DOOR COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- DOOR COUNTY MEMORIAL HOSPITAL (EIN 39-0806324)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-02
- IRS object ID
- 201801229349300320
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-02T16:35:28-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wipfli LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 12237 | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806324 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Door County Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DOOR | BusinessNameControlTxt |
| Phone | 9207435566 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 South 18th Avenue | AddressLine1Txt |
| City | Sturgeon Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GERALD WORRICK | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 9207435566 | PhoneNum |
| Signature | 2018-04-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Terri Rexrode CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2018-03-29 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 74.87.127.216 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-04-06 | IPDt |
| IP Tm | 10:24:55 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GERALD WORRICK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 South 18th Avenue | AddressLine1Txt |
| City | Sturgeon Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $184,774,510 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.dcmedical.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1944 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | To improve the health and well-being of all people in the communities we serve. | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 746 | TotalEmployeeCnt |
| Total Volunteers | 129 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $882,164 | PYContributionsGrantsAmt |
| CY Contributions Grants | $651,518 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $78,975,945 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $84,540,228 | CYProgramServiceRevenueAmt |
| PY Investment Income | $325,699 | PYInvestmentIncomeAmt |
| CY Investment Income | $528,203 | CYInvestmentIncomeAmt |
| PY Other Revenue | $552,339 | PYOtherRevenueAmt |
| CY Other Revenue | $121,937 | CYOtherRevenueAmt |
| PY Total Revenue | $80,736,147 | PYTotalRevenueAmt |
| CY Total Revenue | $85,841,886 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $601,850 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $47,060,985 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $53,221,076 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,710,781 | PYOtherExpensesAmt |
| CY Other Expenses | $30,603,219 | CYOtherExpensesAmt |
| PY Total Expenses | $75,373,616 | PYTotalExpensesAmt |
| CY Total Expenses | $83,824,295 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,362,531 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,017,591 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $94,049,534 | TotalAssetsBOYAmt |
| Total Assets EOY | $102,562,760 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,360,510 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,875,765 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $77,689,024 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $86,686,995 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Our mission as a health care system is to further the healing ministry of Jesus Christ by improving the health and well-being of our community, especially the poor. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $71,379,489 | ExpenseAmt |
| Revenue | $84,279,940 | RevenueAmt |
| Desc | Door County Memorial Hospital ("The Hospital") is a fully accredited, acute-care hospital and outpatient medical center, with 25 licensed beds. The Hospital offers a full range of services and specialties, including home health, a skilled nursing facility for long-term care and rehabilitation services, a rehab services department and North Shore Medical Clinic. During fiscal 2017, the Hospital counted 4,444 inpatient days, including swing bed. The hospital's outpatient facilities, which include its rehabilitation agency, 30 bed extended care facility, emergency room, North Shore Medical Clinic served 148,055 visits, and the North Shore Medical Clinic, including its urgent care facility served 62,642 visits. See Schedule H for further details regarding the community benefits Door County Memorial Hospital provides. | Desc |
| Total Program Service Expenses | $71,379,489 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 119 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 746 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ADAM GINGERY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207435566 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 South 18th Avenue | AddressLine1Txt |
| City | Sturgeon Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| PATRICK O'HERN | ||||||||
| CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BARTH GUILETTE | ||||||||
| VICE CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WILLIAM MUNDY | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CATHY WIESE | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GERALD WORRICK | ||||||||
| CEO/BOARD MEMBER | 41.00 | 1.00 | Yes (X) | Yes (X) | $73,650 | $277,808 | $24,999 | |
| ANDRZEJ KUREK MD | ||||||||
| MEDICAL STAFF PRES/BOARD MEMBER | 41.00 | 1.00 | Yes (X) | Yes (X) | $424,873 | $0 | $43,406 | |
| BRIAN MATYSIAK MD | ||||||||
| MEDICAL STAFF PRES ELECT/ BOARD MEMBER | 41.00 | 1.00 | Yes (X) | Yes (X) | $447,985 | $0 | $49,117 | |
| JOSEPH MCMAHON | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CORWIN DAHL | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIC PAULSEN | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFF RABAS | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KELTON REITZ MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | 1.00 | Yes (X) | $406,844 | $0 | $43,113 | ||
| GRACE ROSSMAN | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID WARD | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD HOGAN MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 41.00 | 1.00 | Yes (X) | $461,182 | $0 | $47,848 | ||
