2018-05-02T16:35:28-05:00 2017-06-30 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-07-01 390806324 Door County Memorial Hospital DOOR 9207435566 323 South 18th Avenue Sturgeon Bay WI 54235 GERALD WORRICK CHIEF EXECUTIVE OFFICER 9207435566 2018-04-06 1 Terri Rexrode CPA MST P00096513 9206620016 2018-03-29 74.87.127.216 2018-04-06 10:24:55 CD P A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 A43ECD1EE6AF4781A69F6BFA161A98BDE8FA2C07 2016 2021-01-29 14:40:06Z GERALD WORRICK 323 South 18th Avenue Sturgeon Bay WI 54235 184774510 0 X www.dcmedical.org X 1944 WI To improve the health and well-being of all people in the communities we serve. 19 15 746 129 0 0 882164 651518 78975945 84540228 325699 528203 552339 121937 80736147 85841886 601850 0 0 0 47060985 53221076 0 0 0 27710781 30603219 75373616 83824295 5362531 2017591 94049534 102562760 16360510 15875765 77689024 86686995 X 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. 0 0 71379489 84279940 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. 71379489 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 119 0 746 1 0 0 0 0 0 0 0 0 0 0 X 19 15 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ADAM GINGERY 9207435566 323 South 18th Avenue Sturgeon Bay WI 54235 PATRICK O'HERN CHAIRPERSON 1.00 1.00 X X 0 0 0 BARTH GUILETTE VICE CHAIRPERSON 1.00 1.00 X X 0 0 0 WILLIAM MUNDY TREASURER 1.00 1.00 X X 0 0 0 CATHY WIESE SECRETARY 1.00 1.00 X X 0 0 0 GERALD WORRICK CEO/BOARD MEMBER 41.00 1.00 X X 73650 277808 24999 ANDRZEJ KUREK MD MEDICAL STAFF PRES/BOARD MEMBER 41.00 1.00 X X 424873 0 43406 BRIAN MATYSIAK MD MEDICAL STAFF PRES ELECT/ BOARD MEMBER 41.00 1.00 X X 447985 0 49117 JOSEPH MCMAHON BOARD MEMBER 1.00 1.00 X 0 0 0 CORWIN DAHL BOARD MEMBER 1.00 1.00 X 0 0 0 ERIC PAULSEN BOARD MEMBER 1.00 1.00 X 0 0 0 JEFF RABAS BOARD MEMBER 1.00 1.00 X 0 0 0 KELTON REITZ MD BOARD MEMBER/PHYSICIAN 41.00 1.00 X 406844 0 43113 GRACE ROSSMAN BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID WARD BOARD MEMBER 1.00 1.00 X 0 0 0 RICHARD HOGAN MD BOARD MEMBER/PHYSICIAN 41.00 1.00 X 461182 0 47848 JAMES SARKIS BOARD MEMBER 1.00 1.00 X 0 0 0 SCOTT WEDERQUIST BOARD MEMBER 1.00 1.00 X 0 0 0 THERESE PANDL BOARD MEMBER 1.00 1.00 X 0 0 0 GREG SIMIA BOARD MEMBER 1.00 1.00 X 0 0 0 SALLY PFEIFER BOARD MEMBER 1.00 1.00 X 0 0 0 BRIAN STEPHENS CHIEF ADMINISTRATIVE OFFICER 40.00 X 148417 0 35710 ADAM GINGERY CHIEF FINANCIAL OFFICER 40.00 X 108162 0 32469 DANIEL TOMASZEWSKI MD PHYSICIAN 40.00 X 964597 0 49871 STEVEN DAVIS MD PHYSICIAN 40.00 X 519137 0 61345 MICHAEL BRUNO MD PHYSICIAN 40.00 X 490828 0 54720 MARC BINARD MD PHYSICIAN 40.00 X 475351 0 44091 SHAUN MELARVIE MD PHYSICIAN 40.00 X 441331 0 56426 4962357 277808 543115 50 0 1 0 INFINITY HEALTHCARE INC 111 E WISCONSIN AVE SUITE 2000 MILWAUKEE WI 54302 ER PHYSICIANS 2904367 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 AGENCY STAFFING 712602 NAVIN HAFFTY & ASSOCIATES LLC 200 CORDWAINDER DRIVE SUITE 100 NORWELL MA 02061 SOFTWARE CONSULTING 706013 NORTHERN XRAY CO INC 2118 4TH AVENUE SOUTH MINNEAPOLIS