2016-05-16T19:37:08-05:00 2015-06-30 861065772 Deloitte Tax LLP 555 East Wells Street Suite 1400 Milwaukee WI 53202 990 2014-07-01 390806268 Mercy Medical Center of Oshkosh Inc MERC 9207382000 500 South Oakwood Road Oshkosh WI 54904 Brian Regan Interim CFO 2016-05-16 true Rachel Becker P00966076 4142713000 2014 2016-08-17 19:52:53Z JEREMY NORMINGTON-SLAY 500 South Oakwood Road Oshkosh WI 54904 111006272 false 0928 X WWW.AFFINITYHEALTH.ORG X 1891 WI To further the healing ministry of Jesus by improving the health and well-being of all people. 15 9 872 555 113646 -70801 35970 300647 103697436 107138132 93874 -129465 2755662 3340731 106582942 110650045 5000 0 0 0 50226679 52372103 0 0 0 51865069 48821182 102096748 101193285 4486194 9456760 135184153 143405746 68163657 66923860 67020496 76481886 The mission of Mercy Medical Center of Oshkosh, Inc. is to live out the healing ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor. false false 78208282 109210516 MERCY MEDICAL CENTER OF OSHKOSH, INC. PROUDLY SERVES THE OSHKOSH COMMUNITY WITH A HISTORY OF MORE THAN A CENTURY OF QUALITY CARE. THE FACILITY PROVIDES TOTAL HEALTH CARE, INCLUDING EMERGENCY/TRAUMA CARE AND SURGICAL SERVICES AS WELL AS MANY MEDICAL SPECIALTIES SUCH AS CARDIOLOGY, ONCOLOGY, ORTHOPEDICS, INTENSIVE CARE, OBSTETRICS AND NEUROSURGERY. MERCY IS THE HOME OF THE KENNEDY CENTER FOR THE HIP AND KNEE, A NATIONALLY-RECOGNIZED PROGRAM FOR HIP REPLACEMENT. WITH 157 PATIENT BEDS AND MORE THAN 300 MEDICAL STAFF, MERCY MEDICAL CENTER TREATS PATIENTS WITH DIGNITY AND COMPASSION. AVAILABLE SERVICES: CANCER; CARDIAC REHABILITATION; CARDIOVASCULAR SURGERY; DIABETES, NUTRITION AND ENDOCRINOLOGY; ER; GENERAL SURGERY; GYNECOLOGY; HOSPITALIST; LABORATORY; LIFELINE HOME MONITORING; NEPHROLOGY; OBSTETRICS; ORTHOPEDICS; PAIN MANAGEMENT; PALLIATIVE CARE (END OF LIFE CARE); PHARMACY; PSYCHIATRY/PSYCHOLOGY; PULMONOLOGY; RADIOLOGY; REHABILITATION SERVICES; SLEEP LAB; SPIRITUAL SERVICES; SPORTS MEDICINE; VASCULAR MEDICINE; WOUND CARE. 78208282 true true false true false false false false false true true false false true true true false true false false false false false false false false true true false false true false false false false false false false false true false false false false true true true false false true 61 0 true 872 true true true false false false false false false false false false X 15 9 true false false false true true true true true false false true true true true true true false false false WI X Craig Aittama 7153465161 5700 Lands End Way 2nd Floor Stevens Point WI 54482 WILLIAM J CALHOUN PRESIDENT (END 9/2014) 40.00 15.30 X X 0 431695 14940 MONICA ANN HILT VP EASTERN REGION, MHC (START 1/11/2015) 3.00 41.90 X X 0 572461 19954 STEPHEN C MORTON CHAIRMAN 0.40 1.10 X X 0 0 0 KATHRYN SIEMAN TREASURER 0.40 1.10 X X 0 0 0 WAYNE TREMBLY SECRETARY 0.40 1.10 X X 0 0 0 LANE EARNS BOARD MEMBER 0.40 1.10 X 0 0 0 MARK W FAUSTICH MD BOARD MEMBER 0.40 40.70 X 0 465056 3699 MARY HARP-JIRSCHELE BOARD MEMBER 0.40 1.10 X 0 0 0 FREDERICK KLEIN MD BOARD MEMBER 0.40 1.10 X 0 0 0 JOSEPH MCCORMICK MD BOARD MEMBER 0.40 1.10 X 0 456058 21532 KEVIN RALOFSKY BOARD MEMBER 0.40 0.80 X 0 0 0 STACEY SENSOR DO BOARD MEMBER 0.40 41.00 X 0 526309 23275 SUDEEP SODHI MD BOARD MEMBER 0.40 40.70 X 0 829590 21095 BARBARA J STRAND MD BOARD MEMBER 0.40 40.70 X 0 369312 7343 MONICA VOMASTIC BOARD MEMBER 0.40 1.10 X 0 0 0 MARLIN GREENFIELD BOARD MEMBER 0.40 1.10 X 0 0 0 JAY SAUTER BOARD MEMBER (END 9/30/14) 0.30 0.40 X 0 0 0 TRAVIS ANDERSON HOSPITAL PRES-STE-APP (END 8/2014) 0.00 27.50 X 0 344821 13716 NICHOLAS DESIEN MINISTRY HEALTH CARE CEO 0.40 55.20 X 0 2134343 18803 JEFFREY FRANCIS MINISTRY HEALTH CARE CAFO 0.40 54.40 X 0 1021840 19803 DANIEL NEUFELDER SR.VP - HOSPITAL OPS 0.40 62.90 X 0 1071649 17365 JEREMY NORMINGTON-SLAY HOSPITAL PRESIDENT-MMC (START 9/29/14) 40.30 0.30 X 0 70651 2362 MARK KEHRBERG MD CHIEF MEDICAL OFFICER AHS 10.00 30.60 X 0 487342 16019 DAVID K HOFFMAN PHARMACIST 35.00 0 X 165664 0 16498 MICHAEL R MILLER PHARMACIST 35.00 0 X 141548 0 17649 MATTHEW T SCHETTLE PHARMACIST 35.00 0 X 145834 0 19187 NICHOLAS A SYLVIA PHARMACY DIRECTOR 40.00 0 X 175520 0 1103 MICHAEL ZERNZACH CLINICAL STAFF PHARMACIST 40.00 0 X 138576 0 7725 