DOOR COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- DOOR COUNTY MEMORIAL HOSPITAL (EIN 39-0806324)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-03-19
- IRS object ID
- 201920789349300012
- Schema version
- 2017v2.3
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-03-19T10:49:47-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | 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 | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806324 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DOOR | BusinessNameControlTxt |
| Phone | 9207435566 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRIAN STEPHENS | PersonNm |
| Person Title | CHIEF ADMINISTRATIVE OFFICER | PersonTitleTxt |
| Phone | 9207435566 | PhoneNum |
| Signature | 2019-03-11 | 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 | 2019-01-26 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 74.87.127.216 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-03-11 | IPDt |
| IP Tm | 12:58:27 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GERALD WORRICK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $111,180,710 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DCMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF ALL PEOPLE IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 754 | TotalEmployeeCnt |
| Total Volunteers | 115 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $651,518 | PYContributionsGrantsAmt |
| CY Contributions Grants | $616,449 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $84,540,228 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $82,735,849 | CYProgramServiceRevenueAmt |
| PY Investment Income | $528,203 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,154,044 | CYInvestmentIncomeAmt |
| PY Other Revenue | $121,937 | PYOtherRevenueAmt |
| CY Other Revenue | -$17,589 | CYOtherRevenueAmt |
| PY Total Revenue | $85,841,886 | PYTotalRevenueAmt |
| CY Total Revenue | $84,488,753 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $32,850 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $53,221,076 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $54,742,418 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $30,603,219 | PYOtherExpensesAmt |
| CY Other Expenses | $28,860,330 | CYOtherExpensesAmt |
| PY Total Expenses | $83,824,295 | PYTotalExpensesAmt |
| CY Total Expenses | $83,635,598 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,017,591 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $853,155 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $102,562,760 | TotalAssetsBOYAmt |
| Total Assets EOY | $107,896,460 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,875,765 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,201,199 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $86,686,995 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $89,695,261 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR MISSION AS A HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITY, ESPECIALLY THE POOR. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $72,158,839 | ExpenseAmt |
| Grant | $32,850 | GrantAmt |
| Revenue | $82,490,546 | RevenueAmt |
| Desc | DOOR COUNTY MEMORIAL HOSPITAL ("THE HOSPITAL") IS A FULLY ACCREDITED, ACUTE-CARE HOSPITAL AND OUTPATIENT MEDICAL CENTER, WITH 25 LICENSED BEDS. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES AND SPECIALTIES, INCLUDING HOME HEALTH, A SKILLED NURSING FACILITY FOR LONG-TERM CARE AND REHABILITATION SERVICES, A REHAB SERVICES DEPARTMENT AND NORTH SHORE MEDICAL CLINIC. DURING FISCAL 2018, THE HOSPITAL COUNTED 4,073 INPATIENT DAYS, INCLUDING SWING BED. THE HOSPITAL'S OUTPATIENT FACILITIES, WHICH INCLUDE ITS REHABILITATION AGENCY, 30 BED EXTENDED CARE FACILITY, EMERGENCY ROOM, NORTH SHORE MEDICAL CLINIC SERVED 147,691 VISITS, AND THE NORTH SHORE MEDICAL CLINIC, INCLUDING ITS URGENT CARE FACILITY SERVED 93,282 VISITS. SEE SCHEDULE H FOR FURTHER DETAILS REGARDING THE COMMUNITY BENEFITS DOOR COUNTY MEMORIAL HOSPITAL PROVIDES. | Desc |
| Total Program Service Expenses | $72,158,839 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln 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 | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 117 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 754 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN STEPHENS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207435566 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| PATRICK O'HERN - TERMED | ||||||||
| CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BARTH GUILETTE | ||||||||
| CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WILLIAM MUNDY | ||||||||
| VICE CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CATHY WIESE - TERMED | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GERALD WORRICK | ||||||||
| CEO/BOARD MEMBER | 41.00 | 1.00 | Yes (X) | Yes (X) | $358,538 | $0 | $45,162 | |
| ANDRZEJ KUREK MD - TERMED | ||||||||
| MEDICAL STAFF PRES/BOARD M | 41.00 | 1.00 | Yes (X) | Yes (X) | $391,368 | $0 | $49,180 | |