MN 55404 RADIOLOGY EQUIPMENT SERVICE 576067 NEWPOINT HEALTHCARE ADVISORS LLC 200 QUEVEC STREET SUITE 300-111 DENVER CO 80230 PROFESSIONAL CONSULTING SERVICES 236173 16 250000 135000 266518 651518 Net patient service revenue 622110 82971497 82971497 medicare and medicaid stimulus ot 909999 354751 354751 occupational health and wellness 909999 330773 330773 miscellaneous revenues 909999 318234 318234 therapy other revenues 909999 304685 304685 260288 260288 84540228 538421 538421 319036 197099 121937 121937 121937 98725307 98735525 -10218 -10218 -10218 85841886 84279940 0 910428 2625584 1924368 701216 38129988 34499626 3630362 1812051 1633395 178656 8695413 7838082 857331 1958040 1753021 205019 419976 419976 97483 97483 7377962 5502073 1875889 11015550 8772054 2243496 1697629 1573160 124469 1143895 1066183 77712 723747 540027 183720 225227 225227 3587113 2444979 1142134 634400 247173 387227 BAD DEBT EXPENSE 3096014 3096014 DUES AND SUBSCRIPTIONS 191611 96722 94889 EQUIPMENT RENTAL 135184 135184 257428 257428 83824295 71379489 12444806 0 3278 3228 12822979 7897748 50558 12452383 15289281 142490 192222 194161 367623 916418 1244241 2026877 859037 45585897 15777878 25883767 29808019 44096909 725282 38831341 2804452 94049534 102562760 5853398 6629838 8111969 7687258 1504651 1050178 890492 508491 16360510 15875765 X 77210429 85236119 478595 1450876 77689024 86686995 94049534 102562760 X 2017591 708879 1564655 4706846 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 7292 7292 0 Part II-B, Line 1: 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. 4203539 4203539 18211595 7733208 10478387 22168808 8044670 14124138 1001955 1001955 29808019 DUE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 508491 508491 83651850 708879 -3096014 -2387135 86038985 -197099 -197099 85841886 80925380 197099 197099 80728281 3096014 3096014 83824295 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. 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 662127 662127 0.00820 7262593 2615989 4646604 0.05760 7924720 2615989 5308731 0.06580 19 876 1586099 282176 1303923 0.01620 7 241 130968 130968 0.00160 2 4889 1455764 378708 1077056 0.01330 7 1063 417088 417088 0.00520 35 7069 3589919 660884 2929035 0.03630 35 7069 11514639 3276873 8237766 0.10210 1 872 872 0.00000 1 852 852 0.00000 1 14300 14300 0.00020 1 181 35390 35390 0.00040 1 3128 3128 0.00000 1 57806 57806 0.00070 6 181 112348 112348 0.00130 3096014 25374682 25794563 -419881 X 1 1 1 1 DOOR COUNTY MEMORIAL HOSPITAL 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 WWW.DCMEDICAL.ORG 1054 X X X X DOOR COUNTY MEMORITAL HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X www.DCMEDICAL.ORG/HOSPITAL-INFORMATION/ABOUT/COMMUNITY-HEALTH-NEEDS X 1 15 1 www.DCMEDICAL.ORG/HOSPITAL-INFORMATION/ABOUT/COMMUNITY-HEALTH-NEEDS 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X http://www.dcmedical.org/Patients-Guests/Patient-Financial-Services/Financi X http://www.dcmedical.org/Patients-Guests/Patient-Financial-Services/Financi X http://www.dcmedical.org/Patients-Guests/Patient-Financial-Services/Financi X X X X X X 1 X 0 X X X X 1 X 0 0 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. 