JEFF BADGER FORMER OFFICER 0.00 0.00 X 0 659840 13832 767143 9440966 275900 24 true true false KENNEDY CENTER FOR THE HIP & KNEE 2700 W NINTH ST SUITE 125 OSHKOSH WI 54904 SALARIES/PROFESSIONAL FEES 4520412 ADVANCED ICU CARE INC PO BOX 671773 DALLAS TX 75267 PHYSICIAN SERVICES 506574 GUNDERSON INC 41 MAIN STREET MENASHA WI 54952 LINEN SERVICE 328202 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 STAFFING AGENCY 315070 MARSHFIELD LABORATORIES 1000 NORTH OAK AVE MARSHFIELD WI 54449 LABORATORY FEES 221600 10 X 0 0 0 262175 38472 0 32542 300647 NET PATIENT REVENUE 621100 104981140 104981140 RENT FROM EXEMPT ORG 531190 1273475 1273475 SLEEP LAB REVENUE 622999 319332 319332 OTHER PROGRAM SERVICE 900099 279685 169017 110668 PHARMACY 446110 284500 284500 0 0 0 0 107138132 -129465 -129465 810850 175505 635345 0 635345 635345 0 0 0 0 0 0 0 0 0 0 0 0 0 202017 180722 21295 0 0 21295 EHR INCENTIVE PYMNT 900099 1922401 1922401 CAFETERIA INCOME 446110 501039 2978 498061 EQUITY INT. IN AFL 900099 46977 46977 213674 213674 0 0 2684091 110650045 109210516 113646 1025236 0 0 40389443 31683238 8706205 1369589 1369589 8285281 5885950 2399331 2327790 2327790 19495 245 19250 30538 30538 8269 8269 6650258 5388221 1262037 0 14632483 14090227 542256 1959 1959 1999427 1359181 640246 365300 95226 270074 2154269 2154269 5946981 5212545 734436 437957 431837 6120 PURCHASED SERVICES 8289426 3652418 4637008 DRUGS 3945765 3930345 15420 FOOD 430616 383751 46865 DUES, RECRUITING 172360 30001 142359 3736079 180952 3555127 0 101193285 78208282 22985003 0 0 0 13697726 22559931 0 0 12874688 15316043 0 0 0 0 0 2493556 2651894 243603 440865 103590621 11020730 95070152 92569891 0 0 0 0 0 0 10804428 9867122 135184153 143405746 19055703 20046011 0 0 0 0 0 0 0 0 0 164919 13069 0 0 48943035 46864780 68163657 66923860 X 65468356 75065030 838140 702851 714000 714005 0 0 0 0 0 0 67020496 76481886 135184153 143405746 X 9456760 4630 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8269 8269 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Mercy Medical Center of Oshkosh, Inc. 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. 229791 -59992 3503 166296 126592 0 110077 0 0 6878 229791 93573 0 44639 0 0 11620 126592 -15262 0 116721 0 0 7886 93573 -10260 0 -4890 0 0 112 -15262 0.0 1.0 0.0 false true true 9977526 9977526 71246022 4868889 66377133 2041623 127416 1914207 19922877 6024425 13898452 402573 0 402573 92569891 A/R - ALL OTHER 4426343 OTHER LONG TERM ASSETS 2858584 INTEREST IN INVESTMENTS HELD BY ASCENSION HEALTH ALLIANCE 1606730 UNEMPLOYMENT DEPOSIT 975465 9867122 INTERCOMPANY DEBT WITH MINISTRY HEALTH CARE, INC. 42775688 PENSION LIABILITY 2315211 OTHER LONG TERM LIABILIITY 1032982 DUE TO THIRD PARTY 740899 46864780 X Schedule D, Part V, Line 4 Intended uses of endowment funds To support the mission and priorities of Mercy Medical Center, with an emphasis on charity care for the uninsured poor and continuing education of employees. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote From the consolidated audited financial statements of Ministry Health Care, Inc. which includes the activity of Mercy Medical Center of Oshkosh, Inc.: The Health Ministry accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. true true X true X true X true true true false true true 261990 0 261990 0.0026 2913818 0 2913818 0.0288 245695 0 245695 0.0024 0 0 3421503 0 3421503 0.0338 8 1263 601472 5482 595990 0.0059 2 5 449068 37390 411678 0.0041 2 0 3982218 3793170 189048 0.0019 0 0 0 0 0 0.0 9 4233 336277 1 336276 0.0033 21 5501 5369035 3836043 1532992 0.0151 21 5501 8790538 3836043 4954495 0.0490 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 75 6455 0 6455 0.0001 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 25 115 0 115 0.0000 0 0 0 0 0 0.0 2 100 6570 0 6570 0.0001 false 4318292 37258823 44902941 -7644118 X true true 1 1 MERCY MEDICAL CENTER OF OSHKOSH INC 500 SOUTH OAKWOOD ROAD OSHKOSH WI 54904 WWW.AFFINITYHEALTH.ORG 186 X X X MERCY MEDICAL CENTER OF OSHKOSH INC 1 false false true X X X X X X X X X 12 true true true true X http://www.affinityhealth.org/Affinity-Files/Community-Health-Needs-Assessments/FY2013-MMC-CHNA-2013 X true 12 true http://www.affinityhealth.org/Affinity-Files/Community-Health-Needs-Assessments/FY2013_MMC_Implement