| JAMES SARKIS | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SCOTT WEDERQUIST | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THERESE PANDL | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GREG SIMIA | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SALLY PFEIFER | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN STEPHENS | ||||||||
| CHIEF ADMINISTRATIVE OFFICER | 40.00 | Yes (X) | $148,417 | $0 | $35,710 | |||
| ADAM GINGERY | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $108,162 | $0 | $32,469 | |||
| DANIEL TOMASZEWSKI MD | ||||||||
| PHYSICIAN | 40.00 | $964,597 | $0 | $49,871 | Yes (X) | |||
| STEVEN DAVIS MD | ||||||||
| PHYSICIAN | 40.00 | $519,137 | $0 | $61,345 | Yes (X) | |||
| MICHAEL BRUNO MD | ||||||||
| PHYSICIAN | 40.00 | $490,828 | $0 | $54,720 | Yes (X) | |||
| MARC BINARD MD | ||||||||
| PHYSICIAN | 40.00 | $475,351 | $0 | $44,091 | Yes (X) | |||
| SHAUN MELARVIE MD | ||||||||
| PHYSICIAN | 40.00 | $441,331 | $0 | $56,426 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,962,357 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $277,808 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $543,115 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 50 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INFINITY HEALTHCARE INC | |||||
| 111 E WISCONSIN AVE SUITE 2000 | MILWAUKEE | WI | 54302 | ER PHYSICIANS | $2,904,367 |
| MEDICAL STAFFING SOLUTIONS INC | |||||
| PO BOX 101 | RICE LAKE | WI | 54868 | AGENCY STAFFING | $712,602 |
| NAVIN HAFFTY & ASSOCIATES LLC | |||||
| 200 CORDWAINDER DRIVE SUITE 100 | NORWELL | MA | 02061 | SOFTWARE CONSULTING | $706,013 |
| NORTHERN XRAY CO INC | |||||
| 2118 4TH AVENUE SOUTH | MINNEAPOLIS | MN | 55404 | RADIOLOGY EQUIPMENT SERVICE | $576,067 |
| NEWPOINT HEALTHCARE ADVISORS LLC | |||||
| 200 QUEVEC STREET SUITE 300-111 | DENVER | CO | 80230 | PROFESSIONAL CONSULTING SERVICES | $236,173 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $250,000 | RelatedOrganizationsAmt |
| Government Grants | $135,000 | GovernmentGrantsAmt |
| All Other Contributions | $266,518 | AllOtherContributionsAmt |
| Total Contributions | $651,518 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient service revenue | 622110 | $82,971,497 | $82,971,497 |
| medicare and medicaid stimulus ot | 909999 | $354,751 | $354,751 |
| occupational health and wellness | 909999 | $330,773 | $330,773 |
| miscellaneous revenues | 909999 | $318,234 | $318,234 |
| therapy other revenues | 909999 | $304,685 | $304,685 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $260,288 | TotalRevenueColumnAmt |
| Exclusion | $260,288 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $84,540,228 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $538,421 | TotalRevenueColumnAmt |
| Exclusion | $538,421 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $319,036 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $197,099 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $121,937 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $121,937 | TotalRevenueColumnAmt |
| Exclusion | $121,937 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $98,725,307 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $98,735,525 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$10,218 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$10,218 | TotalRevenueColumnAmt |
| Exclusion | -$10,218 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,841,886 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $84,279,940 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $910,428 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,625,584 | TotalAmt |
| Program Services | $1,924,368 | ProgramServicesAmt |
| Management And General | $701,216 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,129,988 | TotalAmt |
| Program Services | $34,499,626 | ProgramServicesAmt |
| Management And General | $3,630,362 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,812,051 | TotalAmt |
| Program Services | $1,633,395 | ProgramServicesAmt |
| Management And General | $178,656 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,695,413 | TotalAmt |
| Program Services | $7,838,082 | ProgramServicesAmt |
| Management And General | $857,331 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,958,040 | TotalAmt |
| Program Services | $1,753,021 | ProgramServicesAmt |
| Management And General | $205,019 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $419,976 | TotalAmt |
| Management And General | $419,976 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,483 | TotalAmt |
| Management And General | $97,483 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,377,962 | TotalAmt |
| Program Services | $5,502,073 | ProgramServicesAmt |
| Management And General | $1,875,889 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,015,550 | TotalAmt |
| Program Services | $8,772,054 | ProgramServicesAmt |
| Management And General | $2,243,496 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,697,629 | TotalAmt |
| Program Services | $1,573,160 | ProgramServicesAmt |
| Management And General | $124,469 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,143,895 | TotalAmt |
| Program Services | $1,066,183 | ProgramServicesAmt |
| Management And General | $77,712 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $723,747 | TotalAmt |
| Program Services | $540,027 | ProgramServicesAmt |
| Management And General | $183,720 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $225,227 | TotalAmt |
| Management And General | $225,227 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,587,113 | TotalAmt |
| Program Services | $2,444,979 | ProgramServicesAmt |
| Management And General | $1,142,134 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $634,400 | TotalAmt |
| Program Services | $247,173 | ProgramServicesAmt |
| Management And General | $387,227 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $3,096,014 | $3,096,014 | |
| DUES AND SUBSCRIPTIONS | $191,611 | $96,722 | $94,889 |
