDING HOSPITAL-BASED, EMERGENCY AND PRIMARY CARE SERVICES. THE ORGANIZATION OFFERS THE CARE YOU NEED WHERE YOU WANT IT. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 294 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,467 | PYContributionsGrantsAmt |
| CY Contributions Grants | $11,996 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $45,054,893 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $56,894,851 | CYProgramServiceRevenueAmt |
| PY Investment Income | $671 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,135 | CYInvestmentIncomeAmt |
| PY Other Revenue | $68,158 | PYOtherRevenueAmt |
| CY Other Revenue | $55,429 | CYOtherRevenueAmt |
| PY Total Revenue | $45,132,189 | PYTotalRevenueAmt |
| CY Total Revenue | $56,963,411 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,388,581 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $26,980,052 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,549,101 | PYOtherExpensesAmt |
| CY Other Expenses | $34,701,060 | CYOtherExpensesAmt |
| PY Total Expenses | $52,937,682 | PYTotalExpensesAmt |
| CY Total Expenses | $61,681,112 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$7,805,493 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,717,701 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $42,967,666 | TotalAssetsBOYAmt |
| Total Assets EOY | $42,446,099 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $41,953,666 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $46,104,123 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,014,000 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$3,658,024 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF OCONTO HOSPITAL & MEDICAL CENTER IS TO PROVIDE 24-HOUR LOCAL ACCESS TO EFFECTIVE, EFFICIENT HEALTH, WELLNESS AND PREVENTATIVE SERVICES TO OCONTO AND THE SURROUNDING RURAL COMMUNITIES. TOWARD THIS PURPOSE, OCONTO HOSPITAL & MEDICAL CENTER WORKS IN PARTNERSHIP WITH THE COMMUNITY, THE CITIZENS HOSPITAL FOUNDATION AND BELLIN HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,540,207 | ExpenseAmt |
| Revenue | $17,845,911 | RevenueAmt |
| Desc | AS A KEY REGIONAL ASSET, THE ORGANIZATION IS A NOT-FOR-PROFIT HEALTHCARE PROVIDER. THE ORGANIZATION PROVIDES ACUTE HOSPITAL, EMERGENCY AND URGENT CARE TO RESIDENTS OF OCONTO, WISCONSIN AND THE SURROUNDING COMMUNITIES. DURING THE PERIOD OF OCTOBER 1, 2018 TO SEPTEMBER 30, 2019, 346 INPATIENT DAYS WERE PROVIDED AND 221 SWING BED DAYS WERE PROVIDED. THE NUMBER OF OUTPATIENTS REGISTERED DURING THE SAME 12 MONTH PERIOD WAS 19,102. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $38,988,676 | ExpenseAmt |
| Revenue | $38,872,299 | RevenueAmt |
| Desc | IN 2018 THE OCONTO HOSPITAL & MEDICAL CENTER CORPORATION HAD A MULTISPECIALTY CLINIC IN MARINETTE WISCONSIN. SERVICES OFFERED AT THE MARINETTE LOCATION INCLUDE PRIMARY CARE SERVICES, RADIATION ONCOLOGY SERVICES, CHEMOTHERAPY AND INFUSION SERVICES. IN ADDITION THE ORGANIZATION HAS PRIMARY CARE CLINICS IN OCONTO, CRIVITZ AND PESHTIGO WISCONSIN, AND DAGGETT AND MENOMINEE MICHIGAN. THESE PROGRAM SERVICES PROVIDED 11,771 URGENT CARE VISITS, 84,598 PRIMARY CARE VISITS AND 25,011 SPECIALTY PROVIDER VISITS TO THESE COMMUNITIES DURING THE PERIOD OF OCTOBER 1,2018 TO SEPTEMBER 30, 2019. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $54,528,883 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 294 | 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARA ARNDT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204457260 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2020 SOUTH WEBSTER AVENUE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | 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 |
|---|---|---|---|---|---|---|---|---|---|
| GEORGE KERWIN - TERMED | |||||||||
| BOARD MEMBER | 0.50 | 50.00 | Yes (X) | $0 | $1,082,565 | $38,477 | |||
| SARA ARNDT | |||||||||
| BOARD MEMBER | 0.50 | 40.00 | Yes (X) | $0 | $76,290 | $21,685 | |||
| LAURA HIEB | |||||||||
| BOARD MEMBER | 0.50 | 50.00 | Yes (X) | $0 | $325,643 | $2,795 | |||
| DAVID HONISH | |||||||||
| CHAIRPERSON | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| RODNEY JOHNSON | |||||||||
| SECRETARY/TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| LAURA CORMIER | |||||||||
| CEO | 50.00 | Yes (X) | $159,563 | $0 | $27,423 | Yes (X) | |||
| CRAIG ALWIN | |||||||||
| BOARD MEMBER | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| JAMES DIETSCHE | |||||||||
| BOARD MEMBER | 0.50 | 50.00 | Yes (X) | $0 | $493,837 | $25,547 | |||
| CHARLES HEYKA MD | |||||||||
| PRESIDENT OF MEDICAL STAFF | 50.00 | $382,286 | $0 | $33,154 | Yes (X) | ||||
| PAWNEET SING MD | |||||||||
| PHYSICIAN | 50.00 | $577,443 | $0 | $10,090 | Yes (X) | ||||
| CALVIN NOGLER MD | |||||||||
