BELLIN MEMORIAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
BELLIN MEMORIAL HOSPITAL INC (EIN 39-0884478)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-08-15
IRS object ID
201822279349301907
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-08-15T11:03:17-05:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390758449PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Wipfli LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO Box 12237AddressLine1Txt
CityGreen BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP543072237ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390884478EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Bellin Memorial Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBELLBusinessNameControlTxt
Phone9204457260PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 23400AddressLine1Txt
CityGreen BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54305ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGeorge KerwinPersonNm
Person TitleCEOPersonTitleTxt
Phone9204457260PhoneNum
Signature2018-08-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTerri Rexrode CPA MSTPreparerPersonNm
PTINP00096513PTIN
Phone9206620016PhoneNum
Preparation2018-08-14PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGeorge KerwinPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 23400AddressLine1Txt
CityGreen BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54305ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$498,131,016GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BELLIN.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1908FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionBELLIN MEMORIAL HOSPITAL, INC. (BMH) PROVIDES HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BMH, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, BMH PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR ARE UNINSURED OR UNDERINSURED. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID, ARE ALSO CONSIDERED PART OF THE BELLIN HEALTH BENEFITS PROVIDED TO THE COMMUNITY SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN COST.ActivityOrMissionDesc
Voting Members Governing Body22VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee3793TotalEmployeeCnt
Total Volunteers425TotalVolunteersCnt
Total Gross UBI$7,340,540TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$873,201NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$922,507PYContributionsGrantsAmt
CY Contributions Grants$1,284,229CYContributionsGrantsAmt
PY Program Service Revenue$472,729,864PYProgramServiceRevenueAmt
CY Program Service Revenue$481,484,956CYProgramServiceRevenueAmt
PY Investment Income$1,277,875PYInvestmentIncomeAmt
CY Investment Income$5,294,369CYInvestmentIncomeAmt
PY Other Revenue$4,062,031PYOtherRevenueAmt
CY Other Revenue$5,240,007CYOtherRevenueAmt
PY Total Revenue$478,992,277PYTotalRevenueAmt
CY Total Revenue$493,303,561CYTotalRevenueAmt
PY Grants And Similar Paid$607,321PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$812,484CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$255,739,020PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$264,768,020CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$195,052,016PYOtherExpensesAmt
CY Other Expenses$191,048,949CYOtherExpensesAmt
PY Total Expenses$451,398,357PYTotalExpensesAmt
CY Total Expenses$456,629,453CYTotalExpensesAmt
PY Revenues Less Expenses$27,593,920PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$36,674,108CYRevenuesLessExpensesAmt
Total Assets BOY$491,466,100TotalAssetsBOYAmt
Total Assets EOY$568,232,083TotalAssetsEOYAmt
Total Liabilities BOY$145,530,736TotalLiabilitiesBOYAmt
Total Liabilities EOY$179,599,438TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$345,935,364NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$388,632,645NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionBellin Health is a community-owned not-for-profit organization responsible for improving the health and wellbeing of people living in Northeast Wisconsin and the Upper Peninsula of Michigan, and all others we serve. We carry out this responsibility through individualized care excellence, community health improvement, and equitable healthcare financing plans all designed to positively impact health and wellbeing. We are steadfast in our commitment to providing compassionate, safe, and coordinated care that is accessible and affordable for everyone. We build trusted relationships and advance true collaboration, fueling our desire to constantly improve and innovate.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant ChangeYes (1)SignificantChangeInd
Expense$379,979,963ExpenseAmt
Grant$812,484GrantAmt
Revenue$475,661,929RevenueAmt
DescTHE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2017 32,562 INPATIENT DAYS WERE PROVIDED (29,659 ADULTS AND PEDIATRICS), AS COMPARED TO 33,060 (30,075 ADULTS AND PEDIATRICS) IN FISCAL YEAR 2016. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2017 AND 2016 WERE 247,677 AND 241,774, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 798,411 (AS COMPARED TO 828,162 IN 2016) PHYSICIAN CLINIC VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,795,693ExpenseAmt
Revenue$1,786,180RevenueAmt
DescNorthreach Healthcare is a primary care organization with service lines of family practice, ob/gyn, pediatrics, and internal medicine. NorthReach provides service to Marinette county, Menominee county, and the surrounding areas. In fiscal year 2017, NorthReach Healthcare was sold to a related organization.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$381,775,656TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document331IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee3793EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members22GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1James Dietsche CFOVPBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9204457260PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1744 S Webster AveAddressLine1Txt
Citygreen bayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54301ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
TERRY FULWILER
Board Chair0.50Yes (X)Yes (X)$0$0$0
ELL LEE DDS
Board VICE CHAIR0.50Yes (X)Yes (X)$0$0$0
MARK MCMULLEN
Board SECRETARY0.50Yes (X)Yes (X)$0$0$0
NANCY ARMBRUST
Board MEMBER0.50Yes (X)$0$0$0
G CORT CONDON
Board MEMBER0.50Yes (X)$0$0$0
Daniel Gulling
Board MeMBER0.50Yes (X)$0$0$0
FRED SCHMIDT MD
BOARD MEMBER50.00Yes (X)$747,228$0$17,962
DANIEL ARIENS
Board MEMBER0.50Yes (X)$0$0$0
WILLIAM WITTMAN MD
Board Member/BMG physian50.00Yes (X)$343,107$0$24,386
JOHN JONES
Board MEMBER0.50Yes (X)$0$0$0
SUSAN FINCO
Board MEMBER0.50Yes (X)$0$0$0
MICHAEL HADDAD
BOARD MEMBER0.50Yes (X)$0$0$0
CHRISTINE VANDENHOUTEN
BOARD MEMBER0.50Yes (X)$0$0$0
JOHN DYKEMA
Treasurer0.50Yes (X)Yes (X)$0$0$0
ROBERT CLAUSEN
BOARD MEMBER0.50Yes (X)$0$0$0
GEORGE KERWIN
Bellin CEO/Board Member50.00Yes (X)Yes (X)$901,117$0$36,061
LARRY BORGARD
BOARD MEMBER0.50Yes (X)$0$0$0
KARL SCHMIDT
BOARD MEMBER0.50Yes (X)$0$0$0
PAUL CASEY MD
BOARD MEMBER/PRESIDENT MEDICAL STAFF50.00Yes (X)$138,925$0$0
CYNTHIA LASECKI MD
BOARD MEMBER/FORMER PRESIDENT MEDICAL STAFF50.00Yes (X)$326,317$0$16,179
SABINA SINGH MD
BOARD MEMBER/PRESIDENT BELLIN MEDICAL GROP50.00Yes (X)$243,082$0$26,386
MARK RINGWELSKI MD
BOARD MEMBER/PRESIDENT BELLIN SPECIALTY GROUP50.00Yes (X)$304,193$0$26,784
JAMES DIETSCHE
CFO50.00Yes (X)$407,736$0$31,350
PETER KNOX - Termed
EXECUTIVE VP50.00Yes (X)$308,959$0$33,366
CHRISTINE WOLESKE
EXECUTIVE VP50.00Yes (X)$442,348$0$36,095
CHRISTOPHER WOLFRAM MD