false false true X 2.0 4.0 X X X X true true X X X true X http://ministryhealth.org/Ministry_Health_Care/Financial_Assistance_Program_RC08.pdf X http://ministryhealth.org/Ministry_Health_Care/MHC_FinancialAid_Application_REV4.pdf X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MERCY MEDICAL CENTER OF OSHKOSH, INC.. Mercy Medical Center of Oshkosh, Inc. participated in the assessment processes that gathered input from both private and public Winnebago, Calumet, and Outagamie organization members including: medical staff, nurses and administrators, clinic personnel, public health nurses and educators, behavioral health staff and leaders, health insurance-health management staff, elementary, high school, and post high school educators, police and emergency personnel, child, women's, family and senior social services, as well as interested community members in the health needs assessment process, and service users. Throughout the assessment process, several Affinity representatives participated as members of the Fox Valley and Southern Winnebago L.I.F.E. study and/or the Fox Valley Regional Community Health Coalition. Leona Whitman, Manager of the Living Healthy Community Clinic, was consulted about the medically underserved community health needs. Winnebago County Public Health Experts: -Doug Gieryn, Director/Health Officer, Winnebago County Health Department, has twenty years public health experience with the last nine as Director/Health Officer for Winnebago County. He has previous experience with the City of Milwaukee specializing in environmental health, communicable disease, tuberculosis and refugee health. In 2010, he served as President of the Wisconsin Public Health Association. He has provided oversight of the consolidation of three local public health agencies in Winnebago County in a two-year process ending in 2012. -Denise Krueger, Public Health Nurse, Winnebago County Health Department Has twenty-five years RN experience in Emergency, Home Health and Public Health. thirteen years as public health nurse with the City of Oshkosh and she served as interim health officer for Oshkosh, conducting and overseeing community needs assessments, from 2011 until consolidation with Winnebago County in May 2012. She brought together and served as the chair for what is now the re:TH!NK Nutrition, Diabetes and Obesity (NOD) Committee, currently serving as the public health liaison. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - MERCY MEDICAL CENTER OF OSHKOSH, INC.. The CHNA was conducted with St. Elizabeth's Hospital, Calumet Medical Center, ThedaCare and Aurora Health. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Mercy Medical Center of Oshkosh, Inc.. The CHNA was conducted with the Health Departments of the city of Appleton, the city of Menasha, Calumet County, Outagamie County & Winnebago County. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Mercy Medical Center of Oshkosh, Inc.. Using the CHNA completed in fiscal year 2013, the hospital developed, adopted, and worked on executing an Implementation Strategy adopted in Fiscal Year 2013 (tax year 2012) to address priority community health needs. In 2014, the hospital implemented the following plan to address the priority needs: 1. Obesity: Reduce obesity in Fox Valley residents: Organize a kick-off event for Weight of the Fox Valley action teams. Expand Weight of the Fox Valley's web and social media presence. Establish a process to share BMI information between Weight of the Fox Valley partners. Increase awareness among Fox Valley residents about active community events and opportunities. 