| BRIAN MATYSIAK MD | ||||||||
| MEDICAL STAFF PRES/BOARD M | 41.00 | 1.00 | Yes (X) | Yes (X) | $435,495 | $0 | $51,110 | |
| JOSEPH MCMAHON - TERMED | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CORWIN DAHL | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIC PAULSEN - TERMED | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF RABAS | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KELTON REITZ MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | 1.00 | Yes (X) | $424,143 | $0 | $51,577 | ||
| GRACE ROSSMAN - TERMED | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID WARD | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RICHARD HOGAN MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | 1.00 | Yes (X) | $378,101 | $0 | $51,886 | ||
| JAMES SARKIS - TERMED | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SCOTT WEDERQUIST | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THERESE PANDL | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GREG SIMIA | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SALLY PFEIFER | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MIKE FELHOFER | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HOWARD PHIPPS | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DREW RICHMOND | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SANDY SEKADLO | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PATRICIA VICKMAN | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN STEPHENS | ||||||||
| CHIEF ADMINISTRATIVE OFFIC | 40.00 | Yes (X) | $151,808 | $0 | $37,035 | |||
| ADAM GINGERY | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $126,093 | $0 | $34,631 | |||
| DANIEL TOMASZEWSKI MD | ||||||||
| PHYSICIAN | 40.00 | $1,010,564 | $0 | $58,412 | Yes (X) | |||
| STEVEN DAVIS MD | ||||||||
| PHYSICIAN | 40.00 | $487,810 | $0 | $63,983 | Yes (X) | |||
| MICHAEL BRUNO MD | ||||||||
| PHYSICIAN | 40.00 | $493,044 | $0 | $62,303 | Yes (X) | |||
| MARC BINARD MD | ||||||||
| PHYSICIAN | 40.00 | $539,347 | $0 | $45,673 | Yes (X) | |||
| REYNALDO PALINES MD | ||||||||
| PHYSICIAN | 40.00 | $487,512 | $0 | $22,548 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,283,823 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $573,500 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 67 | 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 |
|---|---|---|---|---|---|
| INFINITY HEALTHCARE INC | |||||
| 111 E WISCONSIN AVE SUITE 2000 | MILWAUKEE | WI | 54302 | ER PHYSICIANS | $3,058,636 |
| MEDICAL STAFFING SOLUTIONS INC | |||||
| PO BOX 101 | RICE LAKE | WI | 54868 | CONTRACTED LABOR | $948,572 |
| MINISTRY HEALTHCARE INC | |||||
| 11925 W LAKE PARK DR SUITE 100 | MILWAUKEE | WI | 53224 | SUPPORT SERVICES | $754,881 |
| CLOUDWAVE | |||||
| DEPT CH 19800 | PALATINE | IL | 600559800 | COMPUTER SUPPORT | $657,183 |
| NAVIN HAFFTY & ASSOCIATES LLC | |||||
| 1900 W PARK DR SUITE 180 | WESTBOROUGH | MA | 01581 | COMPUTER SUPPORT | $554,593 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $231,131 | RelatedOrganizationsAmt |
| Government Grants | $135,000 | GovernmentGrantsAmt |
| All Other Contributions | $250,318 | AllOtherContributionsAmt |
| Total Contributions | $616,449 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 622110 | $80,840,109 | $80,840,109 |
| MISCELLANEOUS REVENUES | 909999 | $707,620 | $707,620 |
| OCCUPATIONAL HEALTH AND WELLNESS | 909999 | $324,231 | $324,231 |
| MOB RENTAL INCOME | 909999 | $322,620 | $322,620 |
| THERAPY OTHER REVENUES | 909999 | $295,966 | $295,966 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $245,303 | TotalRevenueColumnAmt |
| Exclusion | $245,303 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $82,735,849 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,043,524 | TotalRevenueColumnAmt |
| Exclusion | $1,043,524 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,742 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $26,331 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$17,589 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$17,589 | TotalRevenueColumnAmt |
| Exclusion | -$17,589 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,776,146 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,665,626 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $110,520 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $110,520 | TotalRevenueColumnAmt |
| Exclusion | $110,520 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,488,753 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $82,490,546 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,381,758 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,850 | TotalAmt |
| Program Services | $32,850 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,586,128 | TotalAmt |
| Program Services | $1,832,860 | ProgramServicesAmt |
| Management And General | $753,268 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,804,449 | TotalAmt |
| Program Services | $37,265,945 | ProgramServicesAmt |
| Management And General | $3,538,504 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,916,845 | TotalAmt |