| PHYSICIAN | 50.00 | $300,510 | $0 | $26,737 | Yes (X) | ||||
| MICHAEL BRENNER MD | |||||||||
| PHYSICIAN | 50.00 | $336,734 | $0 | $19,804 | Yes (X) | ||||
| JAMES OPOIEN MD | |||||||||
| PHYSICIAN | 50.00 | $288,442 | $0 | $23,669 | Yes (X) | ||||
| JON SIMMONS MD | |||||||||
| PHYSICIAN | 50.00 | $317,559 | $0 | $14,531 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,362,537 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,978,335 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $243,912 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 35 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| THARIO CLEANING SERVICES INC | |||||
| 2936 HOLMGREN WAY | GREEN BAY | WI | 54304 | HOUSEKEEPING SERVICES | $509,727 |
| COMPHEALTH MEDICAL STAFFING | |||||
| PO BOX 972670 | DALLAS | TX | 75397 | CONTRACTED URGENT CARE PROVIDER SERVICES | $265,738 |
| MICHAEL DOWNS MD | |||||
| PO BOX 72062 | CEDARBURG | WI | 53012 | CONTRACTED ED PHYSICIAN SERVICES | $251,855 |
| DAVID HOYER MD | |||||
| 2480 WHISTLING SWAN CT | MENASHA | WI | 54952 | CONTRACTED ED PHYSICIAN SERVICES | $200,077 |
| RADIOLOGY ASSOCIATES OF APPLETON SC | |||||
| 2500 E CAPITAL DR | APPLETON | WI | 54911 | RADIATION ONCOLOGY PROVIDER SERVICES | $169,699 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $11,996 | GovernmentGrantsAmt |
| Total Contributions | $11,996 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621300 | $56,585,297 | $56,585,297 | |
| MISCELLANEOUS REVENUE | 900099 | $189,554 | $189,554 | |
| RENT FROM AFFILIATES | 900099 | $120,000 | $120,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $56,894,851 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,135 | TotalRevenueColumnAmt |
| Exclusion | $1,135 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $95,183 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $52,667 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $42,516 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,516 | TotalRevenueColumnAmt |
| Exclusion | $42,516 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCENTIVE PAYMENTS | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $12,913 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,913 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $12,913 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,963,411 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $56,718,210 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $233,205 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $602,427 | TotalAmt |
| Program Services | $415,441 | ProgramServicesAmt |
| Management And General | $186,986 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,908,604 | TotalAmt |
| Program Services | $21,438,771 | ProgramServicesAmt |
| Management And General | $469,833 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $907,341 | TotalAmt |
| Program Services | $876,341 | ProgramServicesAmt |
| Management And General | $31,000 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,226,552 | TotalAmt |
| Program Services | $2,199,364 | ProgramServicesAmt |
| Management And General | $27,188 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,335,128 | TotalAmt |
| Program Services | $1,295,979 | ProgramServicesAmt |
| Management And General | $39,149 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,910,150 | TotalAmt |
| Program Services | $3,776,343 | ProgramServicesAmt |
| Management And General | $133,807 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,610 | TotalAmt |
| Program Services | $568 | ProgramServicesAmt |
| Management And General | $41,042 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,230 | TotalAmt |
| Program Services | $300,830 | ProgramServicesAmt |
| Management And General | $69,400 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,262 | TotalAmt |
| Program Services | $13,191 | ProgramServicesAmt |
| Management And General | $71 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,548,763 | TotalAmt |
| Program Services | $4,546,499 | ProgramServicesAmt |
| Management And General | $2,264 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $309,450 | TotalAmt |
| Program Services | $298,253 | ProgramServicesAmt |
| Management And General | $11,197 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,205 | TotalAmt |
| Program Services | $100,835 | ProgramServicesAmt |
| Management And General | $3,370 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,896,098 | TotalAmt |
| Management And General | $1,896,098 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,805,599 | TotalAmt |
| Program Services | $3,381,677 | ProgramServicesAmt |
| Management And General | $423,922 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,350 | TotalAmt |