2. Mental Health: Decrease the rate of suicide and illegal drug use in the Fox Valley: Create QPR Portal to promote QPR training and resources, Provide QPR training to school leaders and healthcare providers in the Oshkosh area. Expand QPR trainings to Spanish speaking population in the area. Create community-wide suicide prevention collaboration. Advocate to make Narcan available to families of at-risk users of heroin. Provide educational programs for school and community re heroin. Needs Not Being Addressed: Alcohol consumption, asthma prevalence, preventive health services, smoking. Reasons/Narrative: Alcohol consumption (frequency and amount) is being addressed by Winnebago County re:TH!NK alcohol prevention and control, a program of the Winnebago County Health Department. Asthma prevalence is being addressed on a case by case basis through individual physicians in Affinity Medical Group Medical Home practices. This concern has not yet emerged as an actionable priority at the community level. Preventive health services are available through primary care services at the Living Healthy Community Clinic and Fox Cities Community Health Center for uninsured and under-insured low income individuals and families, as well as through the Wisconsin Well Woman Program. Gaps in services have not yet been addressed by the community. Smoking is being addressed by re:TH!NK tobacco prevention and control, a program of the Winnebago County Health Department and Affinity's "Call it Quits" program. 0 Schedule H, Part I, Line 3c Financial Assistance It is the policy of Mercy Medical Center of Oshkosh, Inc. to provide medically necessary health care services to people in the communities it serves, regardless of their ability to pay. Affinity Care financial assistance is granted based upon the patients' inability to pay and to individuals who are uninsured, under insured or medically indigent. Affinity Care works in collaboration with other financial (both public and private) assistance programs. This is to ensure holistic wellness of patients by facilitating knowledge of available services and programs for health while practicing good stewardship of funds. Key criteria utilized to determine eligibility for Affinity Care financial assistance includes family size, federal poverty income guidelines and available assets. The available asset test includes consideration of the amount of equity in a home, automobiles and savings accounts which are considered part of total allowable income when assessing against the federal poverty income guidelines. Schedule H, Part I, Line 6a Annual Community Benefit Report Mercy Medical Center of Oshkosh, Inc. is included in the annual community benefit report which is published by Ministry Health Care, Inc. (EIN: 39-1490371) and available to the public on its website, www.ministryhealth.org. This report includes all of the related entities within the Ministry Health Care network of hospitals, clinics and other health-related organizations. Schedule H, Part VI, Line 7 List of States List of States Receiving Community Benefit Report: WI Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Amounts calculated in Part I, Line 7 are determined both on a cost accounting system and a cost-to-charge ratio. Other benefits are determined based on the direct and indirect costs (where allocated) associated with a program net of earned revenue. Detail for each program/activity is maintained and determined at the department level. Charity care and means-tested programs are determined based on a cost-to-charge ratio consistent with worksheet 2, ratio of patient care cost to charges. Prior year cost report settlements are excluded from the shortfall calculation in order to get a true fiscal year shortfall amount. Schedule H, Part II Community Building Activities Community building activities include programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness and environmental problems. These activities support community assets by offering the expertise and resources of the organization. Costs for these activities include cash, in-kind donations and expenditures for the development of a variety of community health programs and partnerships. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Mercy Medical Center of Oshkosh, Inc. has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From the consolidated audited financial statements of Ministry Health Care, Inc. (which includes the activity of Mercy Medical Center of Oshkosh, Inc.): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience,economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Ministry follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Ministry's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Mercy Medical Center of Oshkosh, Inc. 