| Program Services | $1,754,810 | ProgramServicesAmt |
| Management And General | $162,035 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,378,946 | TotalAmt |
| Program Services | $6,725,656 | ProgramServicesAmt |
| Management And General | $653,290 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,056,050 | TotalAmt |
| Program Services | $1,856,749 | ProgramServicesAmt |
| Management And General | $199,301 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,435 | TotalAmt |
| Management And General | $279,435 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $113,628 | TotalAmt |
| Management And General | $113,628 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,618 | TotalAmt |
| Management And General | $157,618 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,470,577 | TotalAmt |
| Program Services | $5,649,376 | ProgramServicesAmt |
| Management And General | $1,821,201 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $780,961 | TotalAmt |
| Management And General | $780,961 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,417,514 | TotalAmt |
| Program Services | $8,932,758 | ProgramServicesAmt |
| Management And General | $484,756 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,435,065 | TotalAmt |
| Program Services | $1,788,546 | ProgramServicesAmt |
| Management And General | $646,519 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,364,856 | TotalAmt |
| Program Services | $1,292,537 | ProgramServicesAmt |
| Management And General | $72,319 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $633,877 | TotalAmt |
| Program Services | $454,884 | ProgramServicesAmt |
| Management And General | $178,993 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,955 | TotalAmt |
| Management And General | $270,955 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,639,144 | TotalAmt |
| Program Services | $2,552,451 | ProgramServicesAmt |
| Management And General | $1,086,693 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,009 | TotalAmt |
| Program Services | $140,427 | ProgramServicesAmt |
| Management And General | $202,582 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $1,365,028 | $1,365,028 | |
| DUES AND SUBSCRIPTIONS | $220,692 | $145,991 | $74,701 |
| EQUIPMENT RENTAL | $109,387 | $109,387 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258,584 | TotalAmt |
| Program Services | $258,584 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,635,598 | TotalAmt |
| Program Services | $72,158,839 | ProgramServicesAmt |
| Management And General | $11,476,759 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,228 | BOYAmt |
| EOY | $3,128 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,897,748 | BOYAmt |
| EOY | $6,368,661 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,289,281 | BOYAmt |
| EOY | $12,813,738 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $192,222 | BOYAmt |
| EOY | $129,167 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $367,623 | BOYAmt |
| EOY | $233,614 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,244,241 | BOYAmt |
| EOY | $1,482,613 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $859,037 | BOYAmt |
| EOY | $1,401,372 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $51,593,211 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,504,652 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,808,019 | BOYAmt |
| EOY | $32,088,559 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,096,909 | BOYAmt |
| EOY | $46,212,577 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,804,452 | BOYAmt |
| EOY | $7,163,031 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,562,760 | BOYAmt |
| EOY | $107,896,460 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,629,838 | BOYAmt |
| EOY | $6,593,169 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,687,258 | BOYAmt |
| EOY | $7,223,938 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,050,178 | BOYAmt |
| EOY | $4,384,092 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $508,491 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,875,765 | BOYAmt |
| EOY | $18,201,199 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,236,119 | BOYAmt |
| EOY | $87,307,352 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,450,876 | BOYAmt |
| EOY | $2,387,909 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,686,995 | BOYAmt |
| EOY | $89,695,261 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,562,760 | BOYAmt |
| EOY | $107,896,460 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $853,155 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,218,078 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $937,033 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $10,689 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,689 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT ARE SPECIFICALLY ALLOCABLE TO LOBBYING. DOOR COUNTY MEMORIAL HOSPITAL DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,203,540 | OtherCostOrOtherBasisAmt |