Physician40.00$986,136$0$33,647Yes (X)
TIMOTHY TANKE MD
Physician40.00$932,310$0$35,195Yes (X)
RICHARD TIMMONS MD
PHYSICIAN40.00$866,081$0$37,002Yes (X)
Patrick McKenzie MD
Physician40.00$1,197,045$0$17,522Yes (X)
James spears MD
PHYSICIAN40.00$1,024,597$0$28,678Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$9,169,181TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$400,613TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K323IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
IEI GENERAL CONTRACTORS INC
1725 MIDWAY ROADDEPEREWI54115CONSTRUCTION SERVICES$10,877,814
BLR FURTHER LLC
4841 SUMMER AVENUEMEMPHISTN38122ADVERTISING/MARKETING SERVICES$2,320,176
AMERIEBO LLC
1851 S ALVERNO ROADMANITOWOCWI54220BILLING/COLLECTION SERVICES$1,971,519
MIRON CONSTRUCTION
PO BOX 509NEENAHWI54957CONSTRUCTION SERVICES$934,942
SOMERVILLE INC
2100 RIVERSIDE DRIVEGREEN BAYWI54301ARCHITECT/DESIGN SERVICES$822,136
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K66CntrctRcvdGreaterThan100KCnt
Related Organizations$956,582RelatedOrganizationsAmt
All Other Contributions$327,647AllOtherContributionsAmt
Total Contributions$1,284,229TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE621500$470,705,006$463,796,313$6,908,693
CONTRACTED SERVICES621110$3,543,061$3,543,061
ACO INCENTIVE621110$2,851,274$2,851,274
MISCELLANEOUS621110$1,616,971$1,616,971
Rent from Affiliates621110$1,383,900$1,383,900

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,384,744TotalRevenueColumnAmt
Related Or Exempt Func Income$51,916RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$431,847UnrelatedBusinessRevenueAmt
Exclusion$900,981ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$481,484,956TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,818,728TotalRevenueColumnAmt
Exclusion$2,818,728ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$3,618,209RealAmt
Personal$53,599PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$2,582,876RealAmt
Personal$53,599PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$1,035,333RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,035,333TotalRevenueColumnAmt
Exclusion$1,035,333ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$3,485,289SecuritiesAmt
Other$1,181,332OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$2,190,980OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$3,485,289SecuritiesAmt
Other-$1,009,648OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,475,641TotalRevenueColumnAmt
Exclusion$2,475,641ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
BOSC K-1 INCOME900099$5,412,941$5,412,941
EHR INCENTIVE621110$598,607$598,607
LOSS FROM HEALTHCARE AFFILIATES900099-$1,806,874-$1,806,874
FieldValueIRS element (for citing)
Other Revenue Total$4,204,674OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$493,303,561TotalRevenueColumnAmt
Related Or Exempt Func Income$477,448,109RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$7,340,540UnrelatedBusinessRevenueAmt
Exclusion$7,230,683ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$812,484TotalAmt
Program Services$812,484ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$4,069,257TotalAmt
Program Services$2,075,624ProgramServicesAmt
Management And General$1,993,633ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$210,095,638TotalAmt
Program Services$185,601,174ProgramServicesAmt
Management And General$24,494,464ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$9,557,322TotalAmt
Program Services$8,243,085ProgramServicesAmt
Management And General$1,314,237ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$27,301,540TotalAmt
Program Services$23,578,744ProgramServicesAmt
Management And General$3,722,796ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$13,744,263TotalAmt
Program Services$11,927,938ProgramServicesAmt
Management And General$1,816,325ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$558,314TotalAmt
Program Services$558,314ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$388,315TotalAmt
Management And General$388,315ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$810,702TotalAmt
Management And General$810,702ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$20,849,020TotalAmt
Program Services$13,527,121ProgramServicesAmt
Management And General$7,321,899ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$6,380,081TotalAmt
Program Services$29,794ProgramServicesAmt
Management And General$6,350,287ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,868,738TotalAmt
Program Services$1,614,906ProgramServicesAmt
Management And General$3,253,832ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$7,799,902TotalAmt
Program Services$3,894,239ProgramServicesAmt
Management And General$3,905,663ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$10,696,192TotalAmt
Program Services$9,693,313ProgramServicesAmt
Management And General$1,002,879ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,086,410TotalAmt
Program Services$596,426ProgramServicesAmt
Management And General$489,984ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,612,957TotalAmt
Program Services$774,088ProgramServicesAmt
Management And General$838,869ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$4,535,826TotalAmt
Program Services$337,979ProgramServicesAmt
Management And General$4,197,847ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$21,948,965TotalAmt
Program Services$14,063,132ProgramServicesAmt
Management And General$7,885,833ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$845,003TotalAmt
Program Services$566,472ProgramServicesAmt
Management And General$278,531ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Supplies$74,732,432$74,598,424$134,008
Equipment Rent/Maint$12,142,649$10,204,338$1,938,311
Dues/Subscriptions$9,601,948$8,134,281$1,467,667
Bad Debts$9,419,948$9,265,263$154,685

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,771,547TotalAmt
Program Services$1,678,517ProgramServicesAmt
Management And General$1,093,030ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$456,629,453TotalAmt
Program Services$381,775,656ProgramServicesAmt
Management And General$74,853,797ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$17,432BOYAmt
EOY$15,342EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$80,772,767BOYAmt
EOY$78,649,140EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$48,985,833BOYAmt
EOY$52,251,544EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$2,968,083BOYAmt
EOY$23,012,579EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$5,813,537BOYAmt
EOY$6,090,710EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$5,826,209BOYAmt
EOY$7,723,527EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$400,493,614LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$202,835,344LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$171,774,935BOYAmt
EOY$197,658,270EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$135,677,068BOYAmt
EOY$167,759,089EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$17,958,742BOYAmt
EOY$16,325,625EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$5,368,296BOYAmt
EOY$2,596,515EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$16,303,198BOYAmt
EOY$16,149,742EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$491,466,100BOYAmt
EOY$568,232,083EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$47,700,716BOYAmt
EOY$50,443,691EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$230,863BOYAmt
EOY$166,955EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$67,651,129BOYAmt
EOY$61,503,730EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$29,948,028BOYAmt