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. Schedule H, Part V, Section B, Line 16a FAP website - MERCY MEDICAL CENTER OF OSHKOSH, INC.: Line 16a URL: http://ministryhealth.org/Ministry_Health_Care/Financial_Assistance_Program_RC08.pdf; Schedule H, Part V, Section B, Line 16b FAP Application website - MERCY MEDICAL CENTER OF OSHKOSH, INC.: Line 16b URL: http://ministryhealth.org/Ministry_Health_Care/MHC_FinancialAid_Application_REV4.pdf; Schedule H, Part VI, Line 2 Needs assessment Mercy Medical Center of Oshkosh, Inc. performs Community Health Needs Assessments as needed. Planning work groups consisting of community partners (e.g. Community Health Improvement Partnership (CHIP)) are formed to define the community and its health needs through review of United Way Life Study results, 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 under served. 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 will collaborate through community partnerships (or individually) to address the identified need. Outcomes from the programs are measured and considered in subsequent community health needs assessments. The leadership at Affinity takes their commitment to the health and well-being of the community it serves very seriously. In fact, it is core to the Organization's mission, "to live out the healing Ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor". Senior Leaders and management are also highly encouraged to provide direct service to the poor in their communities. Mercy Medical Center of Oshkosh, Inc. and the Leadership also subscribe to publications like the advisory board to compare national trends to local trends to ensure the hospital is resourcing areas to meet patient needs. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Mercy Medical Center of Oshkosh, Inc. 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 Affinity Care Policy. The Affinity Care Policy and application is posted on the organization's website. Admissions and other key areas contain summary information of the Affinity 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, care encounter, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to Mercy Medical Center of Oshkosh, Inc. Affinity Care Program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of Affinity Care financial assistance can be initiated by any member of the Hospitals' workforce, including medical staff members, who become aware of the patient's potential need for Affinity Care financial assistance. The Affinity Care brochure was also translated into dialects prevalent in the community in order to reach out to those that may speak another language (Spanish and Hmong). Patient registration staff and financial counselors are provided with guidelines to follow when interacting with patients. As part of the Affinity Care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs. Schedule H, Part VI, Line 4 Community information 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. The Organization 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. Mercy Medical Center of Oshkosh, Inc., like most community hospitals, was created and is maintained in order to provide care locally-care that without our Hospital may not be available locally. Certain specialized services available include; in-patient adult behavioral health services, in-patient rehabilitation services, and in-patient sub-acute services. The City of Oshkosh is located in Winnebago County. The population of Winnebago County as of the 2010 census data was 166,994. According to the census data, there were 66,083 people living in Oshkosh, consisting of 26,138 households and 13,836 families. The population density of Oshkosh was 2,582.3 people per square mile. The population consisted of 88.9% White, 2.7 % Hispanic, 3.0% African American, 0.7% Native American, 3.2 % Asian, and 1.4% Other. Of the 26,138 households in Oshkosh, 25.7% of those had children under the age of 18 living at home. The 26,138 households are categorized as 38.7% married couples living together, 4.3% had a male head of household with no wife present, 10% had a female head of household with no husband present, and 47% were non-families. 