| Program Services | $31,429 | ProgramServicesAmt |
| Management And General | $53,921 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES EXPENSE | $14,607,021 | $10,958,175 | $3,648,846 |
| EQUIPMENT RENT/MAINTENA | $2,884,943 | $2,879,560 | $5,383 |
| BAD DEBT EXPENSE | $1,926,711 | $1,926,711 | |
| DUES & SUBSCRIPTIONS | $141,054 | $83,994 | $57,060 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,614 | TotalAmt |
| Program Services | $4,922 | ProgramServicesAmt |
| Management And General | $51,692 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,681,112 | TotalAmt |
| Program Services | $54,528,883 | ProgramServicesAmt |
| Management And General | $7,152,229 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,922,278 | BOYAmt |
| EOY | $2,768,980 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,110,039 | BOYAmt |
| EOY | $8,791,418 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $943,712 | BOYAmt |
| EOY | $851,934 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,451 | BOYAmt |
| EOY | $18,191 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $46,419,837 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,664,837 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,199,542 | BOYAmt |
| EOY | $28,755,000 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $870,622 | BOYAmt |
| EOY | $501,881 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $878,022 | BOYAmt |
| EOY | $758,695 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,967,666 | BOYAmt |
| EOY | $42,446,099 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,883,080 | BOYAmt |
| EOY | $2,316,184 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,236,454 | BOYAmt |
| EOY | $10,782,285 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,834,132 | BOYAmt |
| EOY | $33,005,654 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,953,666 | BOYAmt |
| EOY | $46,104,123 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,980 | BOYAmt |
| EOY | -$4,416,719 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $713,020 | BOYAmt |
| EOY | $758,695 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,014,000 | BOYAmt |
| EOY | -$3,658,024 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,967,666 | BOYAmt |
| EOY | $42,446,099 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,717,701 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $45,677 | 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 | $739,879 | OtherCostOrOtherBasisAmt |
| Book Value | $739,879 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,013,511 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,889,488 | DepreciationAmt |
| Book Value | $14,124,023 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $171,971 | OtherCostOrOtherBasisAmt |
| Depreciation | $154,280 | DepreciationAmt |
| Book Value | $17,691 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,494,476 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,621,069 | DepreciationAmt |
| Book Value | $13,873,407 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $28,755,000 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATE | Desc |
| Amt | $33,005,654 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $33,005,654 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $55,089,367 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,926,711 | OtherRevenueAmt |
| Revenue Not Reported | -$1,926,711 | RevenueNotReportedAmt |
| Revenue Subtotal | $57,016,078 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$52,667 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$52,667 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $56,963,411 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $59,807,068 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $52,667 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $52,667 | ExpensesNotReportedAmt |
| Expenses Subtotal | $59,754,401 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,926,711 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,926,711 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $61,681,112 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -1,926,711. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL DEPRECIATION -52,667. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL DEPRECIATION 52,667. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 1,926,711. |