EOY$67,485,062EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$145,530,736BOYAmt
EOY$179,599,438EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$341,994,662BOYAmt
EOY$384,361,949EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,450,794BOYAmt
EOY$1,773,393EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,489,908BOYAmt
EOY$2,497,303EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$345,935,364BOYAmt
EOY$388,632,645EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$491,466,100BOYAmt
EOY$568,232,083EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$36,674,108ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$5,182,808NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$840,365OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$19,502OtherActivitiesAmt
Total Lobbying Expenditures$19,502TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationAHA and WHA DuesExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,637,679BeginningYearBalanceAmt
Contributions$7,394ContributionsAmt
Investment Earnings Or Losses$56,750InvestmentEarningsOrLossesAmt
Other Expenditures$12,788OtherExpendituresAmt
End Year Balance$2,689,035EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,283,113BeginningYearBalanceAmt
Contributions$319,500ContributionsAmt
Investment Earnings Or Losses$45,890InvestmentEarningsOrLossesAmt
Other Expenditures$10,824OtherExpendituresAmt
End Year Balance$2,637,679EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,446,300BeginningYearBalanceAmt
Contributions$101,050ContributionsAmt
Investment Earnings Or Losses-$255,551InvestmentEarningsOrLossesAmt
Other Expenditures$8,686OtherExpendituresAmt
End Year Balance$2,283,113EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,417,823BeginningYearBalanceAmt
Investment Earnings Or Losses$35,966InvestmentEarningsOrLossesAmt
Other Expenditures$7,489OtherExpendituresAmt
End Year Balance$2,446,300EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,372,548BeginningYearBalanceAmt
Investment Earnings Or Losses$48,841InvestmentEarningsOrLossesAmt
Other Expenditures$3,566OtherExpendituresAmt
End Year Balance$2,417,823EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.92870PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.07130TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,335,294OtherCostOrOtherBasisAmt
Book Value$8,335,294BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$181,744,773OtherCostOrOtherBasisAmt
Depreciation$59,694,760DepreciationAmt
Book Value$122,050,013BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,498,584OtherCostOrOtherBasisAmt
Depreciation$1,700,296DepreciationAmt
Book Value$798,288BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$205,680,163OtherCostOrOtherBasisAmt
Depreciation$141,440,288DepreciationAmt
Book Value$64,239,875BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,234,800OtherCostOrOtherBasisAmt
Book Value$2,234,800BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$197,658,270TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
DEFERRED COMPENSATION$10,394,575
NONCONTROLLING INTEREST OF CONSOLIDATED AFFILIATE$1,226,635
CAPITAL LEASE OBLIGATIONS$48,569,106
INTEREST RATE SWAP VALUATION$7,294,746
FieldValueIRS element (for citing)
Total Liability$67,485,062TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$490,033,243TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$5,182,808NetUnrealizedGainsInvstAmt
Other Revenue-$8,697,343OtherRevenueAmt
Revenue Not Reported-$3,514,535RevenueNotReportedAmt
Revenue Subtotal$493,547,778RevenueSubtotalAmt
Other Revenues Not Included-$244,217OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt-$244,217RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$493,303,561TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$447,797,039TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$1,252,575OtherExpensesIncludedAmt
Expenses Not Reported$1,252,575ExpensesNotReportedAmt
Expenses Subtotal$446,544,464ExpensesSubtotalAmt
Other Expenses Not Included$10,084,989OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$10,084,989ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$456,629,453TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part V, Line 4:ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR HEALTH CARE SERVICES AND EMPLOYEE TRAINING AND DEVELOPMENT.
Part XI, Line 2d - Other Adjustments:Gain ON SWAP AGREEMENT 3,158,428. NON-CONTROLLING INTEREST -2,435,823. Provision for bad debts -9,419,948.
Part XI, Line 4b - Other Adjustments:TRANSFER FROM FOUNDATION 956,582. HOSPITAL SUPPLIES 51,776. RENTAL EXPENSES -2,636,475. Rent from Affiliates 1,383,900.
Part XII, Line 2d - Other Adjustments:RENTAL EXPENSES 2,636,475. Rent from Affiliates -1,383,900.
Part XII, Line 4b - Other Adjustments:REALLOCATION OF SUPPLIES EXPENSE TO 990T 51,776. EXPENSES PAID FOR BY FOUNDATION TRANSFERS 613,265. provision for bad debts 9,419,948.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other220.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,291,740TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,291,740NetCommunityBenefitExpnsAmt
Total Expense0.00740TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$54,428,484TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$31,127,138DirectOffsettingRevenueAmt
Net Community Benefit Expns$23,301,346NetCommunityBenefitExpnsAmt
Total Expense0.05210TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$57,720,224TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$31,127,138DirectOffsettingRevenueAmt
Net Community Benefit Expns$26,593,086NetCommunityBenefitExpnsAmt
Total Expense0.05950TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,473,878TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,473,878NetCommunityBenefitExpnsAmt
Total Expense0.01000TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,047,284TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,047,284NetCommunityBenefitExpnsAmt
Total Expense0.00910TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,179,179TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,179,179NetCommunityBenefitExpnsAmt
Total Expense0.00260TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,700,341TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$9,700,341NetCommunityBenefitExpnsAmt
Total Expense0.02170TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$67,420,565TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$31,127,138DirectOffsettingRevenueAmt
Net Community Benefit Expns$36,293,427NetCommunityBenefitExpnsAmt
Total Expense0.08120TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$694,121TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$694,121NetCommunityBenefitExpnsAmt
Total Expense0.00160TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$694,121TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$694,121NetCommunityBenefitExpnsAmt
Total Expense0.00160TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$3,922,497BadDebtExpenseAmt
Reimbursed By Medicare$135,609,092ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$193,943,141CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$58,334,049MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line11 Bellin Orthopedic Surgery Center LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary Activitiesorthopedic surgery centerPrimaryActivitiesTxt
Org Profit Or Ownership0.55000OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.45000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Bellin Memorial HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1744 S Webster AveAddressLine1Txt