34.4% of the households consisted of individuals and 11.4% had someone 65 and older living alone. The age population is widely spread. 24% were under 18, 13.4% were 19-24, 26.7% were 25-44, 23% were 45-64, and 12.9% were 65+. The median income for a household was $42,938 and the median income for a family was $58,027. The per capita income for the city was $21,901. The largest industry in Oshkosh is educational, health and social services (22.6%). Manufacturing (21.2%) and retail trade (14.2%) are the next largest industries in Oshkosh. Roughly 10.1% of families and 17.8% of the population were below the poverty line. That includes 18.9% of those under 18 years old and 9.1% of those 65 and older. The unadjusted seasonal unemployment rate for Winnebago County as of 2012 was 4.3%, compared to a state unemployment rate of 5.1% and a national unemployment rate of 7.9%. Schedule H, Part VI, Line 5 Promotion of community health Mercy Medical Center of Oshkosh, Inc.'s governing board consists primarily of persons who reside within the primary service area. The majority of the governing board are not employees of the Organization or a related organization. The Organization strives to further its exempt purposes by the following: - Mercy Medical Center of Oshkosh, Inc. participates in government-sponsored health programs (Medicare, Medicaid, Champus, general relief, specialized county programs, and area prisons). Mercy Medical Center of Oshkosh, Inc. donates food to area shelters. - Mercy Health Foundation donated funds to support area organizations that provide services to the following sectors of our population: low-income, physically and mentally challenged, and chronically ill. Mercy Medical Center of Oshkosh, Inc. works with local police departments in the performance of sexual assault exams. The patient does not incur a bill for the exam and the charges are written off. Mercy Medical Center of Oshkosh, Inc. provides community health improvement services through health education lectures, health fairs and support groups. - Mercy Medical Center of Oshkosh, Inc. conducts cardiac and pulmonary rehabilitation family education sessions. Discounted care is provided to low income families up to 300% of federal poverty guidelines. - Mercy Medical Center of Oshkosh, Inc. is a disproportionate share hospital with a combined Medicaid and SSI utilization of over 21.19%. Mercy Medical Center of Oshkosh, Inc. provides a subsidy to a school of radiologic technology program. - Mercy Medical Center of Oshkosh, Inc. serves as a sponsor site for clinical training of college students in various health care programs. Mercy Medical Center of Oshkosh, Inc. helps to subsidize an area community clinic that serves the uninsured and low income members of the community. Support consists of cash donations for operations, use of clinic building and lab and x-ray services. Schedule H, Part VI, Line 6 Affiliated health care system MINISTRY HEALTH CARE, INC. (MINISTRY OR THE HEALTH MINISTRY) IS A MEMBER OF ASCENSION HEALTH. IN DECEMBER 2011, ASCENSION HEALTH ALLIANCE, DOING BUSINESS AS ASCENSION, BECAME THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTH CARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. IN ADDITION TO SERVING AS THE SOLE CORPORATE MEMBER OF ASCENSION HEALTH, ASCENSION SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS OTHER SUBSIDIARIES. ASCENSION, ITS SUBSIDIARIES, AND THE HEALTH MINISTRIES ARE REFERRED TO COLLECTIVELY FROM TIME TO TIME HEREAFTER AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE, THE CONGREGATION OF ST. JOSEPH, THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET, THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE, AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI-US/CARIBBEAN PROVINCE. THE HEALTH MINISTRY IS A WISCONSIN NON-STOCK, TAX-EXEMPT CORPORATION THAT MANAGES, PROMOTES, AND SUPPORTS HEALTH CARE AND RELATED MINISTRIES IN WISCONSIN AND MINNESOTA. THE HEALTH MINISTRY PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF WISCONSIN AND MINNESOTA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. THE HEALTH MINISTRY IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF THE HEALTH MINISTRY ARE RELATED TO PROVIDING HEALTH CARE SERVICES. EFFECTIVE NOVEMBER 1, 2014, THE