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 | $602,118 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $602,118 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01010 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,940,244 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,247,869 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,692,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06180 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,542,362 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,247,869 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,294,493 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07190 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,375 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,519 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,519 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,824 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,718 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,718 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,556,080 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,247,869 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,308,211 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07210 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $7,211 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,211 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 100 | PersonsServedCnt |
| Total Community Benefit Expns | $1,755 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,755 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 100 | PersonsServedCnt |
| Total Community Benefit Expns | $8,966 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,966 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,040,423 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $9,681,301 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,669,215 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,012,086 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONTO HOSPITAL & MEDICAL CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 820 ARBUTUS AVE | AddressLine1Txt |
| City | OCONTO | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54153 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.OCONTOHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 1061 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONTO HOSPITAL & MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION B, LINE 7D | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V, SECTION B, LINE 7D | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION B, LINE 7D | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 220.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BUSOF.001_-_FINANCIAL_ASSISTANCE.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/COMMUNITY_CARE_APPLICATION.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/PLAIN_LANGUAGE_SUMMARY_-_FINANCIAL_AS | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 |
|---|---|
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 5: THIS YEAR'S ASSESSMENT BUILT ON COLLABORATION, ACTIVELY SEEKING INPUT FROM A BROAD CROSS SECTION OF COMMUNITY STAKEHOLDERS WITH THE GOAL OF REACHING CONSENSUS ON PRIORITIES TO MUTUALLY FOCUS HUMAN, MATERIAL AND FINANCIAL RESOURCES ON. BELOW IS A LISTING OF PARTICIPANTS IN A CHNA SUMMIT IN WHICH HEALTH PRIORITIES WERE DETERMINED.-CITY OF GREEN BAY - PARKS & RECREATION-NORTHEASTERN WISCONSIN TECHNICAL COLLEGE-CITY OF DE PERE - HEALTH DEPARTMENT-BELLIN HEALTH-BROWN COUNTY PUBLIC HEALTH-ASHWAUBENON SCHOOLS-INTERN SCHOOL SOCIAL WORKER (HSSD)-WILLOW CREEK BEHAVIORAL HEALTH-HSHS ST VINCENT HOSPITAL/ ST MARY'S HOSPITAL-LIVE 54218-BELLIN PSYCHIATRIC CENTER-BROWN COUNTY BOARD-WIC-FAMILY & CHILDCARE RESOURCES OF NEW-AGING AND DISABILITY RESOURCE CENTER-BROWN COUNTY BOARD OF HEALTH-WI DHS DIVISION OF PUBLIC HEALTH-HOWARD SUAMICO SCHOOLS-CONNECTIONS FOR MENTAL WELLNESS-PULASKI COMMUNITY SCHOOLS-ST NORBERT COLLEGE-HSHS LIBERTAS TREATMENT CENTER-SHERMAN COUNSELING-UW EXTENSIONS-AIDS RESOURCE CENTER OF WISCONSIN (ARCW)-FOUNDATIONS-BOCE/ETC.-AURORA BEHAVIORAL HEALTH - UWGB-UNITED WAY - BROWN COUNTY-EX PRISONER OPPORTUNITIES-INTEGRATED COMMUNITY SOLUTIONS-OCONTO COUNTY PUBLIC HEALTH-RETIRED LAW ENFORCEMENT - DE PERE-BELLIN COLLEGE-BROWN COUNTY - CTC-UW GREEN BAY-ONEIDA NATION-BROWN COUNTY CHILD AND ADOLESCENT BEHAVIORAL HEALTH-PREVEA HEALTH-BROWN COUNTY HEALTH & HUMAN SERVICES-NEW COMMUNITY CLINIC-NEW COMMUNITY CLINIC & BROWN COUNTY BOARD OF HEALTH-GREEN BAY AREA PUBLIC SCHOOLS-CITY OF GREEN BAY - MAYOR-AURORA BAYCARE MEDICAL CENTER (ABMC)-ORAL HEALTH PARTNERSHIP-COMMUNITY VOLUNTEER-CITY OF DE PERE-JOSHUA - BC MENTAL HEALTH TASK FORCE - CONNECTIONS FOR MENTAL WELLNESS-DIOCESE OF GB CATHOLIC CHARITIES-BAY AREA COMMUNITY COUNCIL (BACC)-DARJUNE/EXPOTO ENSURE THAT THE NEEDS OF THESE GROUPS WERE ADEQUATELY REPRESENTED, WE INCLUDED REPRESENTATIVES FROM BROWN COUNTY HEALTH AND HUMAN SERVICES (PUBLIC HEALTH, AGING & DISABILITY RESOURCE CENTER, AND CHILD & FAMILY SERVICES); VARIOUS BROWN COUNTY DEPARTMENTS INCLUDING HEAD START, PROBATION & PAROLE, VICTIM/WITNESS SERVICES, VETERANS SERVICES; LOVE, INC.; BROWN COUNTY INTERFAITH ORGANIZATION; LOCAL SCHOOL DISTRICTS; BROWN COUNTY INTERFAITH; PARTNERS FOR COMMUNITY DEVELOPMENT; FAMILY RESOURCE CENTER OF BROWN COUNTY; SAFE HARBOR. THESE ORGANIZATIONS SERVE THE UNDER-RESOURCED IN OUR COMMUNITY, INCLUDING LOW-INCOME SENIORS, CHILDREN LIVING IN POVERTY, FAMILIES WHO STRUGGLE WITH SHELTER AND FOOD INSECURITY; VETERANS AND VICTIMS OF DOMESTIC VIOLENCE. |
