2016-08-15T11:30:55-05:00 2015-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2014-10-01 390884478 BELLIN MEMORIAL HOSPITAL INC BELL 9204457260 PO BOX 23400 GREEN BAY WI 54305 JAMES DIETSCHE CFO 9204457260 2016-08-15 1 TERRI REXRODE CPA MST P00096513 9206620016 2016-08-15 2014 2016-09-27 15:27:22Z JAMES DIETSCHE PO BOX 23400 GREEN BAY WI 54305 464433932 0 X WWW.BELLIN.ORG X 1908 WI BELLIN MEMORIAL HOSPITAL, INC. (BMH) PROVIDES HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BMH, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, BMH PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR ARE UNINSURED OR UNDERINSURED. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID, ARE ALSO CONSIDERED PART OF THE BELLIN HEALTH BENEFITS PROVIDED TO THE COMMUNITY SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN COST. 22 16 3482 400 7857359 -1285635 891863 1097065 420816902 449192956 6685782 5978466 -5639259 3911513 422755288 460180000 374013 1225882 0 0 211696605 227999752 0 0 0 175184267 194357613 387254885 423583247 35500403 36596753 424570585 454995944 137984774 140678606 286585811 314317338 TO ENGAGE INDIVIDUALS, FAMILIES, EMPLOYERS AND COMMUNITIES IN THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH AND TO PROVIDE SAFE, EASY-TO-USE, HIGH QUALITY, COST-EFFECTIVE, TOTAL HEALTH SOLUTIONS. 0 0 319900266 1225882 429739769 THE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2015 33,329 INPATIENT DAYS WERE PROVIDED (30,590 ADULTS AND PEDIATRICS), AS COMPARED TO 33,964 (31,324 ADULTS AND PEDIATRICS) IN FISCAL YEAR 2014. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2015 AND 2014 WERE 256,348 AND 247,851, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 741,432 (AS COMPARED TO 565,546 IN 2014) PHYSICIAN CLINIC VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS. 17491452 14058890 NORTHREACH HEALTHCARE IS A PRIMARY CARE ORGANIZATION WITH SERVICE LINES OF FAMILY PRACTICE, OB/GYN, PEDIATRICS, AND INTERNAL MEDICINE. NORTHREACH PROVIDES SERVICE TO MARINETTE COUNTY, MENOMINEE COUNTY, AND THE SURROUNDING AREAS. 337391718 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 319 0 3482 1 1 1 0 0 0 0 0 0 0 0 0 X 22 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X JAMES DIETSCHE CFOVP 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 TERRY FULWILER CHAIR 0.50 X X 0 0 0 ELL LEE DDS VICE CHAIR 0.50 X X 0 0 0 MARK MCMULLEN SECRETARY 0.50 X X 0 0 0 JOHN UNDERWOOD FORMER TREASURER 0.50 X X 0 0 0 NANCY ARMBRUST BOARD MEMBER 0.50 X 0 0 0 G CORT CONDON BOARD MEMBER 0.50 X 0 0 0 DANIEL GULLING BOARD MEMBER 0.50 X 0 0 0 ROBERT MEAD MD - TERMED BOARD MEMBER/PRESIDENT BMG 50.00 X 251405 0 34533 FRED SCHMIDT MD BOARD MEMBER 0.50 X 0 0 0 DANIEL ARIENS BOARD MEMBER 0.50 X 0 0 0 WILLIAM WITTMAN MD BOARD MEMBER/BMG PHYSICIAN 50.00 X 294847 0 25594 LARRY BORGARD BOARD MEMBER 0.50 X 0 0 0 JOHN JONES BOARD MEMBER 0.50 X 0 0 0 SUSAN FINCO BOARD MEMBER 0.50 X 0 0 0 MICHAEL HADDAD BOARD MEMBER 0.50 X 0 0 0 LOREN FUGLESTAD MD BOARD MEMBER/BMG PHYSICIAN 50.00 X 298785 0 58814 CHRISTINE VANDENHOUTEN BOARD MEMBER 0.50 X 0 0 0 JOHN DYKEMA TREASURER 0.50 X X 0 0 0 ROBERT CLAUSEN BOARD MEMBER 0.50 X 0 0 0 GEORGE KERWIN PRESIDENT/CEO 50.00 X X 847178 0 35246 PATRICK MANSKY MD - TERMED