| Book Value | $4,203,540 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,305,932 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,470,006 | DepreciationAmt |
| Book Value | $10,835,926 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,658,485 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,034,646 | DepreciationAmt |
| Book Value | $15,623,839 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,425,254 | OtherCostOrOtherBasisAmt |
| Book Value | $1,425,254 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $32,088,559 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| CASH SURRENDER VALUE OF LIFE INSURANCE | $1,458,705 |
| INTEREST IN NET ASSETS OF DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION, INC. | $2,376,780 |
| DUE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS | $3,327,546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,163,031 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $84,210,516 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,218,078 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$1,365,028 | OtherRevenueAmt |
| Revenue Not Reported | -$146,950 | RevenueNotReportedAmt |
| Revenue Subtotal | $84,357,466 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $157,618 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$26,331 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $131,287 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $84,488,753 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $82,139,283 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $26,331 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $26,331 | ExpensesNotReportedAmt |
| Expenses Subtotal | $82,112,952 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $157,618 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $1,365,028 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,522,646 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $83,635,598 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -1,365,028. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -26,331. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 26,331. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 1,365,028. |
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 | 250.000000000000 | 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 | 0 | ExpensesExceedBudgetInd |
| 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 | $831,784 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $831,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01010 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,931,082 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,715,808 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,215,274 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01480 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,762,866 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,715,808 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,047,058 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 18 | ActivitiesOrProgramsCnt |
| Persons Served | 872 | PersonsServedCnt |
| Total Community Benefit Expns | $1,359,641 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $430,864 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $928,777 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 280 | PersonsServedCnt |
| Total Community Benefit Expns | $377,091 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $377,091 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 5024 | PersonsServedCnt |
| Total Community Benefit Expns | $1,719,709 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $383,497 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,336,212 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 1343 | PersonsServedCnt |
| Total Community Benefit Expns | $474,037 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $474,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 35 | ActivitiesOrProgramsCnt |
| Persons Served | 7519 | PersonsServedCnt |
| Total Community Benefit Expns | $3,930,478 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $814,361 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,116,117 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03790 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 35 | ActivitiesOrProgramsCnt |
| Persons Served | 7519 | PersonsServedCnt |
| Total Community Benefit Expns | $12,693,344 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,530,169 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,163,175 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06280 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $108 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $108 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $876 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $876 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $17,146 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,146 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 292 | PersonsServedCnt |
