2018-08-15T11:03:17-05:00 2017-09-30 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-10-01 390884478 Bellin Memorial Hospital Inc BELL 9204457260 PO Box 23400 Green Bay WI 54305 George Kerwin CEO 9204457260 2018-08-14 1 Terri Rexrode CPA MST P00096513 9206620016 2018-08-14 2016 2022-09-23 18:48:47Z George Kerwin PO Box 23400 Green Bay WI 54305 498131016 0 X WWW.BELLIN.ORG X 1908 WI BELLIN 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. 22 15 3793 425 7340540 -873201 922507 1284229 472729864 481484956 1277875 5294369 4062031 5240007 478992277 493303561 607321 812484 0 0 255739020 264768020 0 0 0 195052016 191048949 451398357 456629453 27593920 36674108 491466100 568232083 145530736 179599438 345935364 388632645 X Bellin 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. 0 1 379979963 812484 475661929 THE 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. 1795693 1786180 Northreach 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. 381775656 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 331 0 3793 1 1 1 0 0 0 0 0 0 0 0 0 X 22 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X James Dietsche CFOVP 9204457260 744 S Webster Ave green bay WI 54301 TERRY FULWILER Board Chair 0.50 X X 0 0 0 ELL LEE DDS Board VICE CHAIR 0.50 X X 0 0 0 MARK MCMULLEN Board SECRETARY 0.50 X X 0 0 0 NANCY ARMBRUST Board MEMBER 0.50 X 0 0 0 G CORT CONDON Board MEMBER 0.50 X 0 0 0 Daniel Gulling Board MeMBER 0.50 X 0 0 0 FRED SCHMIDT MD BOARD MEMBER 50.00 X 747228 0 17962 DANIEL ARIENS Board MEMBER 0.50 X 0 0 0 WILLIAM WITTMAN MD Board Member/BMG physian 50.00 X 343107 0 24386 JOHN JONES Board MEMBER 0.50 X 0 0 0 SUSAN FINCO Board MEMBER 0.50 X 0 0 0 MICHAEL HADDAD BOARD MEMBER 0.50 X 0 0 0 CHRISTINE VANDENHOUTEN BOARD MEMBER 0.50 X 0 0 0 JOHN DYKEMA Treasurer 0.50 X X 0 0 0 ROBERT CLAUSEN BOARD MEMBER 0.50 X 0 0 0 GEORGE KERWIN Bellin CEO/Board Member 50.00 X X 901117 0 36061 LARRY BORGARD BOARD MEMBER 0.50 X 0 0 0 KARL SCHMIDT BOARD MEMBER 0.50 X 0 0 0 PAUL CASEY MD BOARD MEMBER/PRESIDENT MEDICAL STAFF 50.00 X 138925 0 0 CYNTHIA LASECKI MD BOARD MEMBER/FORMER PRESIDENT MEDICAL STAFF 50.00 X 326317 0 16179 SABINA SINGH MD BOARD MEMBER/PRESIDENT BELLIN MEDICAL GROP 50.00 X 243082 0 26386 MARK RINGWELSKI MD BOARD MEMBER/PRESIDENT BELLIN SPECIALTY GROUP 50.00 X 304193 0 26784 JAMES DIETSCHE CFO 50.00 X 407736 0 31350 PETER KNOX - Termed EXECUTIVE VP 50.00 X 308959 0 33366 CHRISTINE WOLESKE EXECUTIVE VP 50.00 X 442348 0 36095 CHRISTOPHER WOLFRAM MD Physician 40.00 X 986136 0 33647 TIMOTHY TANKE MD Physician 40.00 X 932310 0 35195 RICHARD TIMMONS MD PHYSICIAN 40.00 X 866081 0 37002 Patrick McKenzie MD Physician 40.00 X 1197045 0 17522 James spears MD PHYSICIAN 40.00 X 1024597 0 28678 9169181 0 400613 323 0 1 0 IEI GENERAL CONTRACTORS INC 1725 MIDWAY ROAD DEPERE WI 54115 CONSTRUCTION SERVICES 10877814 BLR FURTHER LLC 4841 SUMMER AVENUE MEMPHIS TN 38122 ADVERTISING/MARKETING SERVICES 2320176 AMERIEBO LLC 1851 S ALVERNO ROAD MANITOWOC WI 54220 BILLING/COLLECTION SERVICES 1971519 MIRON CONSTRUCTION PO BOX 509 NEENAH WI 54957 CONSTRUCTION SERVICES 934942 SOMERVILLE INC 2100 RIVERSIDE DRIVE GREEN BAY WI 54301 ARCHITECT/DESIGN SERVICES 822136 66 956582 327647 1284229 NET PATIENT SERVICE REVENUE 