BOARD MEMBER/PHYSICIAN 50.00 X 737082 0 22872 DENIS HOGAN BOARD MEMBER 0.50 X 0 0 0 CYNTHIA LASECKI MD BOARD MEMBER/PHYSICIAN 50.00 X 267092 0 17188 MARK RINGWELSKI MD BOARD MEMBER/PHYSICIAN 50.00 X 254486 0 26784 SABINA SINGH MD BOARD MEMBER/PHYSICIAN 50.00 X 241181 0 16693 JAMES DIETSCHE CFO 50.00 X 361178 0 30986 PETER KNOX EXECUTIVE VP 50.00 X 423233 0 36235 CHRISTINE WOLESKE EXECUTIVE VP 50.00 X 378894 0 36573 CHRISTOPHER WOLFRAM MD PHYSICIAN 40.00 X 943854 0 30397 TIMOTHY TANKE MD PHYSICIAN 40.00 X 875354 0 30586 RICHARD TIMMONS MD PHYSICIAN 40.00 X 852348 0 35024 JAMES RIDER MD PHYSICIAN 40.00 X 782531 0 34098 PAUL HUDSON MD PHYSICIAN 40.00 X 823014 0 37352 8632462 0 508975 261 0 1 0 BLR FURTHER LLC 4841 SUMMER AVENUE MEMPHIS TN 38122 ADVERTISING 2324948 NORDIC CONSULTING 740 REGENT STREET SUITE 400 MADISON WI 53715 EPIC CONSULTING SERVICES 1564857 AMERI EBO LLC 1851 S ALVERNO ROAD MANITOWOC WI 54220 COLLECTION SERVICES 1503073 IEI GENERAL CONTRACTORS INC 1725 MIDWAY ROAD DE PERE WI 54115 CONSTRUCTION SERVICES 1293707 BAY TOWEL LINEN & UNIFORM RENTAL 2580 S BROADWAY GREEN BAY WI 54304 CONTRACTED SERVICES 1045844 55 622793 474272 1097065 NET PATIENT SERVICE REVENUE 621500 440803346 433663578 7139768 CONTRACTED SERVICES 621110 3449030 3449030 MISCELLANEOUS 621110 2594951 2594951 CAFETERIA 621110 853690 853690 ACO INCENTIVE 621110 616132 616132 875807 69948 717591 88268 449192956 3966013 3966013 3126293 53271 2307581 53271 818712 0 818712 818712 2430114 1475419 0 1893080 2430114 -417661 2012453 2012453 INCOME FROM HEALTHCARE AFFILIATES 900099 2384599 2384599 EHR INCENTIVE 621110 708202 708202 3092801 460180000 443486440 7857359 7739136 1225882 1225882 4696878 2547355 2149523 183486692 160654091 22832601 8186167 6989940 1196227 19996268 16896916 3099352 11633747 9909434 1724313 609287 609287 718611 19930 698681 574547 574547 27601305 17457166 10144139 7138285 46917 7091368 1603951 1197894 406057 7347313 3588747 3758566 10782824 10229306 553518 1090987 625515 465472 1360295 651633 708662 4441033 375971 4065062 19273882 14336443 4937439 1274621 828405 446216 SUPPLIES 70015754 69244208 771546 DUES/SUBSCRIPTIONS 11564867 9769580 1795287 EQUIPMENT RENT/MAINT 10109303 766440 9342863 BAD DEBTS 8554024 8541603 12421 10296724 879055 9417669 423583247 337391718 86191529 0 11959 15994 73187804 90773641 44842167 48389694 10078772 6347210 5206341 4987231 6755553 6774092 327606716 182650726 145265557 144955990 112501590 123364419 10702660 13839345 6455873 6105842 9562309 9442486 424570585 454995944 43246768 38980842 428585 320036 69788940 72367813 24520481 29009915 137984774 140678606 X 283186098 310758298 1084305 1388632 2315408 2170408 286585811 314317338 424570585 454995944 X 36596753 -5593100 -3272126 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 23519 23519 0 PART II-B, LINE 1: AHA AND WHA DUES 2446300 101050 -255551 -8686 2283113 2417823 35966 7489 2446300 2372548 48841 3566 2417823 2239178 86124 68097 20851 2372548 2220544 129100 -1472 108994 2239178 0.00000 0.95060 0.04940 1 1 1 7155673 7155673 124908703 51844632 73064071 2348682 1750694 597988 188215815 129055400 59160415 4977843 4977843 144955990 DEFERRED COMPENSATION 7784726 NONCONTROLLING INTEREST OF CONSOLIDATED AFFILIATE 