7 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 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 X X X X 0 1 0 0 0 0 0 0 0 GERALD WORRICK CEO/BOARD MEMBER 58793 224592 0 53216 14857 0 4029 16814 4156 0 81835 294622 0 0 ANDRZEJ KUREK MD MEDICAL STAFF PRES/BOARD MEMBER 195704 0 227604 0 1565 0 15900 0 27506 0 468279 0 0 0 BRIAN MATYSIAK MD MEDICAL STAFF PRES ELECT/ BOARD MEMB 407430 0 0 0 40555 0 15900 0 33217 0 497102 0 0 0 KELTON REITZ MD BOARD MEMBER/PHYSICIAN 310792 0 94400 0 1652 0 15900 0 27213 0 449957 0 0 0 RICHARD HOGAN MD BOARD MEMBER/PHYSICIAN 426998 0 23924 0 10260 0 15900 0 31948 0 509030 0 0 0 BRIAN STEPHENS CHIEF ADMINISTRATIVE OFFICER 147836 0 0 0 581 0 9102 0 26608 0 184127 0 0 0 DANIEL TOMASZEWSKI MD PHYSICIAN 847070 0 61094 0 56433 0 15900 0 33971 0 1014468 0 0 0 STEVEN DAVIS MD PHYSICIAN 516434 0 0 0 2703 0 15900 0 45445 0 580482 0 0 0 MICHAEL BRUNO MD PHYSICIAN 489055 0 0 0 1773 0 15900 0 38820 0 545548 0 0 0 MARC BINARD MD PHYSICIAN 456179 0 0 0 19172 0 15900 0 28191 0 519442 0 0 0 SHAUN MELARVIE MD PHYSICIAN 401603 0 11247 0 28481 0 15900 0 40526 0 497757 0 0 0 Part I, Line 4b 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. A wisconsin health & education facilities authority 391337855 2014-08-15 10000000 refund debt issued 10/21/09 0 0 0 A 424710 10000000 10000000 1 0 1 1 A 0 0 1 1 0 0 0 1 A 0 1 0 0 1 0 0 1 A 1 daniel tomaszweski md PHYSICIAN EMPLOYEE RETENTION LOAN X 150000 145833 0 1 1 brian matysiak md BOARD MEMBER/PHYSICIAN EMPLOYEE RETENTION LOAN X 85000 36667 0 1 1 marc binard md PHYSICIAN EMPLOYEE RETENTION LOAN X 50000 9722 0 1 1 192222 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. 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 ASCENSION HEALTH ALLIANCE 0 MINISTRY HEALTH CARE INC 10925 W LAKE PARK DRIVE SUITE 100 MILWAUKEE WI 53224 391490371 PARENT CORPORATION WI 501(C)(3) Line 12b, II ASCENSION HEALTH 0 AFFINITY HEALTH SYSTEM 1570 MIDWAY PLACE MENASHA WI 54952 391568866 SUPPORT RELATED HEALTHCARE ORGANIZATIONS WI 501(C)(3) Line 12b, II MINISTRY HEALTH CARE INC 1 AGAPE COMMUNITY CENTER OF MILWAUKEE INC 6100 NORTH 42ND STREET MILWAUKEE WI 53209 391461846 COMMUNITY CENTER WI 501(C)(3) Line 7 MINISTRY HEALTH CARE INC 1 CALUMET MEDICAL CENTER INC 614 MEMORIAL DRIVE CHILTON WI 53014 390905385 HOSPITAL WI 501(C)(3) Line 3 aFFINITY HEALTH SYSTEM 1 CALTALPA HEALTH INC N4642 COUNTY N APPLETON WI 54914 454681563 MENTAL HEALTH FACILITY WI 501(C)(3) Line 3 ST ELIZABETH HOSPITAL INC 1 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 SAINT MICHAEL'S HOSPITAL OF STEVENS POINT 1 DR KATE NEWCOMB CONVALESCENT CENTER INC PO BOX 829 WOODRUFF WI 54568 391357365 NURSING/ASSISTED LIVING SERVICES WI 501(C)(3) Line 10 HOWARD YOUNG HEALTH CARE INC 1 Eagle River Memorial Hospital Inc 201 Hospital Road EAGLE RIVER WI 54521 390984690 Hospital WI 501(C)(3) Line 3 THE HOWARD YOUNG MEDICAL CENTER 1 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 