CityGreen BayCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54305ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.bellin.orgWebsiteAddressTxt
State License147StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Bellin Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted14CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLwww.bellin.org/patients_visitors/company-information/community-healthOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt14ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLwww.bellin.org/patients_visitors/company-information/community-healthStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care220.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttps://www.bellin.org/patients_visitors/patient-information/financial-assiFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttps://www.bellin.org/images/uploads/Community_Care_Instructions.pdfFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttps://www.bellin.org/images/uploads/Patient_Financial_Assistance.pdfFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Bellin Memorial HospitalPart V, Section B, Line 5: THE BROWN COUNTY AND CITY OF DE PERE HEALTH DEPARTMENTS CONVENED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT INCLUDED REPRESENTATIVES FROM BELLIN HEALTH, ST. MARYS AND ITS SISTER HOSPITAL, ST. VINCENTS, AURORA HEALTH, BROWN COUNTY UNITED WAY, AND THE REGIONAL OFFICE OF WISCONSIN'S DEPARTMENT OF HEALTH. THIS STEERING COMMITTEE WORKED TO IDENTIFY REPRESENTATIVES THAT COULD BROADLY REPRESENT THE COMMUNITY IN ACTUALLY CONDUCTING THE NEEDS ASSESSMENT AND SETTING PRIORITIES. THESE INDIVIDUALS WERE REFERRED TO AS COMMUNITY PARTNERS AND ARE THE FOLLOWING:ACHIEVE BROWN COUNTY: ADAM HARDYAGING AND DISABILITY RESOURCE CENTER: MEREDITH HANSEN, JANELLE WATSONAURORA BAYCARE MEDICAL CENTER: AMY HERDEE, MARK HUBER*BAY AREA COMMUNITY COUNCIL: BOB WOESSNERBC PLANNING AND LAND SERVICES DEPARTMENT: DAN TEATERSBELLIN COLLEGE: KATHIE DE MUTHBELLIN HEALTH: SHARLA BAENEN, LAURA CORMIER, CHRISTOPHER ELFNER, LAURA HIEB*, JOHN ROCHELEAU*, JODI WILMET*BROWN COUNTY EXECUTIVE OFFICE: TROY STRECKENBACHBROWN COUNTY COMMUNITY TREATMENT CENTER: TINA CAZZOLABROWN COUNTY HEALTH DEPARTMENT: DEBORAH ARMBRUSTER, JUDY FRIEDERICHS*, ROB GOLLMAN, STACY ROSS, PATTI SMEESTER, CHUA XIONGBROWN COUNTY HUMAN SERVICES: MARY MICELI-WINKBROWN COUNTY ORAL HEALTH PARTNERSHIP: CARRIE STEMPSKIBROWN COUNTY UNITED WAY: HOWARD ENDOW*, SARAH INMAN, GREG MAASS, JILL SOBIECK, ASHLEY VANDENBOOMENCATHOLIC CHARITIES: CELIA LATOURCENTER FOR CHILDHOOD SAFETY: KIMBERLY HESSCITY OF DE PERE BOARD OF HEALTH: MIKE DONOVAN, PATRICIA FINDER-STONEDE PERE HEALTH DEPARTMENT: ERIN BONGERS, CHRYSTAL WOLLER*ELIZK INSURANCE: ELIZABETH KOSTICHKAGREATER GREEN BAY CHAMBER: GRANT DVORAKGREATER GREEN BAY YMCA: SANDY ATKINSHOSPITAL SISTERS HEALTH SYSTEM: ELAINE DOXTATOR, PATTI GLASER-MARTIN, HEIDI SELBERG*LIBERTA: BARBARA CONIFFLIVE54218: JOHN DYE, MELINDA MORELLA, JEN VAN DEN ELZENN.E.W. COMMUNITY CLINIC: JAMIE CAMPBELL, BONNIE KUHR, SETH MOORE, CATHERINE THERRIENN.E.W. CURATIVE REHABILITATION: STEVE MCCARTHYNORTHEAST WISCONSIN TECHNICAL COLLEGE: SCOTT ANDERSONPREVEA HEALTH: ANGELA RALEIGHSCHNEIDER NATIONAL: CHRISTINE SCHNEIDERST. NORBERT COLLEGE:ST. NICHOLAS HOSPITAL: MARY PALUCHNIAKST. VINCENT HOSPITAL: DONNA BOEHM, CAROLINE GLANDER, KAITLIN SWANSONSTATE OF WISCONSIN-DIVISION OF PUBLIC HEALTH: ELIZABETH SCHEELKUNIFIED SCHOOL DISTRICT OF DE PERE: MARGIE HEMPELUW-GREEN BAY: THOMAS ERDMAN, SARAH HIMMELHEBER, CHRISTINE VANDENHOUTEN, LEANNE ZHUBROWN COUNTY UW-EXTENSION: KAREN EARLYWEST DE PERE SCHOOL DISTRICT: DAWN SCHAEFERWI DEPARTMENT OF HEALTH NORTHEAST REGION: CHRISTOPHER COLLETTA** STEERING COMMITTEE MEMBER
Bellin Memorial HospitalPart V, Section B, Line 6a: Aurora BayCare Medical Center (Green Bay) and St. Mary's and St. Vincent Hospitals (HSHS, Green Bay)
Bellin Memorial HospitalPart V, Section B, Line 6b: BROWN COUNTY HEALTH DEPARTMENT, CITY OF DE PERE HEALTH DEPARTMENT, BROWN COUNTY UNITED WAY, AND WI DIVISION OF PUBLIC HEALTH NE REGIONAL OFFICE
Bellin Memorial HospitalPart V, Section B, Line 11: The most recent CHNA identified community needs from 2015 through 2017. We are in the process of leading a community reassessment.The needs identified are: Oral Health, Alcohol and Other Drug Abuse, Mental Health and Physical Activity and Nutrition. Bellin representatives lead the Alcohol and Other Drug Abuse and Mental Health Community Action teams and is active on the other teams. A summary of how Bellin has been addressing the needs identified in the CHNA is as follows:Oral Health: Bellin sponsored a legislative breakfast to improve health care policy and coverage of Medicaid patients. We have standardized our ED protocols to be consistent with the other health care systems for patients with oral pain., along with conducting a oral health screening pilot with our OB patients. Bellin donates funds annually to the NEW Community Clinic which has been able to expand access for oral care for Medicaid and uninsured patients.Alcohol and Other Drug Misuse:Physical Activity and Nutrition:Mental Health: Mental Health has been working on the following objectives:Brown County Mental Health Task Force Goal: Brown County will increase access to mental health services for all populations in the county by identifying gaps and disparities and creating a common platform that mental health providers, partner agencies, and stakeholders can access 1. By December 31, 2017, with a goal of getting to 0 suicides, the number of annual suicides in Brown County will decrease from 35 to 302. By December 31, 2017, the average number of poor mental health days per 30 days, as reported by county residents, will decrease from 3.2 to 3.0OBJECTIVE #1: By December 31, 2017, the task force will create a document accessible to all stakeholders that identifies the current state of mental health care in Brown County, including all available resources and services provided, gaps and disparities in care, needed programs, and ratio of specific mental health providers to population. We have evaluated best practice screening tools that can be implemented across community and healthcare settings (help identify current state of mental health and needs) In partnership with the St. Norbert College Strategic Research Center, we have identified disparities in poor mental health days in Brown County and created initiatives to address these areas. (see below)OBJECTIVE #2: By December 31, 2017, the mental health task force will create a draft proposal for creating a community-wide "No Wrong Door" access platform for mental health treatment and connection between mental health providers. (The goal is to create the right access at the right time by having a comprehensive view and collaborative connections between all Brown County mental health service providers.) We have selected our virtual online vendor for community-wide access platform. We received a $1M grant in collaboration with Connections for Mental Wellness to reduce the number of poor mental health days by:o Improving accesso Improving community members' knowledge of mental health and mental wellnesso Creating mentally healthy workplaceso Building the workforce (psychiatrists and mental health therapists)
Bellin Memorial HospitalPart V, Section B, Line 13h: Presumptive eligibility includes factors as: homeless, deceased with no estate, approved court bankruptcy, referred from a free clinic, payment assistance rankor eligible for State of WI food share program.
