2019-05-14T17:42:26-05:00 2018-06-30 990 2017-07-01 391127163 Ascension Medical Group-Fox Valley Wisconsin Inc (FKA Network Health System Inc) ASCE 3147338000 PO Box 8005 1570 Midway Place Menasha WI 54952 Tonya Mershon Tax Officer 2019-05-14 2017 2020-01-14 16:20:31Z AFFINITY MEDICAL GROUP Bernard Sherry 400 W River Woods Parkway Glendale WI 53212 152929835 false X https://healthcare.ascension.org/Sites-of-Care/Ascension-Wisconsin X 1969 WI TO IMPROVE THE HEALTH AND WELL-BEING OF ALL PEOPLE IN THE COMMUNITIES WE SERVE. 10 0 1083 0 98354 13667 82700 117780 126883385 152229841 -420402 -455069 1001715 511634 127547398 152404186 0 0 0 0 123282185 114853677 0 0 0 72720590 57860667 196002775 172714344 -68455377 -20310158 37001961 42347134 35743771 29588198 1258190 12758936 OUR MISSION AS PART OF A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES WE SERVE. false false 128440549 0 152245111 NETWORK HEALTH SYSTEM, INC. IS A REGIONAL HEALTH CARE ORGANIZATION FOCUSED ON COMMUNITY-BASED CARE INCLUDING OUTPATIENT, INPATIENT, ANCILLARY, AND LONG-TERM CARE AS WELL AS INSURANCE SERVICES. THE 23 CLINICS IN THE 12 COMMUNITIES AROUND THE FOX CITIES AND OSHKOSH AREA PROVIDE PRIMARY AND SPECIALTY CARE CLOSE TO HOME. 128440549 true true false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true 108 0 true 1083 true true true false false false false false true false false false X 10 0 false false false false true true true true true false false false true true true true true false false false WI X Sara O'Brien 3147338070 11775 BORMAN DRIVE MARYLAND HEIGHTS MO 63146 Tracy A Rogers CHAIR 1.0 49.0 X X 0 1696876 51047 MARK D HORNEFFER MD VICE CHAIR 1.0 49.0 X X 0 298750 48396 SHISHIR N SHETH MD SECRETARY/TREASURER 1.0 49.0 X X 0 533406 38707 MARY B MCDONALD BOARD MEMBER/ADMIN COO - AMG WI 15.0 35.0 X X 0 387315 44884 DEBRA STANDRIDGE BOARD MEMBER 1.0 49.0 X 0 825914 36007 TRAVIS D ANDERSEN BOARD MEMBER 1.0 49.0 X 0 1367565 44454 GREGORY BRUSKO MD BOARD MEMBER (START 4/2018)/INTERIM PRESIDENT-CLINICAL AMG WI 50.0 0 X 0 0 0 CHOON HEONG P'NG MD BOARD MEMBER 1.0 49.0 X 0 653075 52250 CHRISTINE R WEIBEL-LYNN BOARD MEMBER/NURSE PRACTITIONER 48.0 2.0 X 89734 0 32691 ANDREW C ALEXANDER BOARD MEMBER 1.0 49.0 X 0 396187 52587 TIMOTHY J MASEK VP-FINANCE, AMG WI 15.0 35.0 X 0 426799 37698 DOUGLAS REDING MD CHIEF MEDICAL OFFICER - ASCENSION WI 10.0 40.0 X 0 647638 40758 LISA S BENSON MD CHIEF QUALITY OFFICER - ASCENSION WI 10.0 40.0 X 0 510066 20485 SUDEEP S SODHI MD PHYSICIAN 46.0 4.0 X 1682115 0 60593 DOUGLAS B HORAN MD PHYSICIAN 50.0 0 X 1494712 0 53337 MICHELE A HOLDER MD PHYSICIAN 50.0 0 X 1483655 0 60555 JOSEPH C NEILITZ MD PHYSICIAN 50.0 0 X 1146338 0 55665 ZENOUN O ABOUZELAM MD SPECIALIZED SURGEON 50.0 0 X 1032222 0 56597 MARK L FENLON MD FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 474486 21593 GREG P HENN FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 230478 20170 NICOLE A BRADY FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 339650 50267 MONICA A HILT FORMER OFFICER (END 12/2015) 0.0 50.0 X 0 531126 44932 DANIEL E NEUFELDER FORMER OFFICER (END 9/2016) 0.0 0.0 X 0 996775 0 6928776 10316106 923673 220 true true false NEUROSCIENCE GROUP OF NE WISCONSIN 1305 W AMERICAN DR NEENAH WI 54956 NEUROLOGIC PHYSICIAN SERVICES 605197 DAILY CARE HOSPITALISTS LLC 2919 SHELTER CREEK CT GREEN BAY WI 543134549 PHYSICIAN SERVICES 532080 ENCORE ONE LLC 124 N 121ST ST WAUWATOSA WI 532263802 INVESTMENT SERVICES 322662 CLINICAL REFERENCE LABORATORY PO BOX 802273 KANSAS CITY KS 641802273 CLINICAL TESTING SERVICES 125662 4 X 0 0 0 117780 0 0 117780 NET PATIENT SERVICE REVENUE 621111 120099082 120000728 98354 SERVICES TO AFFILIATES 900099 29529099 29529099 CONTRACTED SERVICES REVENUE 900099 1232498 1232498 CARDIOLOGY SERVICES 621111 1037848 1037848 