MINISTRY HEALTH CARE INC 1 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 SAINT JOSEPH'S HOSPITAL OF MARSHFIELD 1 Good Samaritan Health Center of Merrill Wisconsin Inc 601 South Center Avenue MERRILL WI 54452 390808503 Hospital WI 501(C)(3) Line 3 MINISTRY HEALTH CARE INC 1 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 GOOD SAMARITAN HEALTH CENTER OF MERRILL WISCONSIN 1 Howard Young Foundation Inc 240 Maple Street WOODRUFF WI 54568 391521169 Charitable foundation WI 501(C)(3) Line 7 HOWARD YOUNG HEALTH CARE INC 1 Howard Young Health Care Inc 240 Maple Street WOODRUFF WI 54568 391499115 Home Office WI 501(C)(3) Line 12b, II MINISTRY HEALTH CARE INC 1 The Howard Young Medical Center Inc 240 Maple Street WOODRUFF WI 54568 390873606 Hospital WI 501(C)(3) Line 3 HOWARD YOUNG HEALTH CARE INC 1 Mercy Health Foundation Inc PO Box 3370 OSHKOSH WI 54903 237140261 Charitable foundation WI 501(C)(3) Line 10 AFFINITY HEALTH SYSTEM 1 Mercy Medical Center of Oshkosh Inc 500 South Oakwood Road OSHKOSH WI 54904 390806268 Hospital WI 501(C)(3) Line 3 MINISTRY HEALTH CARE INC 1 Ministry Medical Group Inc 824 Illinois Avenue STEVENS POINT WI 54481 391965593 Clinics WI 501(C)(3) Line 12c, III-FI MINISTRY HEALTH CARE INC 1 Ministry Weight Management Inc 2251 North Shore Drive RHINELANDER WI 54501 391829015 Health services WI 501(C)(3) Line 3 SACRED HEART - ST MARY'S HOSPITALS 1 Our Lady of Victory Hospital 1120 Pine Street STANLEY WI 54768 390807065 Hospital WI 501(C)(3) Line 3 MINISTRY HEALTH CARE INC 1 Sacred Heart - St Mary's Hospitals Inc PO Box 347 STEVENS POINT WI 54481 391390638 Hospital WI 501(C)(3) Line 3 MINISTRY HEALTH CARE INC 1 Saint Clare's Hospital of Weston Inc 3400 Ministry Parkway WESTON WI 54476 751531917 Hospital WI 501(C)(3) Line 3 miNISTRY HEALTH CARE INC 1 Saint Elizabeth's Hospital of Wabasha Inc 1200 Grant Boulevard West WABASHA MN 55981 410693877 Hospital MN 501(C)(3) Line 3 miNISTRY HEALTH CARE INC 1 Saint Elizabeth's Hospital Foundation Inc 1506 South Oneida Street APPLETON WI 54915 391256677 Charitable foundation WI 501(C)(3) Line 7 affinITY HEALTH SYSTEM 1 St Elizabeth Hospital Inc 1506 South Oneida Street APPLETON WI 54915 390816818 Hospital WI 501(C)(3) Line 3 minISTRY HEALTH CARE INC 1 Saint Joseph's Hospital of Marshfield Inc 611 Saint Joseph Avenue MARSHFIELD WI 54449 391847631 Hospital WI 501(C)(3) Line 3 miNISTRY HEALTH CARE INC 1 Saint Michael's Hospital of Stevens Point Inc 900 Illinois Avenue STEVENS POINT WI 54481 390808443 Hospital WI 501(C)(3) Line 3 miNISTRY HEALTH CARE INC 1 Network Health System Inc 1570 Appleton Road MENASHA WI 54952 391127163 Clinical healthcare services WI 501(C)(3) Line 3 miNISTRY HEALTH CARE INC 1 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 door county medical corporation 1 TWIN MEDS LLP PO BOX 8005 MENASHA WI 54952 391180341 RENTAL PROPERTY WI N/A 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 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 door county memorial hospital foundation inc C 250000 actual