1042246 CAPITAL LEASE OBLIGATIONS 9977061 INTEREST RATE SWAP VALUATION 9159347 DUE TO AFFILIATES 1046535 29009915 444882787 -5593100 -11292866 -16885966 461768753 -1588753 -1588753 460180000 417672163 -5371610 -5371610 423043773 539474 539474 423583247 PART V, LINE 4: ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR HEALTH CARE SERVICES AND EMPLOYEE TRAINING AND DEVELOPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SWAP AGREEMENT -1,632,401. NON-CONTROLLING INTEREST -1,928,003. LOSS OF DEBT REFUNDING -7,732,462. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM FOUNDATION 622,793. HOSPITAL SUPPLIES 149,306. RENTAL EXPENSES -2,360,852. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 2,360,852. LOSS OF DEBT REFUNDING -7,732,462. PART XII, LINE 4B - OTHER ADJUSTMENTS: REALLOCATION OF SUPPLIES EXPENSE TO 990T 149,306. EXPENSES PAID FOR BY FOUNDATION TRANSFERS 390,168. 1 1 1 X 1 X 1 1 0 1 1 3056792 3056792 0.00740 50654535 27555811 23098724 0.05570 53711327 27555811 26155516 0.06310 3137180 3137180 0.00760 1980152 1980152 0.00480 1387111 1387111 0.00330 6504443 6504443 0.01570 60215770 27555811 32659959 0.07880 1549795 1549795 0.00370 1549795 1549795 0.00370 1 3316682 121516195 168277444 -46761249 X 1 1 1 BELLIN ORTHOPEDIC SURGERY CENTER LLC ORTHOPEDIC SURGERY CENTER 0.55000 0.45000 1 1 BELLIN MEMORIAL HOSPITAL 744 S WEBSTER AVENUE GREEN BAY WI 54305 WWW.BELLIN.ORG 147 X X X BELLIN MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 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 1 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X 1 X WWW.BELLIN.ORG/PATIENTS_VISITORS/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE X X X X 0 0 X X X X 1 X 1 0 BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE BROWN COUNTY AND CITY OF DE PERE HEALTH DEPARTMENTS CONVENED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT INCLUDED REPRESENTATIVES FROM BELLIN HEALTH, ST. MARYS AND ITS SISTER HOSPITAL, ST. VINCENTS, AURORA HEALTH, BROWN COUNTY UNITED WAY, AND THE REGIONAL OFFICE OF WISCONSIN'S DEPARTMENT OF HEALTH. THIS STEERING COMMITTEE WORKED TO IDENTIFY REPRESENTATIVES THAT COULD BROADLY REPRESENT THE COMMUNITY IN ACTUALLY CONDUCTING THE NEEDS ASSESSMENT AND SETTING PRIORITIES. THESE INDIVIDUALS WERE REFERRED TO AS COMMUNITY PARTNERS AND ARE THE FOLLOWING:ACHIEVE BROWN COUNTY: ADAM HARDYAGING AND DISABILITY RESOURCE CENTER: MEREDITH HANSEN, JANELLE WATSONAURORA BAYCARE MEDICAL CENTER: AMY HERDEE, MARK HUBER*BAY AREA COMMUNITY COUNCIL: BOB WOESSNERBC PLANNING AND LAND SERVICES DEPARTMENT: DAN TEATERSBELLIN COLLEGE: KATHIE DE MUTHBELLIN HEALTH: SHARLA BAENEN, LAURA CORMIER, CHRISTOPHER ELFNER, LAURA HIEB*, JOHN ROCHELEAU*, JODI WILMET*BROWN COUNTY EXECUTIVE OFFICE: TROY STRECKENBACHBROWN COUNTY COMMUNITY TREATMENT CENTER: TINA CAZZOLABROWN COUNTY HEALTH DEPARTMENT: DEBORAH ARMBRUSTER, JUDY FRIEDERICHS*, ROB GOLLMAN, STACY ROSS, PATTI SMEESTER, CHUA XIONGBROWN COUNTY HUMAN SERVICES: MARY MICELI-WINKBROWN COUNTY ORAL HEALTH PARTNERSHIP: CARRIE STEMPSKIBROWN COUNTY UNITED WAY: HOWARD ENDOW*, SARAH INMAN, GREG MAASS, JILL SOBIECK, ASHLEY VANDENBOOMENCATHOLIC CHARITIES: CELIA LATOURCENTER FOR CHILDHOOD SAFETY: KIMBERLY HESSCITY OF DE PERE BOARD OF HEALTH: MIKE DONOVAN, PATRICIA