2017-08-14T15:05:58-05:00 2016-09-30 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2015-10-01 391657627 Bellin Psychiatric Center BELL 9204457260 PO Box 23725 Green Bay WI 543053725 Sharla Baenen President 9204457260 2017-08-14 1 Terri Rexrode CPA MST P00096513 9206620016 2017-08-14 2015 2021-01-29 14:40:06Z Sharla Baenen PO Box 23725 Green Bay WI 543053725 20292552 0 X WWW.BELLIN.ORG X 1990 WI BELLIN PSYCHIATRIC CENTER, INC. (BPC) PROVIDES PSYCHIATRIC AND ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BPC, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 9 5 206 7 0 0 42651 0 16802635 20130893 587892 97821 0 0 17433178 20228714 0 0 0 0 13034563 15546128 0 0 0 4810323 5640180 17844886 21186308 -411708 -957594 17972448 20047769 7348258 9900469 10624190 10147300 X Bellin Psychiatric Center will be recognized as the preferred provider for psychiatric disorders and addictive diseases through the delivery of a continuum of care and prevention programs based on the quality care delivered at a reasonable cost with a measurable outcome by:Improving work processes and systemsExceeding customer needs and expectationsEmpowering staff to excel personally and professionallyIn cooperation with psychiatrists, psychologists, primary care physicians, agencies and health professionals, Bellin Psychiatric Center is dedicated to the multidisciplinary treatment of children, adolescents, adults and their family members throughout our primary market of Wisconsin and the upper Peninsula of Michigan. 0 0 17900180 19986608 THE CENTER PROVIDES PSYCHIATRIC AND ALCOHOL AND OTHER DRUG ABUSE (AODA) SERVICES TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2016 7,501 INPATIENT DAYS WERE PROVIDED (4,410 ADULT, 536 CHILD AND 2,555 ADOLESCENT). THE NUMBER OF OUTPATIENT THERAPY VISITS DURING FISCAL YEAR 2016 WERE 28,435. IN ADDITION THERE WERE 37,286 INPATIENT AND OUTPATIENT MD, APNP AND PHD VISITS. 17900180 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 206 1 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN J MCGURK 9204457260 744 South Webster Avenue green bay WI 54301 SHARLA BAENEN BPC PRESIDENT 45.00 X X 172458 0 29395 CHRISTINE WOleske Member/Bellin Executive VP 0.50 40.00 X 0 410015 35558 michael hoffman mD MEMBER/physician 0.50 40.00 X 0 194075 25930 TARA ROBERTSON PSYD MEMBER/clinical psychologi 40.00 X 0 0 0 WILLIAM MCKINLEY MEMBER 0.50 X 0 0 0 ROBERT FRY SECRETARY, TREASURER 0.50 X X 0 0 0 BARBARA GILLING INTERIM CHAIRPERSON 0.50 X X 0 0 0 DAVID VANDER PLOEG MEMBER 0.50 X 0 0 0 Naciye Kalafat MD PreSIDENT OF MEDICAL STAFF 45.00 X 323177 0 34759 Sue mattison former BOD member 0.50 X 0 0 0 ANTHONY MARCHLEWSKI MD Psychiatrist 40.00 X 284011 0 35518 JOHN CHARLES MD psychiatrist 40.00 X 459970 0 34868 Derek Carlson MD Psychiatrist 40.00 X 335119 0 31456 Kim Lasecki PH D Psychologist 40.00 X 286299 0 31929 Susan Uyanna Psychiatrist 40.00 X 289954 0 18078 2150988 604090 277491 20 0 1 0 Bellin Memorial Hospital 744 South Webster Avenue Green Bay WI 54305 Administrative services 2326574 Locumtenenscom LLC 2655 Northwinds Parkway Alpharetta GA 30009 Contracted Services 329391 2 NET PATIENT SERVICE REVENUE 621300 19870760 19870760 MISCELLANEOUS 621300 121936 121936 Contracted services 621110 115848 115848 MEDICAL RECORDS 621300 22349 22349 20130893 161659 161659 63838 -63838 -63838 -63838 20228714 19986608 0 242106 1013199 962538 50661 11851417 11034029 817388 537603 496035 41568 1339420 1221595 117825 804489 749000 55489 5673 5673 32049 32049 903455 768404 135051 43856 1389 42467 109336 60139 49197 35385 33373 2012 308372 