| Total Community Benefit Expns | $49,489 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $49,489 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,217 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,217 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 1 | PersonsServedCnt |
| Total Community Benefit Expns | $120,537 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $120,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 293 | PersonsServedCnt |
| Total Community Benefit Expns | $189,373 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $189,373 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,365,028 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $25,741,282 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $25,990,731 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$249,449 | 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 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DCMEDICAL.ORG | WebsiteAddressTxt |
| State License | 1054 | 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 | DOOR COUNTY MEMORIAL HOSPITAL | 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 | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | HTTP://WWW.DCMEDICAL.ORG/HOSPITAL-INFORMATION/ABOUT/COMMUNITY-HEALTH-NEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.DCMEDICAL.ORG/HOSPITAL-INFORMATION/ABOUT/COMMUNITY-HEALTH-NEEDS | 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 | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.DCMEDICAL.ORG/DCMEDICAL.ORG/MEDIA/FILES/BILLING-AND-INSURANCE/F | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.DCMEDICAL.ORG/DCMEDICAL.ORG/MEDIA/FILES/BILLING-AND-INSURANCE/C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.DCMEDICAL.ORG/DCMEDICAL.ORG/MEDIA/FILES/BILLING-AND-INSURANCE/F | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DOOR COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE CHNA PROCESS LISTED BELOW HAPPENS EVERY THREE YEARS. DOOR COUNTY MEDICAL CENTER'S CHNA PROCESS SOUGHT INPUT FROM COMMUNITY MEMBERS, INCLUDING MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND FROM ORGANIZATIONS THAT SERVE THOSE POPULATIONS. IN JANUARY 2016, A COMMUNITY STAKEHOLDER MEETING WAS HELD. DOOR COUNTY MEDICAL CENTER INTENTIONALLY INVITED ORGANIZATIONS THAT REPRESENT MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE STAKEHOLDER MEETING ATTENDEES PARTICIPATED IN A FACILITATED DISCUSSION ABOUT THE COMMUNITY HEALTH DATA, PROGRESS ON THE PREVIOUS PRIORITY AREAS, AND ANY EMERGING NEEDS. THE LIST OF ORGANIZATIONS PARTICIPATING IN THE JANUARY 2016 STAKEHOLDER MEETING IS BELOW. DOOR COUNTY DEPARTMENT OF PUBLIC HEALTH STAFF* MINISTRY DOOR COUNTY MEDICAL CENTER UNITED WAY OF DOOR COUNTY* DOOR COUNTY PUBLIC LIBRARY MINISTRY DENTAL CLINIC* UW-EXTENSION, DOOR COUNTY UW-GREEN BAY DOOR COUNTY PUBLIC SCHOOLS* BOYS AND GIRLS CLUB OF DOOR COUNTY* DOOR COUNTY YMCA SENIOR RESOURCE CENTER* MINISTRY HOME CARE STURGEON BAY FIRE DEPARTMENT NORTHEAST WISCONSIN TECHNICAL COLLEGE (NWTC) DOOR COUNTY BOARD OF HEALTH BELLIN COLLEGE GOOD SAMARITAN- SCANDIA VILLAGE LAKESHORE CAP FOOD PANTRY* DOOR COUNTY SHERIFF'S DEPARTMENT**DENOTES ORGANIZATIONS OR PROGRAMS |
| DOOR COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: DOOR COUNTY PUBLIC HEALTH DEPARTMENT |
| DOOR COUNTY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: USING THE CHNA COMPLETED IN JANUARY 2016, THE HOSPITAL DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A THREE-YEAR IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. IN FISCAL YEAR 2016 (TAX YEAR 2015), THE HOSPITAL IMPLEMENTED A PLAN TO ADDRESS THE PRIORITY NEEDS. BELOW IS AN UPDATE ON THE PROGRESS OF THE IMPLEMENATION.PRIORITY NEED #1. FOOD, NUTRITION, AND EXERCISEDCMC OFFERS SPACE FOR A COMMUNITY GARDEN WHICH IS A WAY TO HELP LOCAL, LOW-INCOME FAMILIES ENJOY NOT ONLY THE HEALTH BENEFITS ASSOCIATED WITH GROWING THEIR OWN FOOD, BUT THE FINANCIAL BENEFITS AS WELL. AT THE COMMUNITY GARDEN, THE $40 RENTAL FEE FOR A PLOT IS WAIVED FOR FAMILIES THAT RECEIVE WIC OR SNAP BENEFITS THROUGH FOODSHARE, WI. ALL OF THE START-UP COSTS ASSOCIATED WITH A NEW FOOD GARDEN ARE NON-EXISTENT DUE TO ALL TOOLS AND TILLING PROVIDED AND DONE BY DCMC AND THE CITY OF STURGEON BAY.DCMC SPONSORS A FOOD VOUCHER PROGRAM AT THE STURGEON BAY FARMER'S MARKET. THE DOUBLE YOU FOODSHARE DOLLARS PROGRAM AIMS TO INCENTIVIZE HEALTHY EATING BY DOUBLING AVAILABLE FUNDS. THE VOUCHER IS BOUGHT FOR $10 ON A QUEST CARD AND IS WORTH $20 IN FOODSHARE TOKENS TO BE USED AT THE FARMERS MARKET.IN 2017, CONSTRUCTION OF A SIDEWALK AROUND THE PERIMETER OF OUR CAMPUS WAS COMPLETED TO ENCOURAGE EMPLOYEE AND PUBLIC HEALTH AND WELLNESS AS WELL AS CALMING EFFECTS OF NATURE.COMMUNITY HEALTH FAIRS ARE HELD SEVERAL TIMES DURING THE YEAR, WITH DIFFERENT HEALTH AND WELLNESS PARTNERS SUCH AS THE YMCA OF DOOR COUNTY, AND KEWAUNEE COUNTY AGING HEALTH SERVICES. THESE HEALTH FAIRS INCLUDE FREE HEALTH CARE SERVICES FOR THE PUBLIC SUCH AS CHOLESTEROL AND BLOOD PRESSURE SCREENINGS, AS WELL AS SEMINARS FACILITATED BY OUR CLINICAL STAFF AND PHYSICIANS.PRIORITY NEED #2. MENTAL HEALTH AND WELL-BEINGDCMC IS A MAJOR SPONSOR AND PARTICIPANT OF THE "LEARNING TO EMPOWER