FINDER-STONEDE PERE HEALTH DEPARTMENT: ERIN BONGERS, CHRYSTAL WOLLER*ELIZK INSURANCE: ELIZABETH KOSTICHKAGREATER GREEN BAY CHAMBER: GRANT DVORAKGREATER GREEN BAY YMCA: SANDY ATKINSHOSPITAL SISTERS HEALTH SYSTEM: ELAINE DOXTATOR, PATTI GLASER-MARTIN, HEIDI SELBERG*LIBERTA: BARBARA CONIFFLIVE54218: JOHN DYE, MELINDA MORELLA, JEN VAN DEN ELZENN.E.W. COMMUNITY CLINIC: JAMIE CAMPBELL, BONNIE KUHR, SETH MOORE, CATHERINE THERRIENN.E.W. CURATIVE REHABILITATION: STEVE MCCARTHYNORTHEAST WISCONSIN TECHNICAL COLLEGE: SCOTT ANDERSONPREVEA HEALTH: ANGELA RALEIGHSCHNEIDER NATIONAL: CHRISTINE SCHNEIDERST. NORBERT COLLEGE:ST. NICHOLAS HOSPITAL: MARY PALUCHNIAKST. VINCENT HOSPITAL: DONNA BOEHM, CAROLINE GLANDER, KAITLIN SWANSONSTATE OF WISCONSIN-DIVISION OF PUBLIC HEALTH: ELIZABETH SCHEELKUNIFIED SCHOOL DISTRICT OF DE PERE: MARGIE HEMPELUW-GREEN BAY: THOMAS ERDMAN, SARAH HIMMELHEBER, CHRISTINE VANDENHOUTEN, LEANNE ZHUBROWN COUNTY UW-EXTENSION: KAREN EARLYWEST DE PERE SCHOOL DISTRICT: DAWN SCHAEFERWI DEPARTMENT OF HEALTH NORTHEAST REGION: CHRISTOPHER COLLETTA** STEERING COMMITTEE MEMBER BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: AURORA BAYCARE MEDICAL CENTER (GREEN BAY) AND ST. MARY'S AND ST. VINCENT HOSPITALS (HSHS, GREEN BAY) BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BROWN COUNTY HEALTH DEPARTMENT, CITY OF DE PERE HEALTH DEPARTMENT, BROWN COUNTY UNITED WAY, AND WI DIVISION OF PUBLIC HEALTH NE REGIONAL OFFICE BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE 2012-2014 CHNA FOCUSED ON:- ORAL HEALTH- ADEQUATE AND APPROPRIATE FOOD AND NUTRITION- ALCOHOL AND OTHER DRUG ABUSE (AODA)THE 2015-2017 CHNA RECOMMENDED CONTINUED WORK IN THESE THREE AREAS. IT ALSO IDENTIFIED ADDITIONAL AREAS OF NEED AND RECOMMENDED DEVELOPING WORK TEAMS TO FOCUS ON:- MENTAL HEALTH- PHYSICAL ACTIVITY BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 22D: PATIENTS CAN QUALIFY FOR COMMUNITY CARE OR A DISCOUNT DEPENDING ON LEVEL OF QUALIFICATION PRIMARILY DEPENDENT ON INCOME LEVEL AND FAMILY SIZE. THE DISCOUNT IS TAKEN FROM 80% OF GROSS CHARGES. A FAP ELIGIBLE PATIENT WILL NEVER BE RESPONSIBLE FOR MORE THAN 15% OF THEIR ANNUAL INCOME. BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 23: THERE IS A POSSIBILITY UNDER THE POLICY AS IT CURRENTLY EXISTS THAT THIS MAY HAPPEN; HOWEVER, THE PROBABILITY IS REMOTE. A PATIENT COULD QUALIFY UNDER THE FINANCIAL ASSISTANCE AND GET A PERCENTAGE DISCOUNT (IN ADDITION TO THE 20% SELF PAY DISCOUNT) THAT IS LESS THAN THE DISCOUNT GIVEN TO AN INDIVIDUAL WITH INSURANCE. THIS WILL BE CORRECTED BY 09/30/16 TO ELIMINATE THIS REMOTE POSSIBILITY. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: WWW.BELLIN.ORG/PATIENTS_VISITORS/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE 45 THE CANCER TEAM OF BELLIN HEALTH 1580 COMMANCHE AVENUE GREEN BAY WI 54313 HOSPITAL BASED SITE CARDIOLOGY ASSOCIATES OF BELLIN HEALTH 744 S WEBSTER AVENUE GREEN BAY WI 54301 HOSPITAL BASED SITE FAMILY MEDICAL CENTER ASHWAUBENON 1630 COMMANCHE AVENUE GREEN BAY WI 54313 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER DE PERE EAST 555 REDBIRD CIRCLE DE PERE WI 54115 PROVIDER CLINIC SITE BELLIN HEALTH GENERATIONS 704 S WEBSTER AVENUE SUITE 300 GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER HOWARD 2714 RIVERVIEW GREEN BAY WI 54313 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER BELLEVUE 3263 EATON ROAD GREEN BAY WI 543116830 PROVIDER CLINIC SITE BELLIN HEALTH SURGICAL ASSOCIATES 720 S VAN BUREN STREET SUITE 201 GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER DE PERE WEST 1800 LAWRENCE DRIVE DE PERE WI 54115 PROVIDER CLINIC SITE BELLIN HEALTH IRON MOUNTAIN 440 WOODWARD AVENUE IRON MOUNTAIN MI 49801 PROVIDER CLINIC SITE BELLIN HEALTH CARDIOVASCULAR & THORACIC 720 S VAN BUREN STREET SUITE 303 GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH INTERNAL MEDICI 3123 SHORE DRIVE SUITE 102 MARINETTE WI 54143 PROVIDER CLINIC SITE BELLIN HEALTH ESCANABA 610 S LINCOLN ROAD ESCANABA MI 49829 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER GREEN BAY 704 S WEBSTER AVENUE GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH PEDIATRICS 1106 UNIVERSTIY DRIVE MARINETTE WI 54143 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH CRIVITZ MEDICAL 218 S HWY 141 CRIVITZ WI 54114 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER KEWAUNEE 575 4TH STREET KEWAUNEE WI 54216 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH FAMILYCARE MEDI 3123 SHORE DRIVE MARINETTE WI 54143 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH MENOMINEE MEDIC 1100 10TH STREET MENOMINEE MI 49858 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER ALGOMA 831 PARKER AVENUE ALGOMA WI 54201 PROVIDER CLINIC SITE NEUROLOGY CONSULTANTS OF BELLIN HEALTH 725 S WEBSTER AVENUE GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER BRILLION 964 W RYAN STREET SUITE B BRILLION WI 54110 PROVIDER CLINIC SITE BELLIN HEALTH OCONTO FALLS 107 E HIGHLAND DRIVE OCONTO FALLS WI 54154 PROVIDER CLINIC SITE BELLIN HEALTH ASTHMA & ALLERGY 519 S MONROE AVENUE GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH OBGYN 3123 SHORE DRIVE SUITE 201 MARINETTE WI 54143 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER DENMARK 595 COUNTY ROAD R DENMARK WI 54208 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH PESHTIGO FAMILY 441 FRENCH STREET PESHTIGO WI 54143 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER SEYMOUR 405 COMMERCIAL STREET SEYMOUR WI 54165 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH URGENT CARE 3200 SHORE DRIVE MARINETTE WI 54143 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER WRIGHTSTOWN 555 QUALITY COURT WRIGHTSTOWN WI 54180 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER LUXEMBURG 140 B SCHOOL CREEK TRAIL LUXEMBURG WI 54217 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER MANITOWOC 3415 CUSTER STREET SUITE D MANITOWOC WI 54221 PROVIDER CLINIC SITE BELLIN HEALTH MARINETTE MENOMINEE CLINIC 3200 SHORE DRIVE MARINETTE MI 54143 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER PULASKI 331 W GREEN BAY STREET PULASKI WI 541620109 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH DAGGETT MEDICAL 106 S SCHOOL ROAD DAGGETT MI 49821 PROVIDER CLINIC SITE BELLIN HEALTH NORTHREACH AFTER HOURS MAR 1106 UNIVERSTIY DRIVE MARINETTE MI 54143 PROVIDER CLINIC SITE BELLIN HEALTH ASTHMA & ALLERGY - NEENAH 119 E BELL STREET SUITE B NEENAH WI 54957 PROVIDER CLINIC SITE BELLIN HEALTH FAST CARE ASHWAUBENON 301 BAY PARK