280637 27735 10939 2607 8332 71880 59661 12219 202441 202441 432241 16850 415391 43885 22637 21248 Supplies expense 2567591 1403384 1164207 Bad Debt Expense 577436 577436 Equipment Rent/Maint 131501 121074 10427 Dues & Subscriptions 71009 56412 14597 93131 32980 60151 21186308 17900180 3286128 0 2121283 5161717 1662351 1813704 1500 15976 11211331 3423864 5818228 7787467 8333732 5052950 35354 215955 17972448 20047769 1560970 1488131 3291879 3060509 2495409 5351829 7348258 9900469 X 10624190 10147300 10624190 10147300 17972448 20047769 -957594 480704 0 X X 0 1 X 1 0 X 2747765 2747765 4933984 1509053 3424931 366674 235527 131147 2948431 1679284 1269147 214477 214477 7787467 Due to Affiliates 5351829 5351829 20099933 480704 -609485 -128781 20228714 0 20228714 20576823 0 20576823 609485 609485 21186308 Part XI, Line 2d - Other Adjustments: Provision for bad debts -577,436. Investment fees -32,049. Part XII, Line 4b - Other Adjustments: Provision for bad debts 577,436. investment fees 32,049. 1 1 X 1 X 220.000000000000 1 X 1 1 0 1 1 145797 145797 0.00710 6109166 4396825 1712341 0.08310 6254963 4396825 1858138 0.09020 11053 724 10329 0.00050 10498 10498 0.00050 21551 724 20827 0.00100 6276514 4397549 1878965 0.09120 1 310298 2806099 4107956 -1301857 X 1 1 1 1 Bellin Psychiatric Center Inc 301 E St Joseph Street Green Bay WI 543053725 www.bellin.org 263 X Bellin psychiatric center inc 1 0 0 1 X X X X X X X X 14 1 1 1 1 X www.bellin.org/patients_visitors/company-information/community-health X 1 14 1 www.bellin.org/patients_visitors/company-information/community-health 0 0 1 X 220.000000000000 400.000000000000 X X 1 1 X X X 1 X X X X 1 0 X X X X 1 X 0 0 Bellin psychiatric center, inc. Part V, Section B, Line 5: THE BROWN COUNTY AND CITY OF DE PERE HEALTH DEPARTMENTS CONVENED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT INCLUDED REPRESENTATIVES OF BELLIN HEALTH, ST. MARY'S ANDITS SISTER HOSPITAL ST. VINCENT, THE LOCAL UNITED WAY, AND REPRESENTATIVES OF THE REGIONAL OFFICE OF WISCONSIN'S DEPARTMENT OF HEALTH. THIS STEERING COMMITTEE WORKED TO IDENTIFY REPRESENTATIVES THAT COULD BROADLY REPRESENT THE COMMUNITY IN ACTUALLY CONDUCTING THE NEEDS ASSESSMENT AND SETTING PRIORITIES. THESE INDIVIDUALS WERE REFERRED TO AS COMMUNITY PARTNERS. LISTOF NAMES FOLLOWS:- AGING & DISABILITY RESOURCE CENTER, SUNNY ARCHAMBAULT- AURORA HEALTH SYSTEM, JULIE POMASL- BAY AREA COMMUNITY COUNCIL, PAT FINDER-STONE- BELLIN COLLEGE, KATHIE DEMUTH- BELLIN HEALTH, JODY WILMET*- BELLIN HEALTH, LINDA ROETHLE- BOYS & GIRLS CLUB, JOHN BENBERG- BROWN COUNTY BOARD, MIKE FLECK- BROWN COUNTY BOARD OF HEALTH (BOARD MEMBER), AUDREY MURPHY**- BROWN COUNTY COMMUNITY TREATMENT CENTER, MARY JOHNSON- BROWN COUNTY COOPERATIVE EXTENSION, JUDY KNUDSEN- BROWN COUNTY HEALTH DEPARTMENT, JUDY FRIEDERICHS (DIRECTOR, BROWN COUNTYHEALTH DEPARTMENT)* **- BROWN COUNTY HUMAN SERVICES, KEVIN LUNOG- BROWN COUNTY PLANNING, CHUCK LAMINE- BROWN COUNTY UNITED WAY, STEPHANIE FOLEY*#- CENTER FOR CHILDHOOD SAFETY/ SAFE KIDS GREATER GREEN BAY, JUSTINE LODL- CITY OF DE PERE BOARD OF HEALTH (BOARD MEMBER), PAT FINDER-STONE **- CITY OF DE PERE HEALTH DEPARTMENT, MARY DORN, HEALTH DIRECTOR* **- DE PERE AREA CHAMBER OF COMMERCE, CHERYL DETRICK- DIVISION OF PUBLIC HEALTH NORTHEAST REGIONAL OFFICE, REBECCA HOVARTER,REGIONAL PUBLIC HEALTH NURSING CONSULTANT* **- DIVISION OF PUBLIC HEALTH NORTHEAST REGIONAL OFFICE, LYNN HRABIK,EPIDEMIOLOGIST* **- FAMILY SERVICES-CRISIS CENTER, TANA KOSS #- GREATER GREEN BAY COMMUNITY FOUNDATION, MARTHA AHRENDT- GREATER GREEN BAY YMCA, SANDY ATKINS- GREEN BAY