RENTAL INCOME FROM AFFILIATES 531120 329454 329454 1860 1860 0 0 152229841 70580 70580 0 0 0 0 116889 0 0 116889 0 116889 116889 0 0 525649 0 -525649 -525649 -525649 0 0 0 0 0 0 0 0 EDUCATION REVENUE 611430 15270 15270 CAFETERIA/VENDING REVENUE 722514 52 52 MEDICAL RECORDS FEES 900099 26 26 379397 0 0 379397 394745 152404186 152146757 98354 41295 122425 116303 6122 97087161 92173807 4913354 12847821 12197611 650210 4796270 4553545 242725 51 51 6883888 6828675 55213 0 16454 14933 1521 524333 433842 90491 51865 49246 2619 7698191 33606 7664585 392238 334941 57297 157064 149931 7133 8 8 1464944 587011 877933 MANAGEMENT FEE TO AFFILIATE 15193225 15193225 PURCHASED SERVICES 10751887 1039527 9712360 MEDICAL SUPPLIES 8472654 8429472 43182 CORPORATE EXPENSES 5163326 5163326 1090539 1498048 -407509 0 172714344 128440549 44273795 0 423128 19197 0 1127744 0 0 10873652 12424287 0 0 0 0 1303386 1790556 0 0 582948 223485 27456073 7785483 20534859 19670590 0 0 0 36792 32020 0 0 3247196 7059255 37001961 42347134 9933448 10967698 0 0 0 100000 0 0 0 0 0 0 0 0 0 0 25810323 18520500 35743771 29588198 X 1258190 12758936 0 0 0 0 1258190 12758936 37001961 42347134 X -20310158 31810904 X false true X true false X 1508207 1508207 18199942 3265777 14934165 0 0 0 7271023 4519706 2751317 476901 0 476901 19670590 DUE FROM AFFILIATES 5170425 OTHER ACCOUNTS RECEIVABLE 1863830 PP&E HELD FOR SALE SECURITY DEPOSITS 25000 7059255 0 PENSION LIABILITY INTERCOMPANY DEBT WITH MINISTRY HEALTH CARE, INC Estimated Due to 3rd Party Payors DEFERRED RENT/LEASE LIABILITY 250415 Due to Affiliates 16748555 Other Liabilities 904841 Recovery Tail Liability 268255 Property Tax Liability Accrued Tax Liability 348434 18520500 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2018. true true false false false false false false false Tracy A Rogers CHAIR 0 641898 0 611054 0 443924 0 16200 0 34847 0 1747923 0 0 MARK D HORNEFFER MD VICE CHAIR 0 296177 0 1000 0 1573 0 17550 0 30846 0 347146 0 0 SHISHIR N SHETH MD SECRETARY/TREASURER 0 476466 0 10000 0 46940 0 17550 0 21157 0 572113 0 0 MARY B MCDONALD BOARD MEMBER/ADMIN COO - AMG WI 0 331431 0 40000 0 15884 0 16200 0 28684 0 432199 0 0 DEBRA STANDRIDGE BOARD MEMBER 0 493219 0 207295 0 125400 0 9931 0 26076 0 861921 0 0 TRAVIS D ANDERSEN BOARD MEMBER 0 563166 0 701999 0 102400 0 13500 0 30954 0 1412019 0 0 CHOON HEONG P'NG MD BOARD MEMBER 0 615934 0 2881 0 34260 0 16200 0 36050 0 705325 0 0 ANDREW C ALEXANDER BOARD MEMBER 0 339626 0 54200 0 2361 0 15306 0 37281 0 448774 0 0 MONICA A HILT FORMER OFFICER (END 12/2015) 0 398789 0 89542 0 42795 0 17550 0 27382 0 576058 0 0 DANIEL E NEUFELDER FORMER OFFICER (END 9/2016) 0 0 0 0 0 996775 0 0 0 0 0 996775 0 0 TIMOTHY J MASEK VP-FINANCE, AMG WI 0 323543 0 72287 0 30969 0 16200 0 21498 0 464497 0 0 MARK L FENLON MD FORMER KEY EMPLOYEE (END 6/2017) 0 135292 0 0 0 339194 0 10754 0 10839 0 496079 0 0 GREG P HENN FORMER KEY EMPLOYEE (END 6/2017) 0 144612 0 32882 0 52984 0 5873 0 14297 0 250648 0 0 NICOLE A BRADY FORMER KEY EMPLOYEE (END 6/2017) 0 272953 0 65519 0 1178 0 12946 0 37321 0 389917 0 0 DOUGLAS REDING MD CHIEF MEDICAL OFFICER - ASCENSION WI 0 523885 0 115749 0 8004 0 13500 0 27258 0 688396 0 0 LISA S BENSON MD CHIEF QUALITY OFFICER - ASCENSION WI 0 419726 0 87358 0 2982 0 13500 0 6985 0 530551 0 0 SUDEEP S SODHI MD PHYSICIAN 878584 0 800429 0 3102 0 17550 0 43043 0 1742708 0 0 0 DOUGLAS B HORAN MD PHYSICIAN 1450548 0 36629 0 7535 0 17550 0 35787 0 1548049 0 0 0 MICHELE A HOLDER MD PHYSICIAN 1387682 0 95493 0 480 0 17550 0 43005 0 1544210 0 0 0 JOSEPH C NEILITZ MD PHYSICIAN 684106 0 454823 0 7409 0 14850 0 40815 0 1202003 0 0 0 ZENOUN O ABOUZELAM MD SPECIALIZED SURGEON 822008 0 202210 0 8004 0 17550 0 39047 0 1088819 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC., USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual(s) received severance payments from the organization or a related organization: Daniel Neufelder - $994,500 MARK FENLON, MD - $303,293 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No individuals received current year distributions. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL THE PROCESS OF DETERMINING THE AMOUNT OF COMPENSATION PAID TO THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL IS PERFORMED BY MINISTRY HEALTH CARE, INC. AND ITS SUBSIDIARY ORGANIZATIONS. MINISTRY HEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER OF AFFINITY HEALTH SYSTEM WHICH IS THE SOLE CORPORATE MEMBER OF ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.). THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL'S SALARY 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 MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES THE PROCESS OF DETERMINING THE AMOUNT OF COMPENSATION PAID TO THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS PERFORMED BY MINISTRY HEALTH CARE, INC. AND ITS SUBSIDIARY ORGANIZATIONS. MINISTRY HEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER OF AFFINITY HEALTH SYSTEM WHICH IS THE SOLE CORPORATE MEMBER OF ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.). THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES 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 MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) HAS A SINGLE CORPORATE MEMBER, AFFINITY HEALTH SYSTEM. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) HAS A SINGLE CORPORATE MEMBER, AFFINITY HEALTH SYSTEM, WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF NETWORK HEALTH SYSTEM, INC. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO THE ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, AFFINITY HEALTH SYSTEM. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy 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 ON THE GOVERNING BOARD OR COMMITTEE WILL DECIDE IF CONFLICTS OF 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 CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS 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, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue Management Fees - Total Revenue: 150, Related or Exempt Function Revenue: 150, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Sports Medicine Revenue - Total Revenue: 1710, Related or Exempt Function Revenue: 1710, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER MISCELLANEOUS REVENUE - Total Revenue: 379397, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 379397; Form 990, Part XI, Line 9 Other changes in net assets or fund balances TRANSFERS WITH AFFILIATE - -22130641; TRANSFERS WITH ALPHA FUND - 53941545; Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS THE ACTIVITY OF ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) IS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. NO INDIVIDUAL AUDIT OF ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) IS COMPLETED. THEREFORE, THE AUDITED FINANCIAL STATEMENTS ARE OF ASCENSION HEALTH ALLIANCE AND AFFILIATES, WHICH INCLUDE THE ACTIVITY OF ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) Form 990, Part XII, Line 2c AUDIT COMMITTEE ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. THE FINANCE AND AUDIT COMMITTEE OF ASCENSION HEALTH ALLIANCE'S BOARD ASSUMES RESPONSIBILITY FOR THE CONSOLIDATED ORGANIZATION AS A WHOLE. Schedule A, Part I, Line 3 PUBLIC CHARITY STATUS ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC. (F/K/A NETWORK HEALTH SYSTEM, INC.) IS EXEMPT AS A HOSPITAL UNDER INTERNAL REVENUE CODE SECTION 170(B)(1)(A)(III); HOWEVER, IT IS NOT A HOSPITAL AS DEFINED BY FORM 990, SCHEDULE H INSTRUCTIONS. 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