AND APPRECIATE ALL PEOPLE" (LEAP) PROJECT. LEAP IS A COMMUNITY PRODUCTION FEATURING OVER 50 DOOR COUNTY HIGH SCHOOL STUDENTS EACH YEAR IN AN EFFORT TO REACH OUT TO SCHOOLS, FAMILIES, AND YOUTH TO PROMOTE PHYSICAL AND MENTAL WELLNESS. IN 2017 LEAP PROJECT'S THEME WAS ABOUT BUILDING A POSITIVE COMMUNITY. IN LATE APRIL THE PRODUCTION WAS PRESENTED TO HIGH SCHOOL PEERS AND COMMUNITY SERVING OVER 1,500 HIGH SCHOOL STUDENTS AND 800 ADULTS. BARB JOHNSON-GIESE WAS THERE TO ANSWER QUESTIONS ABOUT MENTAL HEALTH AND ISSUES SUCH AS SUICIDE.PRIORITY NEED #3. ORAL HEALTHDCMC HAS A DENTAL CLINIC THAT CURRENTLY OPERATES 5 DAYS A WEEK, 8 HOURS A DAY. EACH YEAR WE INCREASE THE AMOUNT OF PATIENT VISITS WE SEE; IN 2017 WE REACHED OUR ALL-TIME HIGH OF 5,274 PATIENT VISITS. THIS CLINIC IS UNIQUE IN THAT IT IS THE ONLY ORAL HEALTH CLINIC OF ITS KIND IN THE AREA. THE PATIENTS SERVED ARE ON MEDICAID AND/OR ARE LOW INCOME WITH NO DENTAL INSURANCE AND WOULD HAVE NO OTHER PLACE TO TURN FOR DENTAL CARE. IF CALCULATED IN PRODUCTION OF WORK, THE DENTAL CLINIC HAS PROVIDED $1,352,633 WORTH OF DENTAL SERVICES TO THE DOOR AND KEWAUNEE COUNTY LOW INCOME RESIDENTS.THE SEAL A SMILE PROGRAM IS AN OUTREACH PROGRAM WHERE A HYGIENIST FROM THE DENTAL CLINIC BRINGS PORTABLE DENTAL EQUIPMENT INTO THE AREA SCHOOLS AND PROVIDE FLUORIDE VARNISH AND SEALANTS TO 2ND AND 3RD GRADERS, WITH THE CONSENT OF THEIR PARENTS. IN 2017 WE PLACED SEALANTS AND PROVIDED ORAL HEALTH EDUCATION TO 220 STUDENTS. WITH THE HELP OF THE ORAL HEALTH COALITION TEAM OF DOOR COUNTY WE ALSO WENT TO HEADSTART AND WASHINGTON ISLAND WHERE WE PROVIDED FLUORIDE VARNISH TO 175 CHILDREN.ANOTHER SERVICE THE DENTAL CLINIC PROVIDES IS FLUORIDE VARNISH AND EXAMS TO OUR SKILLED NURSING FACILITY (SNF) RESIDENTS. ON A QUARTERLY BASIS ONE OF OUR DENTISTS VISITS OUR SNF AND DOES EXAMS ON THE RESIDENTS. WHILE THERE, ONE OF OUR HYGIENISTS GOES TO EACH OF THE RESIDENTS AND APPLIES FLUORIDE VARNISH. THE VARNISH HELPS WITH DRY MOUTH SYNDROME THAT IS A REACTION FROM MANY TYPES OF PRESCRIPTION DRUGS. THIS ALSO HELPS PREVENT CAVITIES, SINCE MOST OF THESE RESIDENTS DO NOT SEE A DENTIST ON A REGULAR BASIS FOR TEETH CLEANINGS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - NORTH SHORE MEDICAL CLINIC | ||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | OP PHYSICIAN CLINIC |
| 2 - NORTH SHORE MEDICAL CLINIC | ||||
| 3711 HIGHWAY 42 | FISH CREEK | WI | 54212 | OP PHYSICIAN CLINIC |
| 3 - NORTH SHORE MEDICAL CLINIC | ||||
| 815 JEFFERSON STREET | ALGOMA | WI | 54201 | OP PHYSICIAN CLINIC |
| 4 - NORTH SHORE MEDICAL CLINIC | ||||
| 910 MAIN ROAD | WASHINGTON ISLAND | WI | 54201 | OP PHYSICIAN CLINIC |
| 5 - NORTH SHORE MEDICAL CLINIC | ||||
| 2073 COUNTY ROAD DK | BRUSSELS | WI | 54204 | OP PHYSICIAN CLINIC |
| 6 - STURGEON BAY REHAB SERVICES | ||||
| 1300 EGG HARBOR ROAD | STURGEON BAY | WI | 54235 | REHAB SERVICES |
| 7 - SISTER BAY REHAB SERVICES | ||||
| 2311 MEADOW WOOD DRIVE | SISTER BAY | WI | 54234 | REHAB SERVICES |
| 8 - ALGOMA REHAB SERVICES | ||||
| 1510 FREMONT STREET | ALGOMA | WI | 54201 | REHAB SERVICES |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS FOR SCHEDULE H, LINE 7, IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. THE ACTUAL COST OF SUPPLIES USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A RATIO OF ALL BENEFITS RELATED TO THE WAGE CALCULATION. NO COST TO CHARGE RATIO IS USED. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990 (PART IX, LINE 25, COLUMN A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,365,028. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | DOOR COUNTY MEDICAL CENTER PARTICIPATES IN COMMUNITY COALITIONS AND OTHER COLLABORATIVE EFFORTS WITH THE COMMUNITY WHOSE PURPOSE IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE INCLUDE HABITAT FOR HUMANITY, WISCONSIN COMMUNITY HEALTH PROGRAM, SOUTHERN DOOR AUDITORIUM COMMITTEE, DOOR COUNTY ELDER AND ADULT-AT-RISK INTERDISCIPLINARY TEAM, DOOR COUNTY COMMUNITY PARTNERSHIP FOR CHILDREN AND FAMILIES, MENTAL HEALTH FOCUS GROUP ANDDOOR COUNTY UNITED WAY. BY WORKING TOGETHER WITH OTHER ORGANIZATIONS IN THE COMMUNITY, WE EXPECT TO HAVE A GREATER IMPACT ON HEALTH. ACCORDING TO THE COUNTY HEALTH RANKINGS SITE, WITH A SHARED VISION AND COMMITMENT TO IMPROVED HEALTH, WORKING TOGETHER CAN YIELD BETTER RESULTS THAN WORKING ALONE. LEADERSHIP FROM DOOR COUNTY MEDICAL CENTER ALSO ATTEND LEADERSHIP DOOR COUNTY. FUTURE COMMUNITY LEADERS WHO ARE KNOWLEDGEABLE ABOUT BOTH THE ASSETS AND CHALLENGES OUR COMMUNITY HAS WILL HELP US TO POSITIVELY ADDRESS THE HEALTH ISSUES OF THE FUTURE. THE MEDICAL CENTER ALSO IS A COMMUNITY SHARPS DISPOSAL SITE. BY SAFELY REMOVING SHARPS FROM THE ENVIRONMENT, WE MAKE THE COMMUNITY SAFER IN TERMS OF INJURY AND INFECTION. IN ADDITION, DOOR COUNTY MEDICAL CENTER PROVIDES JOB SHADOWING FOR AREA YOUTH. ACCORDING TO THE COUNTY HEALTH RANKINGS, EMPLOYMENT PROVIDES INCOME AND, OFTEN, BENEFITS THAT CAN SUPPORT HEALTHY LIFESTYLE CHOICES. UNEMPLOYMENT AND UNDER EMPLOYMENT LIMIT THESE CHOICES, AND NEGATIVELY AFFECT BOTH QUALITY OF LIFE AND HEALTH OVERALL. |