Bellin Memorial HospitalPart V, Section B, Line 15e: Disclosure under revenue procedure 2015-21:During fiscal year 2017 we completed an IRS 501(r) audit. Pursuant to revenue procedure 2015-21, we want to make the following disclosure. IRC 501(r)(4) and the related treasury regulations require a hospital organization to make the FAP widely available on a website. The FAP on the website is required to include multiple provisions including the basis for calculating amounts charged to patients, and collection actions your hospital may take against patients in the event of nonpayment. These requirements were originally missing from the FAP on our website. The FAP on our website has since been updated to include these provisions. In addition 501(r)(4) has a translation requirement. It is required that our website have the FAP documents translated into Spanish. The translated FAP documents were missing from our website and have since been added.This audit was concluded on September 13, 2017. The audit covered the tax period ending September 30, 2014.To Bellin's knowledge, no one was harmed by the lack of the above in the mentioned timeframe. If we become aware of any harm from these missteps, we will promptly correct the situation.
FieldValueIRS element (for citing)
Facility35FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (35 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - The Cancer Team of Bellin Health
1580 Commanche AveGreen BayWI54313Provider Clinic Site
2 - Cardiology Associates of Bellin Health
744 S Webster AveGreen BayWI54301Hospital Based Site
3 - Family Medical Center Ashwaubenon
1630 Commanche AveGreen BayWI54313Provider Clinic Site
4 - Bellin Health Cardiovascular & Thoracic
720 S Van Buren St Suite 303Green BayWI54301Provider Clinic Site
5 - Bellin Health Surgical Associates
720 S Van Buren St Suite 201Green BayWI54301Provider Clinic Site
6 - Gastroenterology Associates of Green Bay
725 S Webster AveGreen BayWI54301Provider Clinic Site
7 - Family Medical Center De Pere East
555 Redbird CircleDe PereWI54115Provider Clinic Site
8 - Bellin Health Generations
704 S Webster Ave Suite 300Green BayWI54301Provider Clinic Site
9 - Family Medical Center Howard
2714 RiverviewGreen BayWI54313Provider Clinic Site
10 - Family Medical Center Bellevue
3263 Eaton RdGreen BayWI543116830Provider Clinic Site
11 - Family Medical Center De Pere West
1800 Lawrence DrDe PereWI54115Provider Clinic Site
12 - Bellin Health Iron Mountain
440 Woodward AveIron MountainMI49801Provider Clinic Site
13 - Neurology Consultants of Bellin Health
725 S Webster AveGreen BayWI54301Provider Clinic Site
14 - Bellin Health Titletown Sports Medicine
1970 S Ridge RdGreen BayWI54304Provider Clinic Site
15 - Bellin Health Escanaba
610 S Lincoln RoadESCANABAMI49829Provider Clinic Site
16 - Family Medical Center Green BAy
704 S Webster AveGreen BayWI54301Provider Clinic Site
17 - Family Medical Center Kewaunee
575 - 4th StreetKewauneeWI54216Provider Clinic Site
18 - Family Medical Center Algoma
831 Parker AveAlgomaWI54201Provider Clinic Site
19 - Family Medical Center Brillion
964 W Ryan St Suite BBrillionWI54110Provider Clinic Site
20 - Bellin Health Oconto FAlls
107 E Highland DrOconto FAllsWI54154Provider Clinic Site
21 - Bellin Health Asthma & Allergy
519 S Monroe AvenueGreen BayWI54301Provider Clinic Site
22 - Family Medical Center Denmark
595 County Road RDenmarkWI54208Provider Clinic Site
23 - Family Medical Center Seymour
405 Commercial StSeymourWI54165Provider Clinic Site
24 - Family Medical Center Wrightstown
555 Quality CtWrightstownWI54180Provider Clinic Site
25 - Family Medical Center Luxemburg
140 B School Creek TrailLuxemburgWI54217Provider Clinic Site
26 - Family Medical Center Manitowoc
3415 Custer St Suite DManitowocWI54221Provider Clinic Site
27 - Family Medical Center Pulaski
723 s wisconsin stPulaskiWI541620109Provider Clinic Site
28 - Bellin Health Asthma & Allergy - Neenah
119 E Bell St Suite BNeenahWI54957Provider Clinic Site
29 - BELLIN HEALTH FAST CARE ASHWAUBENON
301 BAY PARK SQUAREGreen BayWI54304Convenient Care Center
30 - BELLIN HEALTH FAST CARE EAST TOWNE MALL
2430 E MASON STREETGreen BayWI54302Convenient Care Center
31 - Family Medical Center Bonduel
401 W Mill StBonduelWI54107Provider Clinic Site
32 - Bellin Health Endocrinology
720 S Van Buren St Suite 104Green BayWI54301Provider Clinic Site
33 - BELLIN HEALTH FAST CARE SUAMICO
2318 LINEVILLE ROADSUAMICOWI54173Convenient Care Center
34 - Family Medical Center Suring
307 Manor DrSuringWI54174Provider Clinic Site
35 - Family Medical Center Sturgeon Bay
311 N 3rd AveSturgeon BayWI54235Provider Clinic Site

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 6a:BELLIN MEMORIAL HOSPITAL IN INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT.
Part I, Line 7:AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS.
Part I, Ln 7 Col(f):BAD DEBT EXPENSE OF $9,419,948 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H.