| EQUIPMENT RENTAL | $135,184 | $135,184 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,428 | TotalAmt |
| Program Services | $257,428 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,824,295 | TotalAmt |
| Program Services | $71,379,489 | ProgramServicesAmt |
| Management And General | $12,444,806 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,278 | BOYAmt |
| EOY | $3,228 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,822,979 | BOYAmt |
| EOY | $7,897,748 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,558 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,452,383 | BOYAmt |
| EOY | $15,289,281 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,490 | BOYAmt |
| EOY | $192,222 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,161 | BOYAmt |
| EOY | $367,623 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $916,418 | BOYAmt |
| EOY | $1,244,241 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,026,877 | BOYAmt |
| EOY | $859,037 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $45,585,897 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,777,878 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,883,767 | BOYAmt |
| EOY | $29,808,019 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $44,096,909 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $725,282 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,831,341 | BOYAmt |
| EOY | $2,804,452 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,049,534 | BOYAmt |
| EOY | $102,562,760 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,853,398 | BOYAmt |
| EOY | $6,629,838 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,111,969 | BOYAmt |
| EOY | $7,687,258 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,504,651 | BOYAmt |
| EOY | $1,050,178 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $890,492 | BOYAmt |
| EOY | $508,491 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,360,510 | BOYAmt |
| EOY | $15,875,765 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,210,429 | BOYAmt |
| EOY | $85,236,119 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $478,595 | BOYAmt |
| EOY | $1,450,876 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,689,024 | BOYAmt |
| EOY | $86,686,995 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,049,534 | BOYAmt |
| EOY | $102,562,760 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,017,591 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $708,879 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $1,564,655 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $4,706,846 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,292 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,292 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specifically allocable to lobbying. Door County Memorial Hospital does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,203,539 | OtherCostOrOtherBasisAmt |
| Book Value | $4,203,539 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,211,595 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,733,208 | DepreciationAmt |
| Book Value | $10,478,387 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,168,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,044,670 | DepreciationAmt |
| Book Value | $14,124,138 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,001,955 | OtherCostOrOtherBasisAmt |
| Book Value | $1,001,955 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $29,808,019 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD-PARTY REIMBURSEMENT PROGRAMS | Desc |
| Amt | $508,491 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $508,491 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $83,651,850 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $708,879 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$3,096,014 | OtherRevenueAmt |
| Revenue Not Reported | -$2,387,135 | RevenueNotReportedAmt |
| Revenue Subtotal | $86,038,985 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$197,099 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$197,099 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $85,841,886 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $80,925,380 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $197,099 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $197,099 | ExpensesNotReportedAmt |
| Expenses Subtotal | $80,728,281 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,096,014 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,096,014 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $83,824,295 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d - Other Adjustments: | BAD DEBT EXPENSE -3,096,014. |
| Part XI, Line 4b - Other Adjustments: | RENTAL EXPENSES -197,099. |
| Part XII, Line 2d - Other Adjustments: | RENTAL EXPENSES 197,099. |
| Part XII, Line 4b - Other Adjustments: | BAD DEBT EXPENSE 3,096,014. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $662,127 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $662,127 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00820 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,262,593 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,615,989 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,646,604 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05760 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,924,720 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,615,989 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,308,731 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06580 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Persons Served | 876 | PersonsServedCnt |
| Total Community Benefit Expns | $1,586,099 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $282,176 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,303,923 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01620 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 241 | PersonsServedCnt |
| Total Community Benefit Expns | $130,968 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $130,968 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 4889 | PersonsServedCnt |