| OCONTO HOSPITAL & MEDICAL 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) |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 6B: BROWN COUNTY HEALTH DEPARTMENT, CITY OF DE PERE HEALTH DEPARTMENT, AND BROWN COUNTY UNITED WAY. |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BROWN_COUNTY-FY2018_CHNA_EDITS_04_10_FULL URL FOR PART V, SECTION B, LINE 7B:HTTPS://WWW.CO.OCONTO.WI.US/DEPARTMENTS/PAGE_7389C0128C0F/?DEPARTMENT=AE781FULL URL FOR PART V, SECTION B, LINE 10A:HTTPS://WWW.BELLIN.ORG/IMAGES/UPLOADS/BROWN_COUNTY_FY2018_IMPLEMENTATION_PL |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 11: THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2018 THROUGH 2020. THE NEEDS IDENTIFIED ARE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG ABUSE (AODA), PHYSICAL ACTIVITY AND NUTRITION, IN ADDITION TO ORAL HEALTH. A SUMMARY OF HOW THE HOSPITAL HAS BEEN ADDRESSING SOME OF THE NEEDS IDENTIFIED IN THE CHNA IS AS FOLLOWS:1. ALCOHOL AND OTHER DRUG ABUSE (AODA) -AODA MISUSE TEAM -DARJUNE RECOVERY COACHING -DRUG DROP BOXES IN CLINICS AND PHARMACIES -INFORMATION POWERPOINT TO DECREASE UNDERAGE DRINKING AND DRUGS -EXPLORE SOBER LIVING (IN PARTNERSHIP WITH DARJUNE)2. NUTRITION AND PHYSICAL ACTIVITIES -OCONTO COUNTY FARMERS MARKET -SAFETY FAIR -DONATE HEALTH PLATE - LOCAL FOOD PANTRY SUPPORT AND EDUCATION -PLANT A SEED - GROWING AN ADDITIONAL ROW OF VEGETABLES IN YOUR GARDENS TO DONATE TO FOOD PANTRIES -BELLIN HEART RUN/WALK 5K - MARINETTE, WI -SUMMER MEAL PROGRAM |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY INCLUDES FACTORS AS: HOMELESS, DECEASED WITH NO KNOWN ESTATE, APPROVED COURT BANKRUPTCY, PAYMENT ASSISTANCE RANK ORDER SCORE, ELIGIBLE FOR STATE OF WI FOOD SHARE PROGRAM. |
| OCONTO HOSPITAL & MEDICAL CENTER, INC. | PART V, SECTION B, LINE 16J: DISCLOSURE UNDER REVENUE PROCEDURE 2015-21:FAILURE TO PROVIDE REFUNDS OF OVERPAYMENTS TO FAP-ELIGIBLE INDIVIDUALS(1) DESCRIPTION OF THE FAILURE: (A) TYPE OF FAILURE: IN ORDER TO COMPLY WITH IRS SECTION 501(R) PATIENT FINANCIAL ASSISTANCE REQUIREMENTS, OCONTO HOSPITAL AND MEDICAL CENTER (OHMC) HAS INSTITUTED VARIOUS POLICIES AND PROCEDURES. IT HAS BEEN OHMC'S BELIEF THAT THESE POLICIES AND PROCEDURES WERE CONSISTENT WITH THE INTENT OF THE REGULATIONS PROVIDING FINANCIAL ASSISTANCE TO PATIENTS WHO WOULD FIND THE PATIENT RESPONSIBILITY OF THE BILL TO BE AN EXCESSIVE FINANCIAL BURDEN. THE POLICIES AND PROCEDURE WERE CREATED UNDER THE GUIDANCE OF INDUSTRY EXPERTS AND WERE REVIEWED AS PART OF AN IRS AUDIT IN JUNE 2017. OHMC HAS BEEN FOLLOWING THE POLICIES AND PROCEDURES SINCE EARLY 2016.OHMC'S INTERPRETATION OF THE REGULATIONS WAS TO APPLY THE FINANCIAL ASSISTANCE PROCESS TO FUTURE PATIENT FINANCIAL RESPONSIBILITY AND PATIENT BALANCES AT THE TIME OF A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. ELIGIBILITY IS DETERMINED BY THE PATIENT COMPLETING AN APPLICATION FOR FINANCIAL ASSISTANCE, PRIOR ELIGIBILITY AND/OR PRESUMPTIVE ELIGIBILITY. (B) CAUSE OF THE FAILURE: THE GAP IN OHMC'S INTERPRETATION OF THE REGULATION STEMS FROM THE FAILURE TO CONSIDER PRIOR PATIENT PAYMENTS THAT COULD HAVE BEEN A PART OF THE PATIENT FINANCIAL ASSISTANCE PROGRAM. THIS GAP HAS EXISTED SINCE THE INCEPTION OF THE IRS SECTION 501(R) PATIENT FINANCIAL ASSISTANCE PROGRAM. (C) HOSPITAL FACILITY WHERE THE FAILURE OCCURRED: OCONTO HOSPITAL AND MEDICAL CENTER (D) DATE(S) OF THE FAILURE AND ITS DISCOVERY: THE FAILURE BEGAN ON OCTOBER 1, 2016, WHICH IS THE DATE THE 501(R) REGULATIONS BECAME EFFECTIVE FOR OHMC, AND CONTINUED UNTIL JUNE 30, 2019. SUCH FAILURE WAS DISCOVERED WITH THE ASSISTANCE OF LEGAL COUNSEL ON JULY 9, 2019, UPON REVIEW OF CERTAIN OF THE HOSPITAL'S POLICIES FOR COMPLIANCE WITH SECTION 501(R) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED (THE "CODE"), AND THE REGULATIONS THEREUNDER. (E) NUMBER OF OCCURRENCES: OHMC AND ITS AFFILIATES INITIAL REVIEW OF ACCOUNTS DETERMINED APPROXIMATELY 2,400 INDIVIDUALS MAY HAVE BEEN IMPACTED BY THE FAILURE. THIS NUMBER WAS DERIVED AT BY REVIEWING ALL INDIVIDUALS THAT HAD MADE A PERSONAL PAYMENT FOR A DATE OF SERVICE AFTER 9/30/2016 WHO WERE AT ANY POINT APPROVED FOR ANY LEVEL OF CHARITY CARE AT OHMC AND ITS AFFILIATES (DERIVED AT BY ANY CHARITY CARE ADJUSTMENT ON ANY OF THAT INDIVIDUALS ENCOUNTERS FROM ANY DATE OF SERVICE AFTER 9/30/2016). THIS PROCESS GREW TO