Part II, Community Building Activities:COMMUNITY BUILDING ACTIVITIES FOCUS ON SOCIAL CONDITIONS THAT CONTRIBUTE TO HEALTH PROBLEMS, SUCH AS HOMELESSNESS, POVERTY, AND OTHER LIVING CONDITIONS AFFECTING THE QUALITY OF LIFE. THESE RANGE FROM DEVELOPING COMMUNITY LEADERS, DISASTER READINESS, AND SUPPORT OF LOCAL ECONOMIC DEVELOPMENT, TO HEALTH IMPROVEMENT ADVOCACY. BELLIN MEMORIAL HOSPITAL IS ACTIVE IN THE GREEN BAY PUBLIC SCHOOLS WITH OUR THRIVE PROGRAM THAT ASSISTS IN SETTING AND MEETING HEALTH AND WELLNESS GOALS FOR STUDENTS IN THIS SCHOOL SYSTEM. BELLIN ALSO HOLDS AN ANNUAL BELLIN RUN/WALK 10K EVENT EACH YEAR WITH OVER 13,000 PARTICIPANTS OF ALL AGES LEARNING FIRST HAnD THE VALUE OF EXERCISE IN DAILY LIFE.
Part III, Line 2:THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS.
Part III, Line 3:The hospital utilizes HFMA #15 therefore none of the bad debt would be deemed charity care.
Part III, Line 4:THE ATTACHED FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES DESCRIBES THE PROVISION FOR BAD DEBT ON PAGES 12 AND 13 OF THE FINANCIAL STATEMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), BELLIN HEALTH SYSTEMS RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCES FOR DOUBTFUL ACCOUNTS.
Part III, Line 8:THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RUL 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, FOR-PROFIT HOSPITALS HAVE CARVED OUT HIGH-MARGIN SERVICES (I.E. ONCOLOGY, ORTHO, ETC) LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS MEANS THAT THE SHORTFALL IS NOT NECESSARILY FROM INEFFICIENT OPERATIONS. MEDICARE CAN BE THE LARGEST PAYOR AND HOSPITALS HAVE NO ABILITY TO DENY COVERAGE. THIS, IN TURN, IS A PROMOTION OF ACCESS TO HEALTHCARE SERVICES (A COMMUNITY BENEFIT). ALSO, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES.
Part III, Line 9b:For patients who cannot meet the expectations of the debt collection policy, the organization offers financial assitance. The organization will not engage in extraordinary collection actions before determing whether a guarantor is eligilbe for assistance unter the financial assistance policy. All patients are offered a Plain Language Summary explaining the financial assistance program as part of the registration process in addition, all statements include information regarding financial assistance availability.
Part VI, Line 2:BELLIN MEMORIAL HOSPITAL HAS COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IT IS POSTED ON BELLIN.ORG
Part VI, Line 3:FINANCIAL COUNSELORS ADVISE PATIENTS OF ASSISTANCE PROGRAMS AS WELL AS SERVICE CALLED HRS ERASE IS USED TO REVIEW SELF PAY ACCOUNTS FOR POSSIBLE COVERAGE THROUGH GOVERNMENT PROGRAMS.
Part VI, Line 4:BELLIN MEMORIAL HOSPITAL SERVES NORTHEAST WISCONSIN AND UPPER MICHIGAN. OUR CURRENT PAYOR SUPPLEMENTAL INFORMATION MIX IS 48.5% MEDICARE AND 9.9% MEDICAID. 10% OF THE POPULATION IS BELOW THE POVERTY LEVEL AND 14.3% OF THE POPULATION IS OVER AGE 65.
Part VI, Line 5:A MAJORITY OF BELLIN MEMORIAL HOSPITALS GOVERNING BODY IS COMPRISED OF PERSON WHO RESIDE IN BELLIN MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEROF. IN ADDITION, BELLIN MEMORIAL HOSPITAL EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. BELLIN MEMORIAL HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, EDUCATION AND FACILITIES.
Part VI, Line 6:BELLIN HEALTH IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. DIRECTLY, AND IN PARTNERSHIP WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE GUIDE INDIVIDUALS AND FAMILIES IN THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. WE ARE COMMITTED TO PROVIDING SAFE, RELIABLE, COST-EFFECTIVE TOTAL HEALTH SOLUTIONS WITH RESPECT AND COMPASSION. OUR INNOVATIVE WORK WILL IMPACT HEALTHCARE DELIVERY IN OUR REGION AS WELL AS THROUGHOUT THE WORLD.
Part VI, Line 7, Reports Filed With StatesWI

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (25 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
NEW Community Clinic
622 Bodart StreetGreen BayWI54301391200636501(c)3$100,000Support Free Community Health Clinic
GREEN BAY PUBLIC SCHOOLS
PO BOX 23387Green BayWI543053387396002329GOVT - PUBLIC SCHOOL$63,334HEALTH & WELLNESS PROGRAM
FESTIVAL FOODS TURKEY TROT
2250 W MASON STGREEN BAYWI54303391814712$15,000TURKET TROT RUN FOR CHARITY
DOWNTOWN GREEN BAY INC
130 E WALNUT ST STE 501GREEN BAYWI54301391858389501(c)3$17,000FARMERS MARKET
ENCOMPASS EARLY EDUCATION & CARE
2589 S Webster AveGreen BayWI54301390824004501(c)3$7,500DONATION
KIWANIS SKI CLUB
PO BOX 475IRON MOUNTAINMI49801383254313501(c)3$25,000DONATION
UNIVERSITY OF WI - OSHKOSH
842 ALGOMA BLVDOSHKOSHWI54901391805963GOVT- STATE AGENCY$60,000SUPPORT ORGANIZATION'S ACTIVITIES
NORTHEAST WISCONSIN TECHNICAL COLLEGE
2740 W MASON STGREEN BAYWI54307391087141GOVT- STATE AGENCY$20,000HEALTH SCIENCE SIMULATION LAB
AMERICAN FOUNDATION OF COUNSELING
130 E WALNUT ST 7TH FLOORGREEN BayWI54301391047205501(c)3$5,000ETHICS IN BUSINESS AWARDS AND MORE PROGRAM FOR MENTAL WELLNESS/TREATMENT INDIGENT POPULATION
GREATER GREEN BAY COMMUNITY FOUNDATION
310 W WALNUT ST SUITE 350GREEN BayWI54303391699966501(c)3$76,500Green Bay Neighborhood leadership council, Achieve Brown County
BROWN COUNTY UNITED WAY
112 N ADAMS ST STE 201GREEN BAYWI54301390806299501(c)3$65,500Donation
AMERICAN HEART ASSOCIATION