| Total Community Benefit Expns | $1,455,764 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $378,708 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,077,056 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01330 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 1063 | PersonsServedCnt |
| Total Community Benefit Expns | $417,088 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $417,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 35 | ActivitiesOrProgramsCnt |
| Persons Served | 7069 | PersonsServedCnt |
| Total Community Benefit Expns | $3,589,919 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $660,884 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,929,035 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 35 | ActivitiesOrProgramsCnt |
| Persons Served | 7069 | PersonsServedCnt |
| Total Community Benefit Expns | $11,514,639 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,276,873 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,237,766 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10210 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $872 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $872 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $852 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $852 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $14,300 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $14,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 181 | PersonsServedCnt |
| Total Community Benefit Expns | $35,390 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,390 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $3,128 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,128 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $57,806 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $57,806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 181 | PersonsServedCnt |
| Total Community Benefit Expns | $112,348 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $112,348 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $3,096,014 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $25,374,682 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $25,794,563 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$419,881 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1Txt |
| City | STURGEON BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54235 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DCMEDICAL.ORG | WebsiteAddressTxt |
| State License | 1054 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORITAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.DCMEDICAL.ORG/HOSPITAL-INFORMATION/ABOUT/COMMUNITY-HEALTH-NEEDS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.DCMEDICAL.ORG/HOSPITAL-INFORMATION/ABOUT/COMMUNITY-HEALTH-NEEDS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.dcmedical.org/Patients-Guests/Patient-Financial-Services/Financi | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.dcmedical.org/Patients-Guests/Patient-Financial-Services/Financi | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.dcmedical.org/Patients-Guests/Patient-Financial-Services/Financi | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DOOR COUNTY MEMORITAL HOSPITAL | Part V, Section B, Line 5: THE CHNA PROCESS LISTED BELOW HAPPENS EVERY THREE YEARS. DOOR COUNTY MEDICAL CENTER'S CHNA PROCESS SOUGHT INPUT FROM COMMUNITY MEMBERS, INCLUDING MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND FROM ORGANIZATIONS THAT SERVE THOSE POPULATIONS. IN JANUARY 2016, A COMMUNITY STAKEHOLDER MEETING WAS HELD. DOOR COUNTY MEDICAL CENTER INTENTIONALLY INVITED ORGANIZATIONS THAT REPRESENT MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE STAKEHOLDER MEETING ATTENDEES PARTICIPATED IN A FACILITATED DISCUSSION ABOUT THE COMMUNITY HEALTH DATA, PROGRESS ON THE PREVIOUS PRIORITY AREAS, AND ANY EMERGING NEEDS. THE LIST OF ORGANIZATIONS PARTICIPATING IN THE JANUARY 2016 STAKEHOLDER MEETING IS BELOW. DOOR COUNTY DEPARTMENT OF PUBLIC HEALTH STAFF* MINISTRY DOOR COUNTY MEDICAL CENTER UNITED WAY OF DOOR COUNTY* DOOR COUNTY PUBLIC LIBRARY MINISTRY DENTAL CLINIC* UW-EXTENSION, DOOR COUNTY UW-GREEN BAY DOOR COUNTY PUBLIC SCHOOLS* BOYS AND GIRLS CLUB OF DOOR COUNTY* DOOR COUNTY YMCA SENIOR RESOURCE CENTER* MINISTRY HOME CARE STURGEON BAY FIRE DEPARTMENT NORTHEAST WISCONSIN TECHNICAL COLLEGE (NWTC) DOOR COUNTY BOARD OF HEALTH BELLIN COLLEGE GOOD SAMARITAN- SCANDIA VILLAGE LAKESHORE CAP FOOD PANTRY* DOOR COUNTY SHERIFF'S DEPARTMENT**DENOTES ORGANIZATIONS OR PROGRAMS |
| DOOR COUNTY MEMORITAL HOSPITAL | Part V, Section B, Line 6b: DOOR COUNTY PUBLIC HEALTH DEPARTMENT |
| DOOR COUNTY MEMORITAL HOSPITAL | Part V, Section B, Line 11: USING THE CHNA COMPLETED IN JANUARY 2016, THE HOSPITAL DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A THREE-YEAR IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. IN FISCAL YEAR 2016 (TAX YEAR 2015), THE HOSPITAL IMPLEMENTED THE FOLLOWING PLAN TO ADDRESS THE PRIORITY NEEDS:1. FOOD, NUTRITION AND EXERCISE: CREATE AWARENESS AROUND THE IMPORTANCE OF ADEQUATE, APPROPRIATE AND SAFE FOOD AND. ENCOURAGED RESTAURANTS' USE OF VISUAL INDICATORS OF HEALTHY OPTIONS. SUPPORTED IN-SCHOOL SAMPLING OF FRUITS AND VEGETABLES.2. MENTAL HEALTH AND WELL-BEING: CREATE AWARENESS OF AND ACCESS TO MENTAL HEALTH SERVICES IN THE COMMUNITY. PARTICIPATED IN THE DOOR COUNTY MENTAL HEALTH FOCUS GROUP COMMITTEE. REVISED AND REDISTRIBUTED THE MENTAL HEALTH RESOURCE GUIDE TO AREA RESIDENTS. ELECTRONIC VERSIONS WERE MADE AVAILABLE TO PUBLIC ON PUBLIC WEBSITES. INCREASED THE NUMBER OF MENTAL HEALTH AWARENESS EVENTS.3. ORAL HEALTH: INCREASE ACCESS TO ORAL HEALTH CARE OR PREVENTION FOR DOOR COUNTY RESIDENTS AND INCREASE AWARENESS OF, OR EDUCATION ABOUT, ORAL HEALTH ISSUES IN DOOR COUNTY. CONDUCTED FLUORIDE VARNISH CLINICS FOR CHILDREN. INITIATED A PROGRAM TO PROVIDE DENTAL CARE TO UNDERSERVED ADULTS IN THE COMMUNITY. PROVIDED ORAL HEALTH EDUCATIONAL PRESENTATIONS.USING THE CHNA COMPLETED IN JANUARY 2016, THE HOSPITAL DEVELOPED AND ADOPTED FY17-FY19 (TAX YEARS 2016-2018) IMPLEMENTATION STRATEGY. THE FOLLOWING SUMMARIZES THE STRATEGIES THE HOSPITAL WILL IMPLEMENT