CHAMBER OF COMMERCE, NAN NELSON, CCE- HOMELESS POPULATION REPRESENTATIVE, SETH MOORE #- N.E.W. COMMUNITY CLINIC, BONNIE KUHR #- NWTC HEALTH SCIENCE, KAY TUPALA, DEAN- ONEIDA TRIBE OF INDIANS, MICHELLE MYERS #- PARISH NURSE, KATIE DYKES #- BROWN COUNTY SHERIFF REPRESENTATION - CHIEF'S GROUP, CAPT. RANDY SCHULTZ- PREVEA HEALTH, DR. ASHOK RAI- ST. MARY'S HOSPITAL MEDICAL CENTER, HEIDI SELBERG*- ST. VINCENT HOSPITAL, HEIDI SELBERG*- ST. WILLEBROAD CATHOLIC PARISH, MARIA PLASCENCIA- SCHOOL REPRESENTATION - SUPERINTENDENT'S GROUP, BARB NATELLE- THE SALVATION ARMY, REBECCA LESPERANCE #- UNITED HMONG AND ASIAN AMERICAN COMMUNITY CENTER, STARYOUNG THAO #- UWGB-ENVIRONMENTAL SCIENCES, THOMAS ERDMAN- UW-GREEN BAY NURSING PROGRAM, CHRIS VANDENHOUTEN- WOMEN, INFANT AND CHILDREN (WIC), BONNIE KUHR #* STEERING COMMITTEE MEMBER** PERSON WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH, INCLUDING PUBLIC HEALTHDEPARTMENT LEADERSHIP STAFF AND MEMBERS OF GOVERNANCE BODIES FOR PUBLICHEALTH DEPARTMENTS.# REPRESENTATIVES OF UNDERSERVED, LOW INCOME, MINORITY OR CHRONIC DISEASE Bellin psychiatric center, inc. Part V, Section B, Line 6a: ST. VINCENT HOSPITAL, GREEN BAY, WIST. MARY'S HOSPITAL, GREEN BAY, WI Bellin psychiatric center, inc. Part V, Section B, Line 6b: Brown County and City of De Pere Puplic Health Departments and various other community health, social welfare organizations Bellin psychiatric center, inc. Part V, Section B, Line 11: The most recent CHNA identified community needs from 2015 through 2017. We are in the process of leading a community reassessment.The needs identified are: Oral Health, Alcohol and Other Drug Abuse, Mental Health and Physical Activity and Nutrition. Bellin representatives lead the Alcohol and Other Drug Abuse and Mental Health Community Action teams and is active on the other teams. A summary of how Bellin has been addressing the needs identified in the CHNA is as follows:Oral Health: Bellin sponsored a legislative breakfast to improve health care policy and coverage of Medicaid patients. We have standardized our ED protocols to be consistent with the other health care systems for patients with oral pain., along with conducting a oral health screening pilot with our OB patients. Bellin donates funds annually to the NEW Community Clinic which has been able to expand access for oral care for Medicaid and uninsured patients.Alcohol and Other Drug Misuse:Physical Activity and Nutrition:Mental Health: Mental Health has been working on the following objectives:Brown County Mental Health Task Force Goal: Brown County will increase access to mental health services for all populations in the county by identifying gaps and disparities and creating a common platform that mental health providers, partner agencies, and stakeholders can access 1. By December 31, 2017, with a goal of getting to 0 suicides, the number of annual suicides in Brown County will decrease from 35 to 302. By December 31, 2017, the average number of poor mental health days per 30 days, as reported by county residents, will decrease from 3.2 to 3.0OBJECTIVE #1: By December 31, 2017, the task force will create a document accessible to all stakeholders that identifies the current state of mental health care in Brown County, including all available resources and services provided, gaps and disparities in care, needed programs, and ratio of specific mental health providers to population. We have evaluated best practice screening tools that can be implemented across community and healthcare settings (help identify current state of mental health