| PART III, LINE 2: | ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. ATTEMPTS TO RESOLVE THESE OUTSTANDING BALANCES CAN INCLUDE, BUT ARE NOT LIMITED TO STATEMENTS BEING SENT, PHONE CALLS AND LETTERS BEING SENT. ACCOUNT FOLLOW UP PROTOCOL IS BASED ON PERSONAL PAY BALANCE SIZE OWED. |
| PART III, LINE 3: | DOOR COUNTY MEMORIAL HOSPITAL HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. |
| PART III, LINE 4: | PATIENT PAYMENTS OR DISCOUNTS ARE APPLIED PRIOR TO DETERMINING BAD DEBT EXPENSE AND ARE NOT INCLUDED IN THE BAD DEBT WRITE-OFF REPORTED ON THE AUDITED FINANCIAL STATEMENTS. DEDUCTIBLES AND COINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF EITHER TO BAD DEBT EXPENSE OR, IF APPLICABLE, TO CHARITY CARE IF THE PATIENT SO QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON GROSS CHARGES TO PATIENTS AFTER REFLECTING ANY PAYMENTS OR DISCOUNTS, OR AMOUNTS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE. |
| PART III, LINE 8: | HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SERVICES TO THOSE PATIENTS. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT IS STEP DOWN. |
| PART III, LINE 9B: | DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS MADE AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICES SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS. |
| PART VI, LINE 2: | OTHER THAN THE CHNA PROCESS, WHICH OCCURS EVERY THREE YEARS IN COLLABORATION WITH THE DOOR COUNTY PUBLIC HEALTH DEPARTMENT, THE ORGANIZATION USES MARKET RESEARCH TO GAUGE HEALTH CARE NEEDS. THE ORGANIZATION SURVEYED THE COMMUNITY TWICE IN 2018 USING SOCIAL MEDIA AND RECEIVED INPUT ON HEALTH CARE NEEDS THAT WILL BE USED IN THE CHNA FOR 2019. |
| PART VI, LINE 3: | THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE CHARITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE. PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASSISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. |
| PART VI, LINE 4: | WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THIS IS A WORK IN PROGRESS. DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") PROVIDED SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT, WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. THE CITY OF STURGEON BAY IS LOCATED IN DOOR COUNTY. THE POPULATION OF DOOR COUNTY, AS OF THE 2015 CENSUS DATA, IS 24,038. THE POPULATION CONSISTED OF 97% WHITE, 2% HISPANIC, 1% AFRICAN AMERICAN, AND 1% ASIAN. OF THE 24,038 POPULATION, 51% WERE FEMALE AND 49% MALE. THE AGE POPULATION IS WIDELY SPREAD. 17% WERE UNDER 18 AND 24% WERE 65+. THE LARGEST INDUSTRY IN DOOR COUNTY IS EDUCATIONAL, HEALTH AND SOCIAL SERVICES (18.8%). ARTS, ENTERTAINMENT AND RECREATION (16.1%) AND MANUFACTURING (14.0%) ARE THE NEXT LARGEST INDUSTRIES IN DOOR COUNTY. ROUGHLY 6.2% OF FAMILIES AND 11.4% OF THE POPULATION WERE BELOW THE POVERTY LINE. THAT INCLUDES 20.7% OF THOSE UNDER 18 YEARS OLD AND 7.9% OF THOSE 65 AND OLDER. |
| PART VI, LINE 5: | THE LOCAL BOARD FOR DOOR COUNTY MEMORIAL HOSPITAL IS MADE UP OF COMMUNITY MEMBERS THAT LIVE IN OUR PRIMARY SERVICE AREA. DOOR COUNTY MEMORIAL HOSPITAL PARTNERS WITH THE LOCAL YMCA ON VARIOUS EVENTS PROMOTING HEALTH AND WELL-BEING IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, AND OTHER GOVERNMENT SPONSORED PROGRAMS. |
| PART VI, LINE 6: | N/A |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| NORTHEAST WISCONSIN TECHNICAL COLLEGE | |||||||
| 2740 W MASON STREET | GREEN BAY | WI | 54307 | 237069405 | 501(C)(3) | $25,000 | NURSING & HEALTH CARE PROGRAMS |
| DOOR COUNTY ECONOMIC DEVELOPMENT | |||||||
| 185 E WALNUT STREET | STURGEION BAY | WI | 54235 | 391621905 | 501(C)(3) | $7,500 | DOOR COUNTY ECONOMIC DEVELOPMENT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 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 (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GERALD WORRICK | ||||||||||||||
| CEO/BOARD MEMBER | $343,111 | $0 | $0 | $0 | $15,427 | $0 | $16,200 | $0 | $28,962 | $0 | $403,700 | $0 | $0 | $0 |
| ANDRZEJ KUREK MD - TERMED | ||||||||||||||
| MEDICAL STAFF PRES/BOARD M | $191,232 | $0 | $198,116 | $0 | $2,020 | $0 | $16,200 | $0 | $32,980 | $0 | $440,548 | $0 | $0 | $0 |
| BRIAN MATYSIAK MD | ||||||||||||||
| MEDICAL STAFF PRES/BOARD M | $416,107 | $0 | $0 | $0 | $19,388 | $0 | $16,200 | $0 | $34,910 | $0 | $486,605 | $0 | $0 | $0 |
| KELTON REITZ MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $242,619 | $0 | $128,232 | $0 | $53,292 | $0 | $16,200 | $0 | $35,377 | $0 | $475,720 | $0 | $0 | $0 |
| RICHARD HOGAN MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $335,820 | $0 | $249 | $0 | $42,032 | $0 | $16,200 | $0 | $35,686 | $0 | $429,987 | $0 | $0 | $0 |
| BRIAN STEPHENS | ||||||||||||||
| CHIEF ADMINISTRATIVE OFFIC | $151,223 | $0 | $0 | $0 | $585 | $0 | $9,316 | $0 | $27,719 | $0 | $188,843 | $0 | $0 | $0 |
| ADAM GINGERY | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $123,624 | $0 | $0 | $0 | $2,469 | $0 | $7,764 | $0 | $26,867 | $0 | $160,724 | $0 | $0 | $0 |
| DANIEL TOMASZEWSKI MD | ||||||||||||||