DURING THAT TIME PERIOD TO ADDRESS THE PRIORITY NEEDS.MENTAL HEALTH INCREASE MENTAL HEALTH AWARENESS AND EDUCATION BY CONDUCTING AT LEAST TWO ANNUAL MENTAL HEALTH AWARENESS EVENTS/ACTIVITIES/EDUCATIONAL SESSIONS. INCREASE ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES THROUGH PRIMARY CARE SCREENING AND REFERRAL. CREATE AND DISTRIBUTE A MENTAL HEALTH RESOURCE GUIDE. PROMOTE LOCAL QPR (QUESTION, PERSUADE, REFER) TRAINING. QPR IS A RESEARCH-BASED SUICIDE PREVENTION PROGRAM THAT TRAINS LAY PEOPLE ON HOW TO RECOGNIZE THE WARNING SIGNS OF A SUICIDE CRISIS AND HOW TO QUESTION, PERSUADE AND REFER SOMEONE FOR HELP.ORAL HEALTH INCREASE ACCESS TO DENTAL CARE THROUGH THE DOOR COUNTY DENTAL CLINIC BY CONTINUING TO PROVIDE A FULL RANGE OF DENTAL SERVICES FOR LOW-INCOME RESIDENTS WHO HAVE LIMITED ABILITY TO PURCHASE DENTAL CARE SERVICES. ASSESS OPPORTUNITIES FOR INCREASED ORAL HEALTH-RELATED PROGRAMMING IN SCHOOLS. INCREASE AWARENESS OF ORAL HEALTH ISSUES THROUGH PUBLIC SERVICE ANNOUNCEMENTS. ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION INCORPORATE VISUAL INDICATORS OF HEALTHY FOOD AT LOCAL EATING ESTABLISHMENTS. INCREASE HEALTHY NUTRITIONAL CHOICES IN SCHOOLS. INCREASE ACCESS TO FRESH PRODUCE AND WHOLE FOODS FOR LOW-INCOME INDIVIDUALS BY SPONSORING A VOUCHER PROGRAM AT THE LOCAL FARMER'S MARKET, ENABLING FOODSHARE RECIPIENTS TO DOUBLE EACH FOODSHARE DOLLAR.HEALTHY GROWTH & DEVELOPMENT CONDUCT RESEARCH TO IDENTIFY KEY ISSUES IN THE EARLY CHILDHOOD POPULATION AND TOP FAMILY NEEDS, AND THEN DEVELOP AN ACTION PLAN. PROVIDE PARENTING INFORMATION AND SUPPORT. THE DESCRIPTION BELOW INCLUDES THE NEEDS NOT BEING ADDRESSED AS WELL AS THE REASON WHY THE NEEDS ARE NOT BEING ADDRESSED.IN ADDITION TO THE FOUR HEALTH ISSUES SELECTED AS TOP PRIORITIES, STAKEHOLDERS IDENTIFIED TWO OTHER SIGNIFICANT HEALTH ISSUES IN DOOR COUNTY. THESE ISSUES WILL BE ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY. WHILE THESE ISSUES WILL NOT BE ADDRESSED BY DOOR COUNTY MEDICAL CENTER AS PRIORITY HEALTH NEEDS, WE WILL PROVIDE SUPPORT TO THOSE COMMUNITY EFFORTS WHENEVER POSSIBLE.ALCOHOL AND DRUG USE: THE STAKEHOLDERS IDENTIFIED ALCOHOL MISUSE AND DRUG USE, PARTICULARLY HEROIN AND OTHER OPIATES, AS EMERGING ISSUES IN THE COMMUNITY. WISCONSIN HAS SEEN A 260 PERCENT INCREASE IN OPIATE OVERDOSE DEATH AMONG 12-24 YEAR OLDS IN THE PAST DECADE, WITH PRESCRIPTION OPIOIDS PLAYING A ROLE IN MORE DEATHS THAN HEROIN AND COCAINE COMBINED. MINISTRY WILL ENGAGE IN INCREASED EDUCATIONAL EFFORTS AROUND THIS ISSUE. THE DOOR COUNTY AODA COALITION, OF WHICH MINISTRY IS A PART, AND LOCAL LAW ENFORCEMENT DEPARTMENTS WILL BE ADDRESSING THESE ISSUES.CHRONIC DISEASE PREVENTION: STAKEHOLDERS IDENTIFIED CHRONIC PREVENTABLE DISEASE AS ANOTHER HEALTH ISSUE, IN PARTICULAR HEART HEALTH, OBESITY AND DIABETES. BECAUSE DIET PLAYS A SIGNIFICANT ROLE IN THESE CONDITIONS, THIS HEALTH ISSUE IS BEING ADDRESSED THROUGH THE PRIORITY NEED OF ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION. IN ADDITION, MDCMC'S CONTINUED SUPPORT OF SILENT SPORTING EVENTS, ATHLETIC EVENTS, THE DOOR COUNTY YMCA, YOUTH SPORTS, OUTDOOR ACTIVITIES, NATURE PRESERVES AND OTHER OUTDOOR RESOURCES PROVIDES INCREASED OPPORTUNITIES FOR EXERCISE, WHICH CONTRIBUTES TO ADDRESSING THIS NEED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - NORTH SHORE MEDICAL CLINIC | ||||
| 323 SOUTH 18TH AVENUE | STURGEON BAY | WI | 54235 | OP PHYSICIAN CLINIC |
| 2 - NORTH SHORE MEDICAL CLINIC | ||||
| 3711 HIGHWAY 42 | FISH CREEK | WI | 54212 | OP PHYSICIAN CLINIC |
| 3 - Door county Medical Center SNF | ||||
| 323 S 18th Avenue | stuRGEON BAY | WI | 54235 | Skilled Nursing Facility |
| 4 - Door County Medical Center Dental Clinic | ||||
| 228 S 18th Avenue | stuRGEON BAY | WI | 54235 | Dental Clinic |
| 5 - NORTH SHORE MEDICAL CLINIC | ||||
| 815 JEFFERSON STREET | ALGOMA | WI | 54201 | OP PHYSICIAN CLINIC |
| 6 - NORTH SHORE MEDICAL CLINIC | ||||
| 910 MAIN ROAD | WASHINGTON ISLAND | WI | 54201 | OP PHYSICIAN CLINIC |
| 7 - NORTH SHORE MEDICAL CLINIC | ||||
| 2073 COUNTY ROAD DK | BRUSSELS | WI | 54204 | OP PHYSICIAN CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The costing methodology used to calculate the amounts for Schedule H, Line 7, is a combination of average costs and actual costs pertaining to supplies, wages, and benefits. The actual cost of supplies used for each event is applied. If no actual cost is available, we then use an estimate. Wages are calculated by multiplying the average wage rate times actual hours worked. The benefit rate used includes a ratio of all benefits related to the wage calculation. No cost to charge ratio is used. |
| Part I, Ln 7 Col(f): | The bad debt expense included on form 990 (Part IX, Line 25, Column A) but subtracted for purposes of calculating the percentage in this column is $3,096,014. |
| Part II, Community Building Activities: | DOOR COUNTY MEDICAL CENTER PARTICIPATES IN COMMUNITY COALITIONS AND OTHER COLLABORATIVE EFFORTS WITH THE COMMUNITY WHOSE PURPOSE IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE INCLUDE HABITAT FOR HUMANITY, WISCONSIN COMMUNITY HEALTH PROGRAM, SOUTHERN DOOR AUDITORIUM COMMITTEE, DOOR COUNTY ELDER AND ADULT-AT-RISK INTERDISCIPLINARY TEAM, DOOR COUNTY COMMUNITY PARTNERSHIP FOR CHILDREN AND FAMILIES, MENTAL HEALTH FOCUS GROUP ANDDOOR COUNTY UNITED WAY. BY WORKING TOGETHER WITH OTHER ORGANIZATIONS IN THE COMMUNITY, WE EXPECT TO HAVE A GREATER IMPACT ON HEALTH. ACCORDING TO THE COUNTY HEALTH RANKINGS SITE, WITH A SHARED VISION AND COMMITMENT TO IMPROVED HEALTH, WORKING TOGETHER CAN YIELD BETTER RESULTS THAN WORKING ALONE. LEADERSHIP FROM DOOR COUNTY MEDICAL CENTER ALSO ATTEND LEADERSHIP DOOR COUNTY. FUTURE COMMUNITY LEADERS WHO ARE KNOWLEDGEABLE ABOUT BOTH THE ASSETS AND CHALLENGES OUR COMMUNITY HAS WILL HELP US TO POSITIVELY ADDRESS THE HEALTH ISSUES OF THE FUTURE. THE MEDICAL CENTER ALSO IS A COMMUNITY SHARPS DISPOSAL SITE. BY SAFELY REMOVING SHARPS FROM THE ENVIRONMENT, WE MAKE THE COMMUNITY SAFER IN TERMS OF INJURY AND INFECTION. IN ADDITION, DOOR COUNTY MEDICAL CENTER PROVIDES JOB SHADOWING FOR AREA YOUTH. ACCORDING TO THE COUNTY HEALTH RANKINGS, EMPLOYMENT PROVIDES INCOME AND, OFTEN, BENEFITS THAT CAN SUPPORT HEALTHY LIFESTYLE CHOICES. UNEMPLOYMENT AND UNDER EMPLOYMENT LIMIT THESE CHOICES, AND NEGATIVELY AFFECT BOTH QUALITY OF LIFE AND HEALTH OVERALL. |