and needs) In partnership with the St. Norbert College Strategic Research Center, we have identified disparities in poor mental health days in Brown County and created initiatives to address these areas. (see below)OBJECTIVE #2: By December 31, 2017, the mental health task force will create a draft proposal for creating a community-wide "No Wrong Door" access platform for mental health treatment and connection between mental health providers. (The goal is to create the right access at the right time by having a comprehensive view and collaborative connections between all Brown County mental health service providers.) We have selected our virtual online vendor for community-wide access platform. We received a $1M grant in collaboration with Connections for Mental Wellness to reduce the number of poor mental health days by:o Improving accesso Improving community members' knowledge of mental health and mental wellnesso Creating mentally healthy workplaceso Building the workforce (psychiatrists and mental health therapists) Bellin psychiatric center, inc. Part V, Section B, Line 13b: A patient's liability is capped to 15% of annual income. A patient who receives any percentage of charity care based on their income, will not be responsible for more than 15% of their annual income. Bellin psychiatric center, inc. Part V, Section B, Line 22d: The hospital looked at the average amount collected for all payers (including medicare and medicaid). Average collection rate was 44%. Any patient receiving Financial Assistance, will not be responsible for more than 44% of charges. 13 1 - Bellin Behavioral Health Clinic 301 E St Joseph Street Green Bay WI 54305 clinic 2 - Bellin Behavioral Health Clinic Ashwaube 1630 Commanche Avenue Green Bay WI 54313 clinic 3 - BELLIN HEALTH - RIVERSIDE PSYCHIATRIC GR 1325 ANGELS PATH DE PERE WI 54115 CLINIC 4 - Bellin Behavioral Health Clinic Neuro Ca 744 S Webster Avenue Green Bay WI 54301 Clinic 5 - Bellin Behavioral Health Clinic Bellevue 3263 Eaton Road Green Bay WI 54311 Clinic 6 - Bellin Behavioral Health Clinic Escanaba 610 S Lincoln Road Escanaba MI 49829 Clinic 7 - Bellin Behavioral Health Clinic Manitowo 3415 Custer Street Suite D Manitowoc WI 54221 Clinic 8 - Bellin Behavioral Health Clinic West De 1800 Lawrence Drive De Pere WI 54115 Clinic 9 - Bellin Behavioral Health Clinic Oconto 820 Arbutus Avenue Oconto WI 54153 Clinic 10 - BELLIN BEHAVIORAL HEALTH CLINIC EAST DE 555 REDBIRD CIR DE Pere WI 54115 CLINIC 11 - Bellin Behavioral Health Clinic Oconto F 833 S Main Street Oconto Falls WI 54154 clinic 12 - Bellin Behavioral Health Clinic Cancer T 1580 Commanche Avenue Ashwaubenon WI 54313 Clinic 13 - BELLIN BEHAVIORAL HEALTH CLINIC ALGOMA 831 PARKER AVE ALGOMA WI 54201 CLINIC Part I, Line 6a: BELLIN PSYCHIATRIC CENTER IS INCLUDED IN THE ANNUAL BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. Part I, Line 7: AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. Part I, Ln 7 Col(f): BAD DEBT EXPENSE OF $577,436 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. Part III, Line 2: THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS Part III, Line 3: The hospital utilizes HFMA #15 therefore none of the bad debt would be deemed charity care. Part III, Line 4: The attached financial statements do not contain a specific bad debt expense footnote. However, the summary of significant accounting policies describes the provision for bad debt on pages 12 and 13 of the financial statements.For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for a portion of the bill), Bellin Health