HEALTH MINISTRY SOLD 50% OF ITS OWNERSHIP IN NETWORK HEALTH, INC. TO AN UNRELATED HEALTH SYSTEM (SEE NOTE 3). ON FEBRUARY 1, 2015, THE HEALTH MINISTRY TRANSFERRED ITS OWNERSHIP IN MINISTRY HOME CARE, INC. TO ASCENSION HEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING AFFILIATES LOCATED PRIMARILY IN WISCONSIN, IN WHICH MINISTRY HAS A CONTROLLING INTEREST AND/OR IS THE SOLE SPONSOR. AFFINITY HEALTH SYSTEM, INC. (AFFINITY): CALUMET MEDICAL CENTER, INC. (CMC): AFFINITY MEDICAL GROUP (AMG) TWIN MED, LLC MERCY MEDICAL CENTER, INC. MERCY HEALTH FOUNDATION ST. ELIZABETH HOSPITAL CATALPA HEALTH: ST. ELIZABETH FOUNDATION AGAPE COMMUNITY CENTER OF MILWAUKEE, INC. DOOR COUNTY MEMORIAL HOSPITAL (DOOR COUNTY) GOOD SAMARITAN HEALTH CENTER OF MERRILL GOOD SAMARITAN HEALTH CENTER FOUNDATION HOWARD YOUNG HEALTH CARE, INC. (HOWARD YOUNG): DR. KATE NEWCOMB CONVALESCENT CENTER HOWARD YOUNG MEDICAL CENTER, INC. DR. HOWARD YOUNG FOUNDATION EAGLE RIVER MEMORIAL HOSPITAL, INC. MINISTRY MEDICAL GROUP, INC. MINISTRY HOLDINGS, INC. (THROUGH NOVEMBER 1, 2014): NETWORK HEALTH (NH) (THROUGH NOVEMBER 1, 2014) NETWORK HEALTH INSURANCE CORPORATION (NHIC) (THRU NOVEMBER 1, 2014) OUR LADY OF VICTORY HOSPITAL SACRED HEART HOSPITAL-ST. MARY'S HOSPITAL, INC. ST. CLARE'S HOSPITAL OF WESTON, INC. FOUNDATION OF ST. CLARE'S HOSPITAL OF WESTON, INC. ST. ELIZABETH'S HOSPITAL OF WABASHA, INC. ST. JOSEPH'S HOSPITAL OF MARSHFIELD, INC. FOUNDATION OF ST. JOSEPH'S HOSPITAL OF MARSHFIELD, INC. ST. MICHAEL'S HOSPITAL OF STEVENS POINT, INC. ST. MICHAEL'S FOUNDATION OF STEVENS POINT, INC. THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE THAT SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND TO OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND FOR COMMUNITY BENEFIT PROGRAMS: 1. TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. 2. UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS. 3. COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND THE OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. 4. COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY OR IN THE COST OF OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OF OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA AND IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF TOTAL OPERATING EXPENSES TO BILLED CHARGES FOR PATIENT CARE. THE AMOUNT OF TRADITIONAL CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, WAS APPROXIMATELY $12,600 AND $18,400 FOR THE YEARS ENDED JUNE 30, 2015 AND 2014, RESPECTIVELY. THE AMOUNT OF UNPAID COST OF PUBLIC PROGRAMS, COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS, AND COST OF COMMUNITY BENEFIT PROGRAMS ARE REPORTED IN THE ACCOMPANYING SUPPLEMENTARY INFORMATION. false true false false false false false false false WILLIAM J CALHOUN PRESIDENT (END 9/2014) 0 287898 0 120923 0 22874 0 0 0 14940 0 446636 0 0 MONICA ANN HILT VP EASTERN REGION, MHC (START 1/11/2015) 0 331953 0 118639 0 121869 0 0 0 19954 0 592415 0 0 MARK W FAUSTICH MD BOARD MEMBER 0 440913 0 0 0 24143 0 0 0 3699 0 468754 0 0 JOSEPH MCCORMICK MD BOARD MEMBER 0 424443 0 1000 0 30615 0 0 0 21532 0 477590 0 0 STACEY SENSOR DO BOARD MEMBER 0 526309 0 0 0 0 0 0 0 23275 0 549584 0 0 SUDEEP SODHI MD BOARD MEMBER 0 817681 0 0 0 11909 0 0 0 21095 0 850685 0 0 BARBARA J STRAND MD BOARD MEMBER 0 258827 0 84720 0 25765 0 0 0 7343 0 376654 0 0 JEFF BADGER FORMER OFFICER 0 264031 0 374899 0 20910 0 0 0 13832 0 673672 0 0 TRAVIS ANDERSON HOSPITAL PRES-STE-APP (END 8/2014) 0 176807 0 136945 0 31068 0 0 0 13716 0 358537 0 0 NICHOLAS DESIEN MINISTRY HEALTH CARE CEO 0 1009502 0 1079643 0 45198 0 0 0 18803 0 2153146 0 0 JEFFREY FRANCIS MINISTRY HEALTH CARE CAFO 0 438327 0 141768 0 441745 0 0 0 19803 0 1041644 0 0 DANIEL NEUFELDER SR.VP - HOSPITAL OPS 0 791344 0 259379 0 20926 0 0 0 17365 0 1089014 0 0 MARK KEHRBERG MD CHIEF MEDICAL OFFICER AHS 0 113129 0 344147 0 30066 0 0 0 16019 0 503361 0 0 DAVID K HOFFMAN PHARMACIST 146603 0 0 0 19061 0 0 0 16498 0 182162 0 0 0 MICHAEL R MILLER PHARMACIST 130387 0 0 0 11161 0 0 0 17649 0 159197 0 0 0 MATTHEW T SCHETTLE PHARMACIST 122009 0 11760 0 12065 0 0 0 19187 0 165021 0 0 0 NICHOLAS A SYLVIA PHARMACY DIRECTOR 170395 0 4800 0 325 0 0 0 1103 0 176623 0 0 0 Schedule J, Part