621500 470705006 463796313 6908693 CONTRACTED SERVICES 621110 3543061 3543061 ACO INCENTIVE 621110 2851274 2851274 MISCELLANEOUS 621110 1616971 1616971 Rent from Affiliates 621110 1383900 1383900 1384744 51916 431847 900981 481484956 2818728 2818728 3618209 53599 2582876 53599 1035333 0 1035333 1035333 3485289 1181332 0 2190980 3485289 -1009648 2475641 2475641 BOSC K-1 INCOME 900099 5412941 5412941 EHR INCENTIVE 621110 598607 598607 LOSS FROM HEALTHCARE AFFILIATES 900099 -1806874 -1806874 4204674 493303561 477448109 7340540 7230683 812484 812484 4069257 2075624 1993633 210095638 185601174 24494464 9557322 8243085 1314237 27301540 23578744 3722796 13744263 11927938 1816325 558314 558314 388315 388315 810702 810702 20849020 13527121 7321899 6380081 29794 6350287 4868738 1614906 3253832 7799902 3894239 3905663 10696192 9693313 1002879 1086410 596426 489984 1612957 774088 838869 4535826 337979 4197847 21948965 14063132 7885833 845003 566472 278531 Supplies 74732432 74598424 134008 Equipment Rent/Maint 12142649 10204338 1938311 Dues/Subscriptions 9601948 8134281 1467667 Bad Debts 9419948 9265263 154685 2771547 1678517 1093030 456629453 381775656 74853797 0 17432 15342 80772767 78649140 48985833 52251544 2968083 23012579 5813537 6090710 5826209 7723527 400493614 202835344 171774935 197658270 135677068 167759089 17958742 16325625 5368296 2596515 16303198 16149742 491466100 568232083 47700716 50443691 230863 166955 67651129 61503730 29948028 67485062 145530736 179599438 X 341994662 384361949 1450794 1773393 2489908 2497303 345935364 388632645 491466100 568232083 X 36674108 5182808 840365 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19502 19502 0 Part II-B, Line 1: AHA and WHA Dues 2637679 7394 56750 12788 2689035 2283113 319500 45890 10824 2637679 2446300 101050 -255551 8686 2283113 2417823 35966 7489 2446300 2372548 48841 3566 2417823 0.00000 0.92870 0.07130 1 1 1 8335294 8335294 181744773 59694760 122050013 2498584 1700296 798288 205680163 141440288 64239875 2234800 2234800 197658270 DEFERRED COMPENSATION 10394575 NONCONTROLLING INTEREST OF CONSOLIDATED AFFILIATE 1226635 CAPITAL LEASE OBLIGATIONS 48569106 INTEREST RATE SWAP VALUATION 7294746 67485062 490033243 5182808 -8697343 -3514535 493547778 -244217 -244217 493303561 447797039 1252575 1252575 446544464 10084989 10084989 456629453 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. 1 1 X 1 X 220.000000000000 1 X 1 1 0 1 1 3291740 3291740 0.00740 54428484 31127138 23301346 0.05210 57720224 31127138 26593086 0.05950 4473878 4473878 0.01000 4047284 4047284 0.00910 1179179 1179179 0.00260 9700341 9700341 0.02170 67420565 31127138 36293427 0.08120 694121 694121 0.00160 694121 694121 0.00160 1 3922497 135609092 193943141 -58334049 X 1 1 1 Bellin Orthopedic Surgery Center LLC orthopedic surgery center 0.55000 0.45000 1 1 Bellin Memorial Hospital 744 S Webster Ave Green Bay WI 54305 www.bellin.org 147 X X X Bellin Memorial Hospital 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X www.bellin.org/patients_visitors/company-information/community-health X 1 14 1 www.bellin.org/patients_visitors/company-information/community-health 0 1 X 220.000000000000 400.000000000000 X X X 1 1 X X X X X 1 X https://www.bellin.org/patients_visitors/patient-information/financial-assi