2850 DAIRY DR STE 300MADISONWI53718135613797501(c)3$5,000DONATION
BELLIN COLLEGE
3201 EATON RDGREEN BayWI54311391620530501(c)3$56,237BUILD OUT LAB & NURSING, MCW SPACE
BOYS & GIRLS CLUB OF GREEN BAY
1400 LOMBARDI AVE STE 60GREEn BayWI54304396102943501(c)3$5,000DONATION
BRIAN LAVIOLETTE SCHOLARSHIP
1135 PLEASANT VALLEY DRONEIDAWI54155391836591501(c)3$5,500BELLIN COLLEGE SCHOLARSHIP
CEREBRAL PALSY INC
2801 S WEBSTER AVEGReen BayWI54301390901265501(c)3$23,000CAPITAL CAMPAIGN - BUILDING EXPANSION
CROHNS & COLITIS FOUNDATION
1126 S 70TH ST STE 112-1BMILWAUKEEWI53214136193105501(c)3$5,000DONATION
BROWN COUNTY MEDICAL SOCIETY ALLIANCE
563 CARTER CT STE BKIMBERLYWI54136391516026501(c)3$5,000DOCTORS IN RECITAL SPONSORSHIP
HOWARD SUAMICO SCHOOL DISTRICT
2706 LINEVILLE RDGReen BayWI543137151396031599GOVT - PUBLIC SCHOOL$50,000ATHLETIC PROGRAMS - FIELD SURFACE
KEWAUNEE SCHOOL DISTRICT
915 THIRD STKEWAUNEEWI54216391047904GOVT - PUBLIC SCHOOL$60,000ATHLETIC PROGRAMS
MARINETTE MENOMINEE AREA COMMUNITY FOUNDATION
1101 11TH AVEMENOMINEEWI49858383264725501(c)3$5,000DONATION
MYTEAM TRIUMPH
1406 S JACKSON STGReen BayWI54301262511957501(c)3$10,000Progam support for people with diverse abilities to participate in endurance events
ROTARY CLUB OF GREEN BAY
2360 DUCK CREEK PKWYGReen BayWI543033300392000342501(c)3$18,167Free Enterprise Award Program
UNIVERSITY OF WI - GREEN BAY
2420 NICOLET DRGREEn BayWI54311391805963GOVT- STATE AGENCY$20,000Mark Reinke, MD Memorial Scholarship
US VENTURE OPEN
425 BETTER WAYAPPLETONWI54915391548450501(c)3$25,000Donation - Charity Fund Raising Golf Event
FieldValueIRS element (for citing)
Total501c3 Org25Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION REQUIRES A COMPREHENSIVE REQUEST OF THE GRANTEE TO PROVIDE RATIONALE FOR THE REQUEST. REQUIRED INFORMATION TO BE PROVIDED BY THE GRANTEE INCLUDES, TAX-EXEMPT STATUS, IDENTIFICATION OF USE OF RESOURCES AND FOLLOW UP INFORMATION AS TO THE UTILIZATION OF THE RESOURCES. THE ORGANIZATION REVIEWS EACH GRANTEE REQUEST IN RELATIONSHIP TO THE MISSION OF THE ORGANIZATION AND COMMUNITY SUPPORT. ALL REQUESTS REQUIRE APPROVAL BY SENIOR LEADERSHIP OF THE ORGANIZATION.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
FRED SCHMIDT MD
BOARD MEMBER$619,558$0$127,053$0$617$0$0$0$17,962$0$765,190$0$0$0
WILLIAM WITTMAN MD
Board Member/BMG physian$223,057$0$118,839$0$1,211$0$9,241$0$15,145$0$367,493$0$0$0
GEORGE KERWIN
Bellin CEO/Board Member$547,866$0$347,300$0$5,951$0$18,394$0$17,667$0$937,178$0$0$0
CYNTHIA LASECKI MD
BOARD MEMBER/FORMER PRESIDENT MEDICA$130,516$0$195,526$0$275$0$13,946$0$2,233$0$342,496$0$0$0
SABINA SINGH MD
BOARD MEMBER/PRESIDENT BELLIN MEDICA$155,624$0$87,183$0$275$0$10,729$0$15,657$0$269,468$0$0$0
MARK RINGWELSKI MD
BOARD MEMBER/PRESIDENT BELLIN SPECIA$280,375$0$23,029$0$789$0$8,461$0$18,323$0$330,977$0$0$0
JAMES DIETSCHE
CFO$332,461$0$75,000$0$275$0$10,364$0$20,986$0$439,086$0$0$0
PETER KNOX - Termed
EXECUTIVE VP$273,195$0$34,553$0$1,211$0$15,700$0$17,666$0$342,325$0$0$0
CHRISTINE WOLESKE
EXECUTIVE VP$355,055$0$75,000$0$12,293$0$18,357$0$17,738$0$478,443$0$0$0
CHRISTOPHER WOLFRAM MD
Physician$535,389$0$450,564$0$183$0$13,969$0$19,678$0$1,019,783$0$0$0
TIMOTHY TANKE MD
Physician$532,913$0$398,608$0$789$0$16,013$0$19,182$0$967,505$0$0$0
RICHARD TIMMONS MD
PHYSICIAN$531,630$0$333,662$0$789$0$15,753$0$21,249$0$903,083$0$0$0
Patrick McKenzie MD
Physician$1,196,342$0$0$0$703$0$17,522$0$0$0$1,214,567$0$0$0
James spears MD
PHYSICIAN$746,832$0$276,976$0$789$0$11,642$0$17,036$0$1,053,275$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 1aFormAndLineReferenceDesc
ExplanationBellin Memorial Hospital pays for a portion of membership dues at a local country club for Christine Woleske in order to hold various events at the club. This benefit is treated as taxable compensation.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY
A39133785597712dlh72015-04-09$44,994,006REFUND AND LEGALLY DEFEASE000
WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY
B3913378552011-11-23$12,944,000REFINANCING OF 2001 BONDS000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$1,616,311$44,994,006$528,236$44,465,77020090Yes (1)Yes (1)Yes (1)
B$1,095,000$12,944,000$79,8442001Yes (1)0Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdIndPrivate Bus Concerning UBIPrivateBusConcerningUBIPct
A0Yes (1)Yes (1)Yes (1)00.010000.01000Yes (1)0Yes (1)
B0Yes (1)Yes (1)Yes (1)00.010000.0100000Yes (1)0.00000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A0Yes (1)000000Yes (1)
BYes (1)0000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, line 3In fiscal year 2017, NorthReach Healthcare LLC, a disregarded entity was sold to a related organization.
Form 990, Part VI, Section A, line 6The organization has one corporate member, Bellin Health Systems, Inc.
Form 990, Part VI, Section A, line 7aThe corporate member, Bellin Health Systems, Inc. has the power to appoint board members.
Form 990, Part VI, Section A, line 7bThe corporate member, Bellin Health Systems, Inc., has the power to approve major expenditures and long-term borrowings.
Form 990, Part VI, Section B, line 11bThe Form 990 is reviewed in detail by senior administration and is presented to the Executive Committee in its entirety for a review of the document.