FINALLY EXAMINING 2,884 UNIQUE GUARANTORS (COUNTED IN THE UNIQUE NUMBER OF GUARANTOR ACCOUNTS, WHICH MAYBE HOLD MORE THAN ONE UNIQUE INDIVIDUALS IS CASES WHERE A MINOR IS ON THEIR GUARDIANS GUARANTOR ACCOUNT). THROUGH A PROCESS OF MANUALLY REVIEWING EACH GUARANTOR CHARITY CARE APPLICATION (SUMMARIZED WITH NOTES WITHIN EPIC), IT WAS DEEMED THAT 1,666 GUARANTOR ACCOUNTS WERE OWED A REFUND OF $513,069 IN PREVIOUS PAYMENTS AND $50,300 IN INTEREST FROM THOSE PREVIOUS PAYMENTS (CALCULATED AT A 6% ANNUAL INTEREST RATE COMPOUNDED FROM THE ENCOUNTER DISCHARGE DATE UNTIL AUGUST 15, 2019). EACH INDIVIDUAL AND THEIR ASSOCIATED ACCOUNTS WERE EVALUATED FOR APPROPRIATE APPLICATION TO IRS SECTION 501(R) PATIENT FINANCIAL ASSISTANCE PROGRAM GUIDELINES. THE QUANTITIES WERE SEPARATED AS FOLLOWS (NOTE, THE SUM OF GUARANTORS BEING GREATER THAN THE SUM AMOUNT IS DUE TO PATIENTS VISITING NUMEROUS CORPORATIONS): -OCONTO HOSPITAL AND MEDICAL CENTER = 265 GUARANTORS, $47,226 REFUNDS, $4,123 INTEREST (F) DOLLAR AMOUNTS INVOLVED: OHMC AND ITS AFFILIATES INITIAL REVIEW OF ACCOUNTS HAS DETERMINED THE MAXIMUM FINANCIAL IMPACT OF THE PROGRAM FAILURE IS $563,369, AS EXPLAINED IN SECTION 1.E INCLUDED $513,069 IS PATIENT PAYMENTS AND $50,300 IN INTEREST FROM THOSE PAYMENTS. EACH INDIVIDUAL AND THEIR ASSOCIATED ACCOUNTS WERE EVALUATED FOR APPROPRIATE APPLICATION TO IRS SECTION 501(R) PATIENT FINANCIAL ASSISTANCE PROGRAM GUIDELINES.(2) DESCRIPTION OF THE CORRECTION OF THE FAILURE: (A) METHOD AND DATE OF CORRECTION; DESCRIPTION OF HOW AFFECTED INDIVIDUALS WERE RESTORED TO THE POSITION THEY WOULD HAVE BEEN IN HAD THE FAILURE NOT OCCURRED: IN JULY OF 2019, OHMC REVISED ITS FINANCIAL ASSISTANCE POLICY (THE "FAP"). ADDITIONALLY, THE OHMC REVENUE CYCLE TEAM (THE INTERNAL GROUP RESPONSIBLE FOR THE APPLICATION OF THE FAP) HAS BEEN TRAINED ON THE APPROPRIATE APPLICATION OF THE FAP. IN JULY AND AUGUST OF 2019, OHMC AND ITS AFFILIATES USED ITS BEST EFFORTS TO PROVIDE EACH AFFECTED INDIVIDUAL WITH AN EXPLANATION OF THE ERROR, A CORRECTED BILLING STATEMENT, AND A REFUND OF ANY PAYMENTS THE INDIVIDUALS MADE IN EXCESS OF THE AMOUNTS OWED AFTER FAP DISCOUNTS ARE APPLIED (IN CASES IN WHICH THE EXCESS WAS $5 OR MORE). DURING THE PROCESS OF REFUNDING INDIVIDUALS, CHECKS WERE SENT TO ALL IDENTIFIED INDIVIDUALS AND APPROXIMATELY 63 WERE IDENTIFIED AS DECEASED. STEPS WERE TAKEN TO IDENTIFY THE INDIVIDUAL FINANCIALLY RESPONSIBLE OF THE DECEASED ESTATE. NO KNOWN ISSUED REFUND CHECKS OF BEEN RETURNED.(3) DESCRIPTION OF THE PRACTICES OR PROCEDURES THAT THE HOSPITAL REVISED OR NEWLY ESTABLISHED TO MINIMIZE THE LIKELIHOOD OF THE TYPE OF FAILURE RECURRING AND TO FACILITATE THE PROMPT IDENTIFICATION AND CORRECTION OF ANY SUCH FUTURE FAILURES THAT DO OCCUR: (A)WHILE OHMC IS COMFORTABLE THAT THE REVENUE CYCLE TEAM IS ACCURATELY AND APPROPRIATELY APPLYING THE IRS SECTION 501(R) PATIENT FINANCIAL ASSISTANCE PROGRAM REQUIREMENTS, A NUMBER OF PROCESSES HAVE BEEN PUT INTO PLACE TO ENSURE NO ADDITIONAL FAILURES OCCUR. THE PROCESSES INCLUDE: 1. IMPLEMENTATION OF A FINANCIAL ASSISTANCE DATABASE; 2. A MULTI-TIER SIGN-OFF PROCESS FOR NEW FINANCIAL ASSISTANCE PROGRAM PARTICIPANTS; 3. EXPLORE THE PRACTICALITY OF IMPLEMENTING THE EPIC FINANCIAL ASSISTANCE MODULE; 4. INTERNAL AUDITS (PERFORMED BY THE CORPORATE COMPLIANCE OFFICE) SCHEDULED IN SEPTEMBER 2019, DECEMBER 2019 AND ANNUALLY THEREAFTER. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - BELLIN HEALTH MARINETTE | ||||
| 2820 ROOSEVELT ROAD | MARINETTE | WI | 54143 | RURAL HEALTH CLINIC, AMBUL |
| 2 - BELLIN HEALTH CRIVITZ | ||||
| 218 S US HWY 141 SUITE 100 | CRIVITZ | WI | 54114 | RURAL HEALTH CLINIC |
| 3 - BELLIN HEALTH PESHTIGO | ||||
| 441 FRENCH STREET | PESHTIGO | WI | 54162 | RURAL HEALTH CLINIC |
| 4 - BELLIN HEALTH MENOMINEE | ||||
| 1100 10TH STREET | MENOMINEE | MI | 49858 | RURAL HEALTH CLINIC |
| 5 - BELLIN HEALTH LAKEWOOD | ||||
| 15481 COMMERCIAL RD STE E | LAKEWOOD | WI | 54138 | PRIMARY CARE CLINIC |
| 6 - BELLIN HEALTH DAGGETT | ||||
| 106 S SCHOOL ROAD | DAGGETT | MI | 49821 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | OCONTO HOSPITAL AND MEDICAL CENTER IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. |
| PART I, LINE 7: | AMOUNTS ARE CALCULATED BASED ON THE COST TO CHARGE RATIOS AND WORKSHEET 2 PROVIDED BY THE IRS. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE OF $1,926,711 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COORDINATION AND SUPPORT OF LOCAL EMS - COMMUNITY DISASTER DRILL, MASS CASUALTY DRILL, EDUCATION, SMOKE INHALATION KITS STOCKED AT THE HOSPITAL. WORK IN PARTNERSHIP WITH COUNTY HEALTH DEPARTMENTS TO MEET COMMUNITY NEEDS. |
| PART III, LINE 2: | THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHANGE RATIOS. |