X https://www.bellin.org/images/uploads/Community_Care_Instructions.pdf X https://www.bellin.org/images/uploads/Patient_Financial_Assistance.pdf X X X X X X 1 X 0 X X X X 1 X 0 0 Bellin Memorial Hospital Part 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 Hospital Part V, Section B, Line 6a: Aurora BayCare Medical Center (Green Bay) and St. Mary's and St. Vincent Hospitals (HSHS, Green Bay) Bellin Memorial Hospital Part 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 Hospital Part 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 Hospital Part 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 Hospital Part 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. 35 1 - The Cancer Team of Bellin Health 1580 Commanche Ave Green Bay WI 54313 Provider Clinic Site 2 - Cardiology Associates of Bellin Health 744 S Webster Ave Green Bay WI 54301 Hospital Based Site 3 - Family Medical Center Ashwaubenon 1630 Commanche Ave Green Bay WI 54313 Provider Clinic Site 4 - Bellin Health Cardiovascular & Thoracic 720 S Van Buren St Suite 303 Green Bay WI 54301 Provider Clinic Site 5 - Bellin Health Surgical Associates 720 S Van Buren St Suite 201 Green Bay WI 54301 Provider Clinic Site 6 - Gastroenterology Associates of Green Bay 725 S Webster Ave Green Bay WI 54301 Provider Clinic Site 7 - Family Medical Center De Pere East 555 Redbird Circle De Pere WI 54115 Provider Clinic Site 8 - Bellin Health Generations 704 S Webster Ave Suite 300 Green Bay WI 54301 Provider Clinic Site 9 - Family Medical Center Howard 2714 Riverview Green Bay WI 54313 Provider Clinic Site 10 - Family Medical Center Bellevue 3263 Eaton Rd Green Bay WI 543116830 Provider Clinic Site 11 - Family Medical Center De Pere West 1800 Lawrence Dr De Pere WI 54115 Provider Clinic Site 12 - Bellin Health Iron Mountain 440 Woodward Ave Iron Mountain MI 49801 Provider Clinic Site 13 - Neurology Consultants of Bellin Health 725 S Webster Ave Green Bay WI 54301 Provider Clinic Site 14 - Bellin Health Titletown Sports Medicine 1970 S Ridge Rd Green Bay WI 54304 Provider Clinic Site 15 - Bellin Health Escanaba 610 S Lincoln Road ESCANABA MI 49829 Provider Clinic Site 16 - Family Medical Center Green BAy 704 S Webster Ave Green Bay WI 54301 Provider Clinic Site 17 - Family Medical Center Kewaunee 575 - 4th Street Kewaunee WI 54216 Provider Clinic Site 18 - Family Medical Center Algoma 831 Parker Ave Algoma WI 54201 Provider Clinic Site 19 - Family Medical Center Brillion 964 W Ryan St Suite B Brillion WI 54110 Provider Clinic Site 20 - Bellin Health Oconto FAlls 107 E Highland Dr Oconto FAlls WI 54154 Provider Clinic Site 21 - Bellin Health Asthma & Allergy 519 S Monroe Avenue Green Bay WI 54301 Provider Clinic Site 22 - Family Medical Center Denmark 595 County Road R Denmark WI 54208 Provider Clinic Site 23 - Family Medical Center Seymour 405 Commercial St Seymour WI 54165 Provider Clinic Site 24 - Family Medical Center Wrightstown 555 Quality Ct Wrightstown WI 54180 Provider Clinic Site 25 - Family Medical Center Luxemburg 140 B School Creek Trail Luxemburg WI 54217 Provider Clinic Site 26 - Family Medical Center Manitowoc 3415 Custer St Suite D Manitowoc WI 54221 Provider Clinic Site 27 - Family Medical