I, Line 3 CEO Compensation Ministry Health Care, Inc., a related organization of Mercy Medical Center of Oshkosh, Inc., uses the following methods to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board of Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan 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. The following individuals received payout from Ministry Health Care's nonqualified retirement plan in the amount as noted: Jeffrey Francis - $260,079 Monica Hilt - $52,618 X WISCOM RADIOS 1 32542 Market value 0 false true false Schedule M, Part I Explanations of reporting method for number of contributions Other: THE AMOUNTS SHOWING COLUMN (B) REPRESENT THE NUMBER OF CONTRIBUTIONS. Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIPS AMONG INTERESTED PERSONS MANY OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EMPLOYMENT BY MINISTRY HEALTHCARE, INC. RELATED ENTITIES. Form 990, Part VI, Line 15b CEO COMPENSATION IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF MERCY MEDICAL CENTER OF OSHKOSH, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE 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. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS OF THE ORGANIZATION, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF MERCY MEDICAL CENTER OF OSHKOSH, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS 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, Line 6 Classes of members or stockholders Mercy Medical Center of Oshkosh, Inc. has a single corporate member, Ministry Health Care, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Mercy Medical Center of Oshkosh, Inc. has a single corporate member, Ministry Health Care, Inc. who has the ability to elect members to the governing body of Mercy Medical Center of Oshkosh, Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to Mercy Medical Center of Oshkosh, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, Ministry Health Care, Inc. Form 990, Part VI, Line 11b Review of form 990 by governing body Management, including certain officers, 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, Line 12c Conflict of interest policy 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 on the governing board or committee will decide if conflicts of 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 understands 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, Line 19 Required documents available to the public The Ministry web page is available to the public for inspection with a good deal of information regarding who Ministry Health Care is and the entities included 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 VIII, Line 11d Other Miscellaneous Revenue Interest on Patient Accts - Total Revenue: 24175, Related or Exempt Function Revenue: 24175, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Vendor Discounts/Rebates - Total Revenue: 27907, Related or Exempt Function Revenue: 27907, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Credit Card (Procurement) Revenue - Total Revenue: 50853, Related or Exempt Function Revenue: 50853, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Trade-in reclassification - Total Revenue: 11963, Related or Exempt Function Revenue: 11963, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Corporate Overhead Allocation - Total Revenue: 98776, Related or Exempt Function Revenue: 98776, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Donations from Restricted Funds - 17829; FASB136 Elimination-Mercy Health Foundation - -135284; Transfer from Mercy Health Foundation, Inc - 143381; Gift Shop Revenue - -21296; ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false MINISTRY HEALTH CARE INC 10925 W LAKE PARK DR STE 100 MILWAUKEE WI 53224 391490371 PARENT CORPORATION WI 501(c)(3 Type II ASCENSION HEALTH false AFFINITY HEALTH SYSTEM 1570 MIDWAY PLACE MENASHA WI 54952 391568866 SUPPORT RELATED HEALTHCARE ORGANIZATIONS IL 501(c)(3 Type II MINISTRY HEALTH CARE INC true AGAPE COMMUNITY CENTER OF MILWAUKEE INC 6100 NORTH 42ND STREET MILWAUKEE WI 53209 391461846 COMMUNITY CENTER WI 501(c)(3 7 MINISTRY HEALTH CARE INC true CALUMET MEDICAL CENTER INC 614 MEMORIAL DRIVE CHILTON 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