| PART III, LINE 4: | THE ATTACHED FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES DESCRIBES THE HOSPITAL'S POLICY ON PAGE 16 OF THE FINANCIAL STATEMENTS. CONSISTENT WITH BELLIN HEALTH SYSTEMS' MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, BELLIN HEALTH SYSTEMS HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS BELLIN HEALTH SYSTEMS EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. BELLIN HEALTH SYSTEMS' POLICY IS TO PROVIDE A 35% DISCOUNT FROM ESTABLISHED CHARGES TO UNINSURED PATIENTS. THIS POLICY DID NOT CHANGE IN 2019 AND 2018. |
| 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 SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT EXEMPT HOSPITALS, CMS WOULD NEED TO PROVIDE THESE SERVICES. |
| PART III, LINE 9B: | FOR PATIENTS WHO CANNOT MEET THE EXPECTATIONS OF THE DEBT COLLECTION POLICY, THE ORGANIZATION OFFERS FINANCIAL ASSITANCE. THE ORGANIZATION WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE DETERMING WHETHER A GUARANTOR IS ELIGILBE FOR ASSISTANCE UNTER THE FINANCIAL ASSISTANCE POLICY. ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM AS PART OF THE REGISTRATION PROCESS IN ADDITION, ALL STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE AVAILABILITY. |
| PART VI, LINE 2: | THE ORGANIZATION HAS A KEY STRATEGIC OBJECTIVES OF "THE BEST CARE & HEALTHIEST COMMUNITIES" FOCUSED ON INCREASING YEARS OF QUALITY LIFE BY PROVIDING APPROPRIATE, HIGHEST QUALITY, SAFE AND COORDINATED CARE THAT IS AFFORDABLE FOR EVERYONE. WITH A RELENTLESS DESIRE TO IMPROVE HEALTH AND WELL-BEING, WE USE OUR EXPERTISE, TECHNOLOGY, RELATIONSHIPS, FINANCIAL AND OTHER RESOURCES TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH AND POSITIVELY IMPACT THE HEALTH AND WELL-BEING OF OUR COMMUNITIES. WE ANNUALLY REVIEW THE COUNTY HEALTH RANKINGS THROUGH THE UW POPULATIONS HEALTH DEPARTMENT, MINE OUR PATIENT DATA BY REGION FOR THE HEALTH AREAS MOST IN NEED OF IMPROVEMENT AND MANAGE THIS THROUGH OUR PRIMARY CARE PROVIDER RELATIONSHIPS WITH KEY QUALITY INDICATORS. |
| PART VI, LINE 3: | INFORMATION ON GOVERNMENT ASSISTANCE PROGRAMS AND THE CHARITY CARE PROGRAM IS MADE AVAILABLE TO PATIENTS IN THE EMERGENCY ROOM AND AT THE TIME OF REGISTRATION. ADDITIONALLY, THE INFORMATION IS INCLUDED IN PATIENT STATEMENTS AND LETTERS FROM THE BILLING OFFICE. |
| PART VI, LINE 4: | THE ORGANIZATION IS LOCATED IN THE CITY OF OCONTO, WISCONSIN. ITS PRIMARY SERVICE AREA IS THE CITY OF OCONTO AND ITS SECONDARY SERVICE AREA SPREADS TO THE NORTHERN PORTION OF OCONTO COUNTY AND SOUTHERN MARINETTE COUNTY. THE CITY OF OCONTO HAS A POPULATION OF 4,500. 17% OF THE POPULATION IS OVER AGE 65 AND 8.8% OF THE POPULATION IS BELOW THE POVERTY LINE. |
| PART VI, LINE 5: | THE ORGANIZATION IS A STEERING TEAM MEMBER OF THE HEALTHY OCONTO COUNTY IMPROVEMENT WORK ALONG WITH HSHS ST. CLARE HOSPITAL AND OCONTO COUNTY PUBLIC HEALTH. THE ORGANIZATION ACTIVELY PARTICIPATES IN THE OCONTO AREA CHAMBER OF COMMERCE BUSINESS EXPOR, COPPERFEST SPONSORSHIP, NEWCAP AND HUMANE SOCIETY FOOD DRIVES. IN ADDITION THE ORGANIZATION IS A SOLE COMMUNITY HOSPITAL WITH AN EMERGENCY ROOM AVAILABLE 24/7 TO ALL. |
| PART VI, LINE 6: | THE ORGANIZATION, IN PARTNERSHIP WITH BELLIN HEALTH SYSTEMS, INC., CONTINUES TO SERVE IT'S COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GEORGE KERWIN - TERMED | ||||||||||||||
| BOARD MEMBER | $0 | $597,016 | $0 | $430,400 | $0 | $55,149 | $0 | $19,788 | $0 | $18,689 | $0 | $1,121,042 | $0 | $0 |
| LAURA HIEB | ||||||||||||||
| BOARD MEMBER | $0 | $240,115 | $0 | $60,000 | $0 | $25,528 | $0 | $0 | $0 | $2,795 | $0 | $328,438 | $0 | $0 |
| LAURA CORMIER | ||||||||||||||
| CEO | $147,277 | $0 | $10,000 | $0 | $2,286 | $0 | $6,613 | $0 | $20,810 | $0 | $186,986 | $0 | $0 | $0 |
| JAMES DIETSCHE | ||||||||||||||
| BOARD MEMBER | $0 | $383,423 | $0 | $110,000 | $0 | $414 | $0 | $3,735 | $0 | $21,812 | $0 | $519,384 | $0 | $0 |
| CHARLES HEYKA MD | ||||||||||||||
| PRESIDENT OF MEDICAL STAFF | $381,098 | $0 | $0 | $0 | $1,188 | $0 | $11,624 | $0 | $21,530 | $0 | $415,440 | $0 | $0 | $0 |
| PAWNEET SING MD | ||||||||||||||
| PHYSICIAN | $440,919 | $0 | $136,362 | $0 | $162 | $0 | $8,330 | $0 | $1,760 | $0 | $587,533 | $0 | $0 | $0 |
| CALVIN NOGLER MD | ||||||||||||||
| PHYSICIAN | $177,148 | $0 | $122,174 | $0 | $1,188 | $0 | $8,214 | $0 | $18,523 | $0 | $327,247 | $0 | $0 | $0 |
| MICHAEL BRENNER MD | ||||||||||||||
| PHYSICIAN | $336,572 | $0 | $0 | $0 | $162 | $0 | $130 | $0 | $19,674 | $0 | $356,538 | $0 | $0 | $0 |
| JAMES OPOIEN MD | ||||||||||||||
| PHYSICIAN | $196,057 | $0 | $90,099 | $0 | $2,286 | $0 | $5,103 | $0 | $18,566 | $0 | $312,111 | $0 | $0 | $0 |
| JON SIMMONS MD | ||||||||||||||
| PHYSICIAN | $145,374 | $0 | $171,771 | $0 | $414 | $0 | $5,702 | $0 | $8,829 | $0 | $332,090 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2011-08-18 | BondIssuedDt |