| Part III, Line 2: | ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. ATTEMPTS TO RESOLVE THESE OUTSTANDING BALANCES CAN INCLUDE, BUT ARE NOT LIMITED TO STATEMENTS BEING SENT, PHONE CALLS AND LETTERS BEING SENT. ACCOUNT FOLLOW UP PROTOCOL IS BASED ON PERSONAL PAY BALANCE SIZE OWED. |
| Part III, Line 3: | DOOR COUNTY MEMORIAL HOSPITAL HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. |
| Part III, Line 4: | Patient payments or discounts are applied prior to determining bad debt expense and are not included in the bad debt write-off reported on the audited financial statements. Deductibles and coinsurance amounts that are deemed uncollectible are written off either to bad debt expense or, if applicable, to charity care if the patient so qualifies for financial assistance. The financial statements do not contain a footnote but they account for bad debts based on gross charges to patients after reflecting any payments or discounts, or amounts determined to be eligible for charity care/financial assistance. |
| Part III, Line 8: | Hospitals must accept Medicare patients regardless of whether they make a surplus or deficit from providing services to those patients. The costing methodology used to determine the Medicare allowable costs reported in the organizations Medicare cost report is step down. |
| Part III, Line 9b: | DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS MADE AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICES SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS. |
| Part VI, Line 2: | THE ORGANIZATION PERFORMS COMMUNITY NEEDS ASSESSMENTS AS NEEDED. PLANNING WORKGROUPS CONSISTING OF COMMUNITY PARTNERS ARE FORMED TO DEFINE THE COMMUNITY AND ITS NEEDS THROUGH REVIEW OF HEALTHY PEOPLE INITIATIVES, CENSUS DOCUMENTS, AND LOCAL GOVERNMENT HEALTH AND WELFARE AGENCIES. CONSIDERING OTHER COMMUNITY RESOURCES/ASSETS, DATA COLLECTION METHODS ARE USED TO IDENTIFY PARTICULAR PROBLEMS OR SUBGROUPS AND AREAS KNOWN TO HAVE HIGH POVERTY RATES AND TO BE UNDERSERVED. THE DATA IS ANALYZED AND PRIORITIES ARE SET BASED ON TRENDING INFORMATION WHICH MAY TARGET A SPECIFIC NEED. WHEN A NEED IS IDENTIFIED, THE HOSPITAL DEVELOPS A PLAN TO IMPLEMENT A PROGRAM EITHER THROUGH COMMUNITY COLLABORATION OR INDIVIDUALLY. OUTCOMES FROM THE PROGRAMS ARE MEASURED AND CONSIDERED IN SUBSEQUENT COMMUNITY NEEDS ASSESSMENTS. COMMUNITY BENEFIT PLANS ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE INCORPORATED INTO THE ORGANIZATION'S STRATEGY AND POLICY DEVELOPMENT. FOR EXAMPLE, SENIOR LEADERS ARE REQUIRED TO PROVIDE DIRECT SERVICE HOURS TO THE POOR AS PART OF THEIR PERFORMANCE GOALS. 3. In addition to the CHNA results, the community benefit report includes time for Patient Transportation Service, Cleaning of Neighbor to Neighbor equipment, Door County School to work program, time spent on non-profit committees. |
| Part VI, Line 3: | THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE CHARITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE. PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASSISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. |
| Part VI, Line 4: | WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THIS IS A WORK IN PROGRESS. DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") PROVIDED SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT, WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. THE CITY OF STURGEON BAY IS LOCATED IN DOOR COUNTY. THE POPULATION OF DOOR COUNTY, AS OF THE 2015 CENSUS DATA, IS 24,038. THE POPULATION CONSISTED OF 97% WHITE, 2% HISPANIC, 1% AFRICAN AMERICAN, AND 1% ASIAN. OF THE 24,038 POPULATION, 51% WERE FEMALE AND 49% MALE. THE AGE POPULATION IS WIDELY SPREAD. 17% WERE UNDER 18 AND 24% WERE 65+. THE LARGEST INDUSTRY IN DOOR COUNTY IS EDUCATIONAL, HEALTH AND SOCIAL SERVICES (18.8%). ARTS, ENTERTAINMENT AND RECREATION (16.1%) AND MANUFACTURING (14.0%) ARE THE NEXT LARGEST INDUSTRIES IN DOOR COUNTY. ROUGHLY 6.2% OF FAMILIES AND 11.4% OF THE POPULATION WERE BELOW THE POVERTY LINE. THAT INCLUDES 20.7% OF THOSE UNDER 18 YEARS OLD AND 7.9% OF THOSE 65 AND OLDER. |
| Part VI, Line 5: | THE LOCAL BOARD FOR DOOR COUNTY MEMORIAL HOSPITAL IS MADE UP OF COMMUNITY MEMBERS THAT LIVE IN OUR PRIMARY SERVICE AREA. DOOR COUNTY MEMORIAL HOSPITAL PARTNERS WITH THE LOCAL YMCA ON VARIOUS EVENTS PROMOTING HEALTH AND WELL-BEING IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, AND OTHER GOVERNMENT SPONSORED PROGRAMS. |
| Part VI, Line 6: | N/A |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GERALD WORRICK | ||||||||||||||
| CEO/BOARD MEMBER | $58,793 | $224,592 | $0 | $53,216 | $14,857 | $0 | $4,029 | $16,814 | $4,156 | $0 | $81,835 | $294,622 | $0 | $0 |
| ANDRZEJ KUREK MD | ||||||||||||||
| MEDICAL STAFF PRES/BOARD MEMBER | $195,704 | $0 | $227,604 | $0 | $1,565 | $0 | $15,900 | $0 | $27,506 | $0 | $468,279 | $0 | $0 | $0 |
| BRIAN MATYSIAK MD | ||||||||||||||
| MEDICAL STAFF PRES ELECT/ BOARD MEMB | $407,430 | $0 | $0 | $0 | $40,555 | $0 | $15,900 | $0 | $33,217 | $0 | $497,102 | $0 | $0 | $0 |
| KELTON REITZ MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $310,792 | $0 | $94,400 | $0 | $1,652 | $0 | $15,900 | $0 | $27,213 | $0 | $449,957 | $0 | $0 | $0 |
| RICHARD HOGAN MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $426,998 | $0 | $23,924 | $0 | $10,260 | $0 | $15,900 | $0 | $31,948 | $0 | $509,030 | $0 | $0 | $0 |
| BRIAN STEPHENS | ||||||||||||||
| CHIEF ADMINISTRATIVE OFFICER | $147,836 | $0 | $0 | $0 | $581 | $0 | $9,102 | $0 | $26,608 | $0 | $184,127 | $0 | $0 | $0 |
| DANIEL TOMASZEWSKI MD | ||||||||||||||
| PHYSICIAN | $847,070 | $0 | $61,094 | $0 | $56,433 | $0 | $15,900 | $0 | $33,971 | $0 | $1,014,468 | $0 | $0 | $0 |
| STEVEN DAVIS MD | ||||||||||||||
| PHYSICIAN | $516,434 | $0 | $0 | $0 | $2,703 | $0 | $15,900 | $0 | $45,445 | $0 | $580,482 | $0 | $0 | $0 |
| MICHAEL BRUNO MD | ||||||||||||||
| PHYSICIAN | $489,055 | $0 | $0 | $0 | $1,773 | $0 | $15,900 | $0 | $38,820 | $0 | $545,548 | $0 | $0 | $0 |