Systems records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowances for doubtful accounts. Part III, Line 8: THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RUL 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE SHORTFALL IS NOT NECESSARILY FROM INEFFICIENT OPERATIONS. MEDICARE CAN BE THE LARGEST PAYOR AND HOSPITALS HAVE NO ABILITY TO DENY COVERAGE. THIS, IN TURN, IN A PROMOTION OF ACCESS TO HEALTHCARE SERVICES (A COMMUNITY BENEFIT). ALSO, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. Part III, Line 9b: If a patient is known to qualify for charity care, the amount of charity care the patient receives is based on the patients income. We have a sliding scale that looks at your income as a % of the Federal Poverty Level. Income from 0-220% gets 100% charity care. Income 401% or more than the federal poverty level gets 0%. In between 220% and 400% is the sliding scale. Once qualified for charity care, this qualification is good for 6 months going forward. Part VI, Line 2: BELLIN PSYCHIATRIC CENTER HAS COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IT IS POSTED ON BELLIN.ORG Part VI, Line 3: FINANCIAL COUNSELORS ADVISE PATIENTS OF ASSISTANCE PROGRAMS AS WELL AS SERVICE CALLED HRS ERASE IS USED TO REVIEW SELF PAY ACCOUNTS FOR POSSIBLE COVERAGE THROUGH GOVERNMENT PROGRAMS. Part VI, Line 4: BELLIN PSYCHIATRIC CENTER SERVES NORTHEAST WISCONSIN INCLUDING CLINICS IN THE CITIES OF GREEN BAY, ASHWAUBENON, BELLEVUE, DE PERE, LEDGEVIEW, MANITOWOC, OCONTO, OCONTO FALLS, PESHTIGO AND ALGOMA. Part VI, Line 5: A MAJORITY OF BELLIN PSYCHIATRIC CENTER'S GOVERNING BODY IS COMPRISED OF PERSON WHO RESIDE IN BELLIN PSYCHIATRIC CENTER'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, BELLIN PSYCHIATRIC CENTER EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. BELLIN PSYCHIATRIC CENTER APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, EDUCATION AND FACILITIES. Part VI, Line 6: BELLIN HEALTH IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. DIRECTLY, AND IN PARTNERSHIP WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE GUIDE INDIVIDUALS AND FAMILIES IN THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. WE ARE COMMITTED TO PROVIDING SAFE, RELIABLE, COST-EFFECTIVE TOTAL HEALTH SOLUTIONS WITH RESPECT AND COMPASSION. OUR INNOVATIVE WORK WILL IMPACT HEALTHCARE DELIVERY IN OUR REGION AS WELL AS THROUGHOUT THE WORLD. Part VI, Line 7, Reports Filed With States WI X X X X 0 0 0 0 0 0 0 0 0 SHARLA BAENEN BPC PRESIDENT 147278 0 25000 0 180 0 11690 0 17705 0 201853 0 0 0 CHRISTINE WOleske Member/Bellin Executive VP 0 329653 0 79948 0 414 0 16752 0 18806 0 445573 0 0 michael hoffman mD MEMBER/physician 0 171514 0 22291 0 270 0 11047 0 14883 0 220005 0 0 Naciye Kalafat MD PreSIDENT OF MEDICAL STAFF 251576 0 71331 0 270 0 13303 0 21456 0 357936 0 0 0 Sue mattison former BOD member 0 0 0 0 0 0 0 0 0 0 0 0 ANTHONY MARCHLEWSKI MD Psychiatrist 262037 0 21560 0 414 0 15395 0 20123 0 319529 0 0 0 JOHN CHARLES MD psychiatrist 279877 0 179823 0 270 0 15745 0 19123 0 494838 0 0 0 Derek Carlson MD Psychiatrist 334345 0 0 0 774 0 12500 0 18956 0 366575 0 0 0 Kim Lasecki PH D Psychologist 284279 0 1750 0 270 0 14306 0 17623 0 318228 0 0 0 Susan Uyanna Psychiatrist 257684 0 32000 0 270 0 3377 0 14701 0 308032 0 0 0 A Wisconsin Health and Educational Facilities Authority 391337855 97712DLH7 2015-04-09 2468852 Refund and legally defease 0 0 0 A 74384 2468852 28985 2439867 2009 0 1 1 1 A 0 1 1 1 0 1 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Form 990, Part VI, Section A, line 6 The organization has one corporate member, Bellin Health Systems, Inc. Form 990, Part VI, Section A, line 7a The corporate member, Bellin Health Systems, Inc. has the power to appoint and remove board members. Form 990, Part VI, Section A, line 7b The corporate member, Bellin Health Systems, Inc., has the power to approve major expenditures and long-term borrowings. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed in detail by senior administration and is provided to the board of directors prior to filing. Form 990, Part VI, Section B, line 12c Each year a conflict of interest request document is provided to each board member. All documents are provided back to administration and reviewed. All employees are required to review the conflict of interest policy as part of annual mandatory education. An interested person may make a presentation at the governing board or committee meeting, but after the presentation, he/she shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement involving the possible conflict of interest. Should there be a conflict of interest which arises at a board meeting, the individual with a conflict will be asked to leave the meeting during a vote on the matter and is required to abstain from voting. Form 990, Part VI, Section B, line 15 Compensation for the CEO and key executives are set by the executive committee of the Board supported by market data from surveys and an independent consultants report. The compensation is determined by members of the executive committee without conflict and is documented. CEO Compensation: CEO presents results of Performance Objectives to the Executive Committee in January of each year. The Chair applies a formula to the results and comes up with a recommendation. The Chair facilitates getting approval from other members of the Executive Committee. Senior Leaders: Compensation for those who report to the CEO is taken to the Executive Committee for discussion/approval. Form 990, Part VI, Section C, line 19 THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. Form 990, Part XI, Line 2B-2C THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED AUDIT OF BELLIN HEALTH SYSTEMS, INC. THE BOARD OF DIRECTORS OF BELLIN HEALTH SYSTEMS, INC. ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(c)(3) Line 11b, II BELLIN HEALTH SYSTEMS INC 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING AND RADIOLOGIC SCIENCE COLLEGE WI 501(c)(3) Line 2 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54305 391809171 FOUNDATION WI 501(c)(3) Line 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC PO BOX 23400 GREEN BAY WI 54305 390884478 ACUTE CARE HOSPITAL WI 501(c)(3) Line 3 BELLIN HEALTH SYSTEMS INC 1 OCONTO HOSPITAL & MEDICAL CENTER INC PO BOX 357 OCONTO WI 54153 061745397 HOSPITAL WI 501(c)(3) Line 3 BELLIN MEMORIAL HOSPITAL INC 1 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(c)(3) Line 11b, II N/A 0 Unity Limited Partnership 2366 Oak Ridge Circle De Pere WI 54115 391750729 Hospice, Palliative, and Bereavement services WI 501(c)(3) Line 9 Bellin Memorial Hospital Inc 1 BELLIN ORTHOPEDIC SURGERY CENTER LLC 2223 LIME KILN RD GREEN BAY WI 54311 264677834 AMBULATORY ORTHOPEDIC SURGERY WI N/A D1 Training of Green Bay LLC 7115 South Springs Drive Franklin TN 37067 454848172 Sports Training TN N/A BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 0 BELLIN INVESTMENTS INC PO BOX 23400 GREEN BAY WI 54305 391564939 OTHER WI N/A C 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 1 1 0 0 Bellin Memorial Hospital E 3060492 Actual BELLin Memorial Hospital M 2097955 actual