Center Pulaski 723 s wisconsin st Pulaski WI 541620109 Provider Clinic Site 28 - Bellin Health Asthma & Allergy - Neenah 119 E Bell St Suite B Neenah WI 54957 Provider Clinic Site 29 - BELLIN HEALTH FAST CARE ASHWAUBENON 301 BAY PARK SQUARE Green Bay WI 54304 Convenient Care Center 30 - BELLIN HEALTH FAST CARE EAST TOWNE MALL 2430 E MASON STREET Green Bay WI 54302 Convenient Care Center 31 - Family Medical Center Bonduel 401 W Mill St Bonduel WI 54107 Provider Clinic Site 32 - Bellin Health Endocrinology 720 S Van Buren St Suite 104 Green Bay WI 54301 Provider Clinic Site 33 - BELLIN HEALTH FAST CARE SUAMICO 2318 LINEVILLE ROAD SUAMICO WI 54173 Convenient Care Center 34 - Family Medical Center Suring 307 Manor Dr Suring WI 54174 Provider Clinic Site 35 - Family Medical Center Sturgeon Bay 311 N 3rd Ave Sturgeon Bay WI 54235 Provider Clinic Site 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 States WI 1 NEW Community Clinic 622 Bodart Street Green Bay WI 54301 391200636 501(c)3 100000 Support Free Community Health Clinic GREEN BAY PUBLIC SCHOOLS PO BOX 23387 Green Bay WI 543053387 396002329 GOVT - PUBLIC SCHOOL 63334 HEALTH & WELLNESS PROGRAM FESTIVAL FOODS TURKEY TROT 2250 W MASON ST GREEN BAY WI 54303 391814712 15000 TURKET TROT RUN FOR CHARITY DOWNTOWN GREEN BAY INC 130 E WALNUT ST STE 501 GREEN BAY WI 54301 391858389 501(c)3 17000 FARMERS MARKET ENCOMPASS EARLY EDUCATION & CARE 2589 S Webster Ave Green Bay WI 54301 390824004 501(c)3 7500 DONATION KIWANIS SKI CLUB PO BOX 475 IRON MOUNTAIN MI 49801 383254313 501(c)3 25000 DONATION UNIVERSITY OF WI - OSHKOSH 842 ALGOMA BLVD OSHKOSH WI 54901 391805963 GOVT- STATE AGENCY 60000 SUPPORT ORGANIZATION'S ACTIVITIES NORTHEAST WISCONSIN TECHNICAL COLLEGE 2740 W MASON ST GREEN BAY WI 54307 391087141 GOVT- STATE AGENCY 20000 HEALTH SCIENCE SIMULATION LAB AMERICAN FOUNDATION OF COUNSELING 130 E WALNUT ST 7TH FLOOR GREEN Bay WI 54301 391047205 501(c)3 5000 ETHICS IN BUSINESS AWARDS AND MORE PROGRAM FOR MENTAL WELLNESS/TREATMENT INDIGENT POPULATION GREATER GREEN BAY COMMUNITY FOUNDATION 310 W WALNUT ST SUITE 350 GREEN Bay WI 54303 391699966 501(c)3 76500 Green Bay Neighborhood leadership council, Achieve Brown County BROWN COUNTY UNITED WAY 112 N ADAMS ST STE 201 GREEN BAY WI 54301 390806299 501(c)3 65500 Donation AMERICAN HEART ASSOCIATION 2850 DAIRY DR STE 300 MADISON WI 53718 135613797 501(c)3 5000 DONATION BELLIN COLLEGE 3201 EATON RD GREEN Bay WI 54311 391620530 501(c)3 56237 BUILD OUT LAB & NURSING, MCW SPACE BOYS & GIRLS CLUB OF GREEN BAY 1400 LOMBARDI AVE STE 60 GREEn Bay WI 54304 396102943 501(c)3 5000 DONATION BRIAN LAVIOLETTE SCHOLARSHIP 1135 PLEASANT VALLEY DR ONEIDA WI 54155 391836591 501(c)3 5500 BELLIN COLLEGE SCHOLARSHIP CEREBRAL PALSY INC 2801 S WEBSTER AVE GReen Bay WI 54301 390901265 501(c)3 23000 CAPITAL CAMPAIGN - BUILDING EXPANSION CROHNS & COLITIS FOUNDATION 1126 S 70TH ST STE 112-1B MILWAUKEE WI 53214 136193105 501(c)3 5000 DONATION BROWN COUNTY MEDICAL SOCIETY ALLIANCE 563 CARTER CT STE B KIMBERLY WI 54136 391516026 501(c)3 5000 DOCTORS IN RECITAL SPONSORSHIP HOWARD SUAMICO SCHOOL DISTRICT 2706 LINEVILLE RD GReen Bay WI 543137151 396031599 GOVT - PUBLIC SCHOOL 50000 ATHLETIC PROGRAMS - FIELD SURFACE KEWAUNEE SCHOOL DISTRICT 