| MARC BINARD MD | ||||||||||||||
| PHYSICIAN | $456,179 | $0 | $0 | $0 | $19,172 | $0 | $15,900 | $0 | $28,191 | $0 | $519,442 | $0 | $0 | $0 |
| SHAUN MELARVIE MD | ||||||||||||||
| PHYSICIAN | $401,603 | $0 | $11,247 | $0 | $28,481 | $0 | $15,900 | $0 | $40,526 | $0 | $497,757 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b | FormAndLineReferenceDesc |
| Explanation | Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | wisconsin health & education facilities authority | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2014-08-15 | BondIssuedDt |
| Issue Price | $10,000,000 | IssuePriceAmt |
| Purpose | refund debt issued 10/21/09 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $424,710 | RetiredAmt |
| Total Proceeds | $10,000,000 | TotalProceedsAmt |
| Other Spent Proceeds | $10,000,000 | OtherSpentProceedsAmt |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (3 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| daniel tomaszweski md | |||||||
| PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $150,000 | $145,833 | 0 | Yes (1) | Yes (1) |
| brian matysiak md | |||||||
| BOARD MEMBER/PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $85,000 | $36,667 | 0 | Yes (1) | Yes (1) |
| marc binard md | |||||||
| PHYSICIAN | EMPLOYEE RETENTION LOAN | Yes (X) | $50,000 | $9,722 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $192,222 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 4 | As of November 1st, our sponsoring organization changed from Ascension to Door County Memorial Hospital (DCMH), with a minority-equity partnership with Hospital Sisters Health System (HSHS). The changes in the by-laws primarily relate to decision making with regard to reserve powers, defined as decisions that must be made with complete agreement from both DCMH and HSHS. Examples of reserves powers are the selection of the CEO, large capital improvement, taking on debt, etc. We have 12 class D board members who are traditional DCMH board members, and 2 class H board members, who are representatives from HSHS. For reserve power decisions, each of the classes, D and H, each has one equal vote. Obviously, to move forward then on reserve power decisions, both D and H must agree to do so. For all other votes and matters of the board, the 2 class H board members have an equal vote to each of the 12 class D board members. The balance of the by-laws remained largely the same. |
| Form 990, Part VI, Section A, line 6 | Effective 10/31/16, the hospital has no corporate members. Prior to 10/31/16, Ministry Health Care, Inc. was the single corporate member. |
| Form 990, Part VI, Section A, line 7a | effective 10/31/16, HSHS has the right to elect class H board members. prior to 10/31/16, ministry health care, inc. had the ability to elect members to the governing board of the hospital. |
| Form 990, Part VI, Section A, line 7b | Prior to 10/31/16, all decisions that have a material impact to Door County Memorial Hospital financial information or corporation as a whole were subject to approval by its sole corporate member, Ministry Health Care, Inc. Effective 10/31/16, no decisions are reserved to a specific corporate member. |
| Form 990, Part VI, Section B, line 11b | Management, including certain officer, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all board members are provided the Form 990 and management team members are available to answer any Board Members' questions. |
| Form 990, Part VI, Section B, line 12c | The Organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals of the governing board or committee will decide if conflicts on interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understand the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. |
| Form 990, Part VI, Section B, line 15 | IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, WHICH IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO, WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. |
| Form 990, Part VI, Section C, line 19 | The Door County Memorial Hospital web page is available to the public for inspection with a good deal of information regarding who Door County Memorial Hospital is along with our mission. The articles of incorporation, bylaws, conflict of interest policy, and financial statements are not included on any web page. However, if any inquiry is made for any documents they are shared as appropriate. |
| Form 990, Part XI, line 9: | CHANGE IN INTEREST IN NET ASSETS IN DOOR COUNTY HOSPITAL FOUNDATION 708,533. RESTRICTED CONTRIBUTIONS 480. TRANSFER TO RELATED PARTY FOR DISAFFILIATION -35,234,572. TRANSFER FROM RELATED PARTY FOR AFFILIATION 40,000,000. OTHER TRANSFER TO RELATED PARTY -767,595. |
| Form 990, Part XII, Line 2c: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (32 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ASCENSION HEALTH ALLIANCE | |||||||||||
| PO BOX 45998 | ST LOUIS | MO | 63145 | 453358926 | NATIONAL HEALTH SYSTEM | MO | 501(C)(3) | Line 12a, I | N/A | 0 | |
| ASCENSION HEALTH | |||||||||||
| PO BOX 45998 | ST LOUIS | MO | 63145 | 311662309 | NATIONAL HEALTH SYSTEM | MO | 501(C)(3) | Line 12a, I | 0 | ASCENSION HEALTH ALLIANCE | |
| MINISTRY HEALTH CARE INC | |||||||||||
| 10925 W LAKE PARK DRIVE SUITE 100 | MILWAUKEE | WI | 53224 | 391490371 | PARENT CORPORATION | WI | 501(C)(3) | Line 12b, II | 0 | ASCENSION HEALTH | |
| AFFINITY HEALTH SYSTEM | |||||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 391568866 | SUPPORT RELATED HEALTHCARE ORGANIZATIONS | WI | 501(C)(3) | Line 12b, II | Yes (1) | MINISTRY HEALTH CARE INC | |
| AGAPE COMMUNITY CENTER OF MILWAUKEE INC | |||||||||||
| 6100 NORTH 42ND STREET | MILWAUKEE | WI | 53209 | 391461846 | COMMUNITY CENTER | WI | 501(C)(3) | Line 7 | Yes (1) | MINISTRY HEALTH CARE INC | |
| CALUMET MEDICAL CENTER INC | |||||||||||
| 614 MEMORIAL DRIVE | CHILTON | WI | 53014 | 390905385 | HOSPITAL | WI | 501(C)(3) | Line 3 | Yes (1) | aFFINITY HEALTH SYSTEM | |
| CALTALPA HEALTH INC | |||||||||||
| N4642 COUNTY N | APPLETON | WI | 54914 | 454681563 | MENTAL HEALTH FACILITY | WI | 501(C)(3) | Line 3 | Yes (1) | ST ELIZABETH HOSPITAL INC | |