| PHYSICIAN | $889,687 | $0 | $20,589 | $0 | $100,288 | $0 | $16,058 | $0 | $42,354 | $0 | $1,068,976 | $0 | $0 | $0 |
| STEVEN DAVIS MD | ||||||||||||||
| PHYSICIAN | $483,081 | $0 | $0 | $0 | $4,729 | $0 | $16,200 | $0 | $47,783 | $0 | $551,793 | $0 | $0 | $0 |
| MICHAEL BRUNO MD | ||||||||||||||
| PHYSICIAN | $477,924 | $0 | $0 | $0 | $15,120 | $0 | $16,200 | $0 | $46,103 | $0 | $555,347 | $0 | $0 | $0 |
| MARC BINARD MD | ||||||||||||||
| PHYSICIAN | $520,557 | $0 | $0 | $0 | $18,790 | $0 | $16,200 | $0 | $29,473 | $0 | $585,020 | $0 | $0 | $0 |
| REYNALDO PALINES MD | ||||||||||||||
| PHYSICIAN | $475,686 | $0 | $0 | $0 | $11,826 | $0 | $16,200 | $0 | $6,348 | $0 | $510,060 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | PHYSICIANS ARE ALLOWED UP TO $1,000 FOR SPOUSE TRAVEL TO CONFERENCES. SUPPORTING DOCUMENTATION OF THE EXPENSES IS MAINTAINED AND TRACKED BY THE PHYSICIANS. SPOUSE TRAVEL AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. |
| SCHEDULE J, PART I | FOUR HIGHLY COMPENSATED INDIVIDUALS RECEIVED TRAVEL FOR COMPANIONS WHICH WAS TAXED AS ADDITIONAL COMPENSATION. |
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 & EDUCATION FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2014-08-15 | BondIssuedDt |
| Issue Price | $10,000,000 | IssuePriceAmt |
| Purpose | REFUND DEBT ISSUED 10/21/09 | 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 | $463,320 | RetiredAmt |
| Total Proceeds | $10,000,000 | TotalProceedsAmt |
| Other Spent Proceeds | $10,000,000 | OtherSpentProceedsAmt |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| 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 | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| 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 | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (3 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| DANIEL TOMASZWESKI MD | |||||||
| HIGHEST COMPENSATED/PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $150,000 | $95,833 | 0 | Yes (1) | Yes (1) |
| BRIAN MATYSIAK MD | |||||||
| BOARD MEMBER/PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $85,000 | $26,667 | 0 | Yes (1) | Yes (1) |
| REYNALDO PALINES | |||||||
| HIGHEST COMPENSATED/PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $30,000 | $6,667 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $129,167 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THERE ARE TWO CLASSES OF MEMBERS. CLASS H MEMBERS ARE REPRESENTATIVES FROM HSHS. TWO CLASS H MEMBERS ARE REQUIRED PER THE PARTNERSHIP AGREEMENT WITH HSHS. CLASS D MEMBERS ARE REPRESENTATIVES FROM DOOR COUNTY MEDICAL CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | CLASS H DIRECTORS OF THE GOVERNING BODY OF DOOR COUNTY MEMORIAL HOSPITAL SHALL BE APPOINTED BY ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS PROVIDED THAT THE CLASS D DIRECTORS SHALL RECEIVE ADVANCE NOTICE OF AND THE RIGHT TO ATTEND AND PARTICIPATE IN DISCUSSION AT SVGB MEETINGS DURING WHICH SVGB DISCUSSES POTENTIAL CANDIDATES TO THE CLASS H DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | STARTING 11/1/16 DOOR COUNTY MEMORIAL HOSPITAL ENTERED INTO AN AFFILIATION AGREEMENT WITH HOSPITAL SISTERS HEALTH SYSTEM, HOSPITAL SISTERS SERVICES, INC. AND ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS. THERE ARE SOME DECISIONS THAT REQUIRE AFFIRMATIVE APPROVAL OF THE CLASS H DIRECTORS, VOTING A SINGLE VOTE AS A CLASS, AND THE AFFIRMATIVE APPROVAL OF THE CLASS D DIRECTORS, VOTING A SINGLE VOTE AS A CLASS. |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT, INCLUDING CERTAIN OFFICER, WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS' QUESTIONS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS OF THE GOVERNING BOARD OR COMMITTEE WILL DECIDE IF CONFLICTS ON INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTAND THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. |
| FORM 990, PART VI, SECTION B, LINE 15 | IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, WHICH IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO, WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE DOOR COUNTY MEMORIAL HOSPITAL WEB PAGE IS AVAILABLE TO THE PUBLIC FOR INSPECTION WITH A GOOD DEAL OF INFORMATION REGARDING WHO DOOR COUNTY MEMORIAL HOSPITAL IS ALONG WITH OUR MISSION. THE ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT INCLUDED ON ANY WEB PAGE. HOWEVER, IF ANY INQUIRY IS MADE FOR ANY DOCUMENTS THEY ARE SHARED AS APPROPRIATE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS IN DOOR COUNTY HOSPITAL FOUNDATION 937,033. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|
| DOOR COUNTY MEDICAL CORPORATION | ||||||||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | 814221171 | SUPPORTING ORGANIZATION | WI | 501(C)(3) | LINE 12B, II | 0 | |
| DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 1843 MICHIGAN STREET | STURGEON BAY | WI | 54235 | 391649104 | CHARITABLE FOUNDATION | WI | 501(C)(3) | LINE 7 | Yes (1) | DOOR COUNTY MEDICAL CORPORATION |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $231,131 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL | MethodOfAmountDeterminationTxt |