915 THIRD ST KEWAUNEE WI 54216 391047904 GOVT - PUBLIC SCHOOL 60000 ATHLETIC PROGRAMS MARINETTE MENOMINEE AREA COMMUNITY FOUNDATION 1101 11TH AVE MENOMINEE WI 49858 383264725 501(c)3 5000 DONATION MYTEAM TRIUMPH 1406 S JACKSON ST GReen Bay WI 54301 262511957 501(c)3 10000 Progam support for people with diverse abilities to participate in endurance events ROTARY CLUB OF GREEN BAY 2360 DUCK CREEK PKWY GReen Bay WI 543033300 392000342 501(c)3 18167 Free Enterprise Award Program UNIVERSITY OF WI - GREEN BAY 2420 NICOLET DR GREEn Bay WI 54311 391805963 GOVT- STATE AGENCY 20000 Mark Reinke, MD Memorial Scholarship US VENTURE OPEN 425 BETTER WAY APPLETON WI 54915 391548450 501(c)3 25000 Donation - Charity Fund Raising Golf Event 25 0 Part I, Line 2: THE 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. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 FRED SCHMIDT MD BOARD MEMBER 619558 0 127053 0 617 0 0 0 17962 0 765190 0 0 0 WILLIAM WITTMAN MD Board Member/BMG physian 223057 0 118839 0 1211 0 9241 0 15145 0 367493 0 0 0 GEORGE KERWIN Bellin CEO/Board Member 547866 0 347300 0 5951 0 18394 0 17667 0 937178 0 0 0 CYNTHIA LASECKI MD BOARD MEMBER/FORMER PRESIDENT MEDICA 130516 0 195526 0 275 0 13946 0 2233 0 342496 0 0 0 SABINA SINGH MD BOARD MEMBER/PRESIDENT BELLIN MEDICA 155624 0 87183 0 275 0 10729 0 15657 0 269468 0 0 0 MARK RINGWELSKI MD BOARD MEMBER/PRESIDENT BELLIN SPECIA 280375 0 23029 0 789 0 8461 0 18323 0 330977 0 0 0 JAMES DIETSCHE CFO 332461 0 75000 0 275 0 10364 0 20986 0 439086 0 0 0 PETER KNOX - Termed EXECUTIVE VP 273195 0 34553 0 1211 0 15700 0 17666 0 342325 0 0 0 CHRISTINE WOLESKE EXECUTIVE VP 355055 0 75000 0 12293 0 18357 0 17738 0 478443 0 0 0 CHRISTOPHER WOLFRAM MD Physician 535389 0 450564 0 183 0 13969 0 19678 0 1019783 0 0 0 TIMOTHY TANKE MD Physician 532913 0 398608 0 789 0 16013 0 19182 0 967505 0 0 0 RICHARD TIMMONS MD PHYSICIAN 531630 0 333662 0 789 0 15753 0 21249 0 903083 0 0 0 Patrick McKenzie MD Physician 1196342 0 0 0 703 0 17522 0 0 0 1214567 0 0 0 James spears MD PHYSICIAN 746832 0 276976 0 789 0 11642 0 17036 0 1053275 0 0 0 Part I, Line 1a Bellin 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. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712dlh7 2015-04-09 44994006 REFUND AND LEGALLY DEFEASE 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2011-11-23 12944000 REFINANCING OF 2001 BONDS 0 0 0 A 1616311 44994006 528236 44465770 2009 0 1 1 1 B 1095000 12944000 79844 2001 1 0 1 1 A 0 1 1 1 0 0.01000 0.01000 1 0 1 B 0 1 1 1 0 0.01000 0.00000 0.01000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 1 0 0 0 0 1 A 1 B 1 Form 990, Part III, line 3 In fiscal year 2017, NorthReach Healthcare LLC, a disregarded entity was sold to a related organization. Form 990, Part VI, Section A, line 6 The organization has one corporate member, Bellin Health Systems, Inc. Form 990, Part VI, Section A, line 7a The corporate member, Bellin Health Systems, Inc. has the power to appoint board members. Form 990, Part VI, Section A, line 7b The corporate member, Bellin Health Systems, Inc., has the power to approve major expenditures and long-term borrowings. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed in detail by senior administration and is presented to the Executive Committee in its entirety for a review of the document. Form 990, Part VI, Section B, line 12c Each year a conflict of interest request document is provided to each board member. All documents are provided back to administration and reviewed. All employees are required to review the conflict of interest policy as part of annual mandatory education. 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 15 Compensation 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 19 THE 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-2C BELLIN 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. NORTHREACH HEALTHCARE LLC 3120 RIVERSIDE AVE GATE B BLDG 1 MARINETTE WI 54143 391999260 PRIMARY AND SPECIALTY PHYSICIAN CLINICS WI 1821289 0 BELLIN MEMORIAL HOSPITAL LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(c)(3) Line 12b, II Bellin Health Systems Inc 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING COLLEGE WI 501(c)(3) Line 2 Bellin Health Systems Inc 1 THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54305 391809171 FOUNDATION WI 501(c)(3) Line 7 Bellin Health Systems Inc 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PPSYCHIATRIC HOSPITAL WI 501(c)(3) Line 3 Bellin Health Systems Inc 1 OCONTO HOSPITAL & MEDICAL CENTER INC PO BOX 357 OCONTO WI 54153 061745397 HOSPITAL WI 501(c)(3) Line 3 BELLIN MEMORIAL HOSPITAL INC 1 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(c)(3) Line 12b, II N/A 0 UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HOSPICE, PALLIATIVE & BEREAVEMENT SERVICES WI 501(c)(3) Line 10 BELLIN MEMORIAL HOSPITAL INC 1 BELLIN ORTHOPEDIC SURGERY CENTER LLC 2223 LIME KILN RD GREEN BAY WI 54311 264677834 AMBULATORY ORTHOPEDIC SURGERY WI Bellin Memorial Hospital Inc RELATED 2497828 884171 0 0 0.55000 D1 SPORTS TRAINING OF GREEN BAY LLC SOUTH SPRINGS DRIVE FRANKLIN TN 37067 454848172 SPORTS TRAINING TN N/A BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 1 BELLIN INVESTMENTS INC PO BOX 23400 GREEN BAY WI 54305 391564939 OTHER WI N/A C 1 narayan amarnani md sc 725 s webster ave green BAY WI 54301 391325918 medical clinic WI BELLIN MEMORIAL HOSPITAL C 1.00000 1 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 OCONTO HOSPITAL & MEDICAL CENTER D 11783328 ACTUAL oCONTO HOSPITAL & MEDICAL CENTER Q 18180000 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER O 2553025 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER M 4014020 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER J 1360027 ACTUAL bellin college L 350281 ACTUAL Bellin college N 355593 AcTUAL Bellin Health Foundation C 956582 ActUAL Bellin Psychiatric Center L 1958010 ActUAL Bellin psychiatric Center D 2779352 ACTUAL bellin college Q 249203 aCTUAL bellin health Foundation Q 143418 aCTUAL bellin health Foundation O 344049 aCTUAL bellin health Foundation S 1100000 aCTUAL bellin college D 606068 acTUAL bellin psychiatric Center D 4519174 acTUAL narayan amarnani md sc D 4695904 aCTUAL ocONTO HOSPITAL & MEDICAL CENTER D 2080038 aCTUAL bellin health Foundation D 742894 aCTUAL bel-regional home medical inc D 3500223 aCTUAL ocONTO HOSPITAL & MEDICAL CENTER D 20000000 acTUAL Form 990, Schedule R, Part IV In 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.