| SAINT MICHAEL'S FOUNDATION OF STEVENS POINT INC | |||||||||||
| 900 ILLINOIS AVENUE | STEVENS POINT | WI | 54481 | 391657410 | CHARITABLE FOUNDATION | WI | 501(C)(3) | Line 12a, I | Yes (1) | SAINT MICHAEL'S HOSPITAL OF STEVENS POINT | |
| DR KATE NEWCOMB CONVALESCENT CENTER INC | |||||||||||
| PO BOX 829 | WOODRUFF | WI | 54568 | 391357365 | NURSING/ASSISTED LIVING SERVICES | WI | 501(C)(3) | Line 10 | Yes (1) | HOWARD YOUNG HEALTH CARE INC | |
| Eagle River Memorial Hospital Inc | |||||||||||
| 201 Hospital Road | EAGLE RIVER | WI | 54521 | 390984690 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | THE HOWARD YOUNG MEDICAL CENTER | |
| Foundation of Saint Clare's Hospital of Weston Inc | |||||||||||
| 3400 Ministry Parkway | WESTON | WI | 54476 | 753193633 | Charitable foundation | WI | 501(C)(3) | Line 12a, I | Yes (1) | MINISTRY HEALTH CARE INC | |
| Foundation of Saint Joseph's Hospital of Marshfield | |||||||||||
| 611 Saint Joseph Avenue | MARSHFIELD | WI | 54449 | 391684957 | Charitable foundation | WI | 501(C)(3) | Line 12a, I | Yes (1) | SAINT JOSEPH'S HOSPITAL OF MARSHFIELD | |
| Good Samaritan Health Center of Merrill Wisconsin Inc | |||||||||||
| 601 South Center Avenue | MERRILL | WI | 54452 | 390808503 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | MINISTRY HEALTH CARE INC | |
| Good Samaritan Health Center Foundation of Merrill Wisconsin Inc | |||||||||||
| 601 South Center Avenue | MERRILL | WI | 54452 | 391627755 | Charitable foundation | WI | 501(C)(3) | Line 12a, I | Yes (1) | GOOD SAMARITAN HEALTH CENTER OF MERRILL WISCONSIN | |
| Howard Young Foundation Inc | |||||||||||
| 240 Maple Street | WOODRUFF | WI | 54568 | 391521169 | Charitable foundation | WI | 501(C)(3) | Line 7 | Yes (1) | HOWARD YOUNG HEALTH CARE INC | |
| Howard Young Health Care Inc | |||||||||||
| 240 Maple Street | WOODRUFF | WI | 54568 | 391499115 | Home Office | WI | 501(C)(3) | Line 12b, II | Yes (1) | MINISTRY HEALTH CARE INC | |
| The Howard Young Medical Center Inc | |||||||||||
| 240 Maple Street | WOODRUFF | WI | 54568 | 390873606 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | HOWARD YOUNG HEALTH CARE INC | |
| Mercy Health Foundation Inc | |||||||||||
| PO Box 3370 | OSHKOSH | WI | 54903 | 237140261 | Charitable foundation | WI | 501(C)(3) | Line 10 | Yes (1) | AFFINITY HEALTH SYSTEM | |
| Mercy Medical Center of Oshkosh Inc | |||||||||||
| 500 South Oakwood Road | OSHKOSH | WI | 54904 | 390806268 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | MINISTRY HEALTH CARE INC | |
| Ministry Medical Group Inc | |||||||||||
| 824 Illinois Avenue | STEVENS POINT | WI | 54481 | 391965593 | Clinics | WI | 501(C)(3) | Line 12c, III-FI | Yes (1) | MINISTRY HEALTH CARE INC | |
| Ministry Weight Management Inc | |||||||||||
| 2251 North Shore Drive | RHINELANDER | WI | 54501 | 391829015 | Health services | WI | 501(C)(3) | Line 3 | Yes (1) | SACRED HEART - ST MARY'S HOSPITALS | |
| Our Lady of Victory Hospital | |||||||||||
| 1120 Pine Street | STANLEY | WI | 54768 | 390807065 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | MINISTRY HEALTH CARE INC | |
| Sacred Heart - St Mary's Hospitals Inc | |||||||||||
| PO Box 347 | STEVENS POINT | WI | 54481 | 391390638 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | MINISTRY HEALTH CARE INC | |
| Saint Clare's Hospital of Weston Inc | |||||||||||
| 3400 Ministry Parkway | WESTON | WI | 54476 | 751531917 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | miNISTRY HEALTH CARE INC | |
| Saint Elizabeth's Hospital of Wabasha Inc | |||||||||||
| 1200 Grant Boulevard West | WABASHA | MN | 55981 | 410693877 | Hospital | MN | 501(C)(3) | Line 3 | Yes (1) | miNISTRY HEALTH CARE INC | |
| Saint Elizabeth's Hospital Foundation Inc | |||||||||||
| 1506 South Oneida Street | APPLETON | WI | 54915 | 391256677 | Charitable foundation | WI | 501(C)(3) | Line 7 | Yes (1) | affinITY HEALTH SYSTEM | |
| St Elizabeth Hospital Inc | |||||||||||
| 1506 South Oneida Street | APPLETON | WI | 54915 | 390816818 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | minISTRY HEALTH CARE INC | |
| Saint Joseph's Hospital of Marshfield Inc | |||||||||||
| 611 Saint Joseph Avenue | MARSHFIELD | WI | 54449 | 391847631 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | miNISTRY HEALTH CARE INC | |
| Saint Michael's Hospital of Stevens Point Inc | |||||||||||
| 900 Illinois Avenue | STEVENS POINT | WI | 54481 | 390808443 | Hospital | WI | 501(C)(3) | Line 3 | Yes (1) | miNISTRY HEALTH CARE INC | |
| Network Health System Inc | |||||||||||
| 1570 Appleton Road | MENASHA | WI | 54952 | 391127163 | Clinical healthcare services | WI | 501(C)(3) | Line 3 | Yes (1) | miNISTRY HEALTH CARE INC | |
| Door County Medical Corporation | |||||||||||
| 323 south 18th avenue | STURGEON BAY | WI | 54235 | 814221171 | supporting organization | WI | 501(C)(3) | Line 12b, II | 0 | ||
| door county memorial hospital foundation inc | |||||||||||
| 1843 michigan street | sturGEON BAY | WI | 54235 | 391649104 | cHARITABLE FOUNDATION | WI | 501(C)(3) | Line 12a, I | Yes (1) | door county medical corporation | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TWIN MEDS LLP | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8005 | AddressLine1Txt |
| City | MENASHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54952 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391180341 | EIN |
| Primary Activities | RENTAL PROPERTY | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| NETWORK HEALTH PLAN INC | |||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 391442058 | INSURANCE | WI | N/A | C | 0 |
| MINISTRY HOLDINGS INC | |||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 422966177 | INSURANCE HOLDING COMPANY | WI | N/A | C | 0 |
| NETWORK HEALTH INSURANCE CORPORATION | |||||||||
| 1570 MIDWAY PLACE | MENASHA | WI | 54952 | 392020474 | INSURANCE | WI | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | door county memorial hospital foundation inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $250,000 | InvolvedAmt |
| Method Of Amount Determination | actual | MethodOfAmountDeterminationTxt |
Comments