Form 990, Part VI, Section B, line 12cEach year a conflict of interest request document is provided to each board member. All documents are provided back to administration and reviewed. All employees are required to review the conflict of interest policy as part of annual mandatory education. If there is a conflict of interest, the corporate compliance officer and corporate compliance committee which is a committee of the board of directors is notified. The corporate compliance officer and corporate compliance committee addresses the issue.
Form 990, Part VI, Section B, line 15Compensation for the CEO and key executives are set by the executive committee of the Board supported by market data from surveys and an independent consultants report. The compensation is determined by members of the executive committee without conflict and is documented. CEO Compensation: CEO presents results of Performance Objectives to the Executive Committee in January of each year. The Chair applies a formula to the results and comes up with a recommendation. The Chair facilitates getting approval from other members of the Executive Committee. Senior Leaders: Compensation for those who report to the CEO is taken to the Executive Committee for discussion/approval.
Form 990, Part VI, Section C, line 19THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION.
Form 990, Part XI, line 9:CHANGE IN INTEREST IN FOUNDATION 117,760. INTEREST RATE SWAP AGREEMENT 3,158,428. TRANSFERS TO/FROM AFFILIATES NON-CONTROLLING INTEREST IN CONSOLIDATED AFFILIATE -2,435,823.
FORM 990, PART XI, LINE 2B-2CBELLIN MEMORIAL HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED AUDIT OF BELLIN HEALTH SYSTEMS, INC. THE BOARD OF DIRECTORS OF BELLIN HEALTH SYSTEMS, INC. ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTHREACH HEALTHCARE LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13120 RIVERSIDE AVE GATE B BLDG 1AddressLine1Txt
CityMARINETTECityNm
State AbbreviationWIStateAbbreviationCd
ZIP54143ZIPCd
FieldValueIRS element (for citing)
EIN391999260EIN
Primary ActivitiesPRIMARY AND SPECIALTY PHYSICIAN CLINICSPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Total Income$1,821,289TotalIncomeAmt
End Of Year Assets$0EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BELLIN MEMORIAL HOSPITALBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
LAKE MICHIGAN HEALTH SERVICES INC
744 SOUTH WEBSTER AVEGREEN BAYWI54305391512903SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITALWI501(c)(3)Line 12b, IIBellin Health Systems IncYes (1)
BELLIN COLLEGE INC
3201 EATON ROADGREEN BAYWI54311391620530NURSING COLLEGEWI501(c)(3)Line 2Bellin Health Systems IncYes (1)
THE BELLIN HEALTH FOUNDATION INC
PO BOX 23400GREEN BAYWI54305391809171FOUNDATIONWI501(c)(3)Line 7Bellin Health Systems IncYes (1)
BELLIN PSYCHIATRIC CENTER INC
PO BOX 23725GREEN BAYWI54305391657627PPSYCHIATRIC HOSPITALWI501(c)(3)Line 3Bellin Health Systems IncYes (1)
OCONTO HOSPITAL & MEDICAL CENTER INC
PO BOX 357OCONTOWI54153061745397HOSPITALWI501(c)(3)Line 3BELLIN MEMORIAL HOSPITAL INCYes (1)
BELLIN HEALTH SYSTEMS INC
744 SOUTH WEBSTER AVEGREEN BAYWI54305391512904SUPPORT OF HEALTHCARE ORGANIZATIONSWI501(c)(3)Line 12b, II0N/A
UNITY LIMITED PARTNERSHIP
2366 OAK RIDGE CIRCLEDE PEREWI54115391750729HOSPICE, PALLIATIVE & BEREAVEMENT SERVICESWI501(c)(3)Line 10BELLIN MEMORIAL HOSPITAL INCYes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPctDirect Controlling NADirectControllingNACd
BELLIN ORTHOPEDIC SURGERY CENTER LLC
2223 LIME KILN RDGREEN BAYWI54311264677834AMBULATORY ORTHOPEDIC SURGERYWIBellin Memorial Hospital IncRELATED$2,497,828$884,171000.55000
D1 SPORTS TRAINING OF GREEN BAY LLC
SOUTH SPRINGS DRIVEFRANKLINTN37067454848172SPORTS TRAININGTNN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtOwnershipOwnershipPct
BEL-REGIONAL HOME MEDICAL INC
617 S ROOSEVELTGREEN BAYWI54301391504766DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESSWIN/ACYes (1)
BELLIN INVESTMENTS INC
PO BOX 23400GREEN BAYWI54305391564939OTHERWIN/ACYes (1)
narayan amarnani md sc
725 s webster avegreen BAYWI54301391325918medical clinicWICYes (1)BELLIN MEMORIAL HOSPITAL1.00000
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (21 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
OCONTO HOSPITAL & MEDICAL CENTER
D$11,783,328ACTUAL
oCONTO HOSPITAL & MEDICAL CENTER
Q$18,180,000ACTUAL
OCONTO HOSPITAL & MEDICAL CENTER
O$2,553,025ACTUAL
OCONTO HOSPITAL & MEDICAL CENTER
M$4,014,020ACTUAL
OCONTO HOSPITAL & MEDICAL CENTER
J$1,360,027ACTUAL
bellin college
L$350,281ACTUAL
Bellin college
N$355,593AcTUAL
Bellin Health Foundation
C$956,582ActUAL
Bellin Psychiatric Center
L$1,958,010ActUAL
Bellin psychiatric Center
D$2,779,352ACTUAL
bellin college
Q$249,203aCTUAL
bellin health Foundation
Q$143,418aCTUAL
bellin health Foundation
O$344,049aCTUAL
bellin health Foundation
S$1,100,000aCTUAL
bellin college
D$606,068acTUAL
bellin psychiatric Center
D$4,519,174acTUAL
narayan amarnani md sc
D$4,695,904aCTUAL
ocONTO HOSPITAL & MEDICAL CENTER
D$2,080,038aCTUAL
bellin health Foundation
D$742,894aCTUAL
bel-regional home medical inc
D$3,500,223aCTUAL
ocONTO HOSPITAL & MEDICAL CENTER
D$20,000,000acTUAL

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceForm 990, Schedule R, Part IVFormAndLineReferenceDesc
ExplanationIn regard to our investment in Narayan Amarnani, MD SC, this c-corporation was purchased during our fiscal year on 1/1/17. It is on a calendar year end and therefore, since we did not own any of the income or asset amounts at 12/31/16 (the tax return for Narayan Amarnani, MD SC that falls within our fiscal year), no activity is reported on this tax return (refleclting activity from 10/1/16 to 9/30/17.ExplanationTxt

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