| Issue Price | $14,000,000 | IssuePriceAmt |
| Purpose | FACILITY AND SERVICE EXPANSION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $466,667 | RetiredAmt |
| Total Proceeds | $14,000,000 | TotalProceedsAmt |
| Capitalized Interest | $36,149 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $132,033 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $13,831,818 | CapitalExpendituresAmt |
| Substantial Completion | 2012 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS TWO MEMBERS, BELLIN MEMORIAL HOSPITAL, INC. AND OCONTO MEMORIAL HOSPITAL CITIZENS FOUNDATION, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF THE ORGANIZATION HAVE THE POWER TO APPOINT/ELECT THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS ALSO HAVE THE POWER TO APPROVE, BUT NOT LIMITED TO, THE PHILOSOPHY, MISSION, AND VALUE OF THE ORGANIZATION, STRATEGIC PLANS, THE ANNUAL OPERATING AND CAPITAL BUDGET, AMENDMENTS OR RESTATEMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED IN DETAIL BY SENIOR ADMINISTRATION AND IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUESTS AN ANNUAL UPDATE FROM ALL BOARD MEMBERS WHO SIGN THE POLICY. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. IF THERE IS A CONFLICT OF INTERST, THE CORPORATE COMPLIANCE OFFICER IS NOTIFIED. MEMBERS OF THE BOARD WHO HAVE A CONFLICT OF INTEREST WITH A BOARD DECISION ABSTAIN FROM VOTING ON THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD WITHOUT CONFLICT OF INTEREST AND IS SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANT'S REPORT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION CONSIDERS THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS PROPERTY OF THE ORGANIZATION AND THEREFORE ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN OCONTO MEMORIAL HOSPITAL CITIZENS' FOUNDATION, INC. 45,677. |
| FORM 990, PART XI, LINE 2B-2C | THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED AUDIT OF BELLIN HEALTH SYSTEMS, INC. THE BOARD OF DIRECTORS OF BELLIN HEALTH SYSTEMS, INC. ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LAKE MICHIGAN HEALTH SERVICES INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54305 | 391512903 | SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL | WI | 501(C) | LINE 12B, II | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN COLLEGE INC | |||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | NURSING AND RADIOLOGIC SCIENCE COLLEGE | WI | 501(C) | LINE 2 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| THE BELLIN HEALTH FOUNDATION INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 391809171 | FOUNDATION | WI | 501(C) | LINE 7 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN PSYCHIATRIC CENTER INC | |||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54305 | 391657627 | PSYCHIATRIC HOSPITAL | WI | 501(C) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN MEMORIAL HOSPITAL INC | |||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 391900586 | ACUTE CARE HOSPITAL | WI | 501(C) | LINE 3 | BELLIN HEALTH SYSTEMS INC | Yes (1) | |
| BELLIN HEALTH SYSTEMS INC | |||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54305 | 391512904 | SUPPORT OF HEALTHCARE ORGANIZATIONS | WI | 501(C) | LINE 12B, II | 0 | N/A | |
| UNITED LIMITY PARTNERSHIP | |||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HOSPICE, PALLIATIVE & BEREAVEMENT SERVICES | WI | 501(C) | LINE 10 | 0 | N/A | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLIN ORTHOPEDIC SURGERY CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2223 LIME KILN RD | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264677834 | EIN |
| Primary Activities | AMBULATORY ORTHOPEDIC SURGERY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| BEL-REGIONAL HOME MEDICAL INC | |||||||||
| 617 S ROOSEVELT | GREEN BAY | WI | 54301 | 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | N/A | C | Yes (1) |
| BELLIN INVESTMENTS INC | |||||||||
| PO BOX 23400 | GREEN BAY | WI | 54305 | 391564939 | OTHER | WI | N/A | C | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (8 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BELLIN MEMORIAL HOSPITAL INC | ||
| E | $10,849,991 | FMV |
| BEL-REGIONAL HOME MEDICAL INC | ||
| J | $120,000 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| K | $2,770,525 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| M | $5,335,585 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| P | $35,000,000 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| O | $5,092,283 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| E | $30,800,000 | FMV |
| BELLIN MEMORIAL HOSPITAL INC | ||
| E | $2,205,773 | FMV |
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