SQUARE GREEN BAY WI 54304 CONVENIENT CARE CENTER BELLIN HEALTH FAST CARE EAST TOWNE MALL 2430 E MASON STREET GREEN BAY WI 54302 CONVENIENT CARE CENTER BELLIN HEALTH NORTHREACH LABORATORY 3200 SHORE DRIVE MARINETTE WI 54143 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER BONDUEL 401 W MILL STREET BONDUEL WI 54107 PROVIDER CLINIC SITE BELLIN HEALTH ENDOCRINOLOGY 720 S VAN BUREN STREET SUITE 104 GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH FAST CARE SUAMICO 2318 LINEVILLE ROAD SUAMICO WI 54173 CONVENIENT CARE CENTER BELLIN HEALTH NORTHREACH FAST CARE MARIN 2741 ROOSEVELT ROAD MARINETTE MI 54143 CONVENIENCE CARE CENTER FAMILY MEDICAL CENTER SURING 307 MANOR DRIVE SURING WI 54174 PROVIDER CLINIC SITE PART I, LINE 6A: BELLIN MEMORIAL HOSPITAL IN INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. PART I, LINE 7: AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $8,554,024 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES FOCUS ON SOCIAL CONDITIONS THAT CONTRIBUTE TO HEALTH PROBLEMS, SUCH AS HOMELESSNESS, POVERTY, AND OTHER LIVING CONDITIONS AFFECTING THE QUALITY OF LIFE. THESE RANGE FROM DEVELOPING COMMUNITY LEADERS, DISASTER READINESS, AND SUPPORT OF LOCAL ECONOMIC DEVELOPMENT, TO HEALTH IMPROVEMENT ADVOCACY. BELLIN MEMORIAL HOSPITAL IS ACTIVE IN THE GREEN BAY PUBLIC SCHOOLS WITH OUR THRIVE PROGRAM THAT ASSISTS IN SETTING AND MEETING HEALTH AND WELLNESS GOALS FOR STUDENTS IN THIS SCHOOL SYSTEM. BELLIN ALSO HOLDS AN ANNUAL BELLIN RUN/WALK 10K EVENT EACH YEAR WITH OVER 18,000 PARTICIPANTS OF ALL AGES LEARNING FIRST HAND THE VALUE OF EXERCISE IN DAILY LIFE. 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 13 AND 14 OF THE FINANCIAL STATEMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), BELLIN HEALTH SYSTEMS RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCES FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RUL 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, FOR-PROFIT HOSPITALS HAVE CARVED OUT HIGH-MARGIN SERVICES (I.E. ONCOLOGY, ORTHO, ETC) LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS MEANS THAT THE SHORTFALL IS NOT NECESSARILY FROM INEFFICIENT OPERATIONS. MEDICARE CAN BE THE LARGEST PAYOR AND HOSPITALS HAVE NO ABILITY TO DENY COVERAGE. THIS, IN TURN, IS A PROMOTION OF ACCESS TO HEALTHCARE SERVICES (A COMMUNITY BENEFIT). ALSO, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. PART III, LINE 9B: PATIENTS EXPRESSING CONCERNS ABOUT THEIR ABILITY TO PAY FOR SERVICES ARE OFFERED INFORMATION ABOUT OUR COMMUNITY CARE PROGRAM AND, IF REQUESTED, ARE PROVIDED A COMMUNITY CARE APPLICATION. A COMPLETED APPLICATION WILL BE RETURNED ALONG WITH A COPY OF THE MOST RECENT FEDERAL INCOME TAX RETURN. WE MAY ALSO REQUEST THE MOST RECENT THREE MONTHS OF CHECK STUBS, AND EMPLOYER LETTER OR PROOF OF OTHER EARNINGS (SOCIAL SECURITY, PENSION, DISABILITY INCOME). IN ADDITION WE WILL REVIEW THE NET ASSETS AVAILABLE TO BE USED TOWARDS PAYMENT OF THE BILL. ONCE A COMPLETED APPLICATION AND OTHER MATERIALS ARE RECEIVED THEY WILL BE REVIEWED BY A FINANCIAL ADVISOR. THE ADJUSTED INCOME WHICH IS DETERMINED WILL BE COMPARED TO GOVERNMENT FEDERAL POVERTY GUIDELINES AND THE APPROVED DISCOUNT FROM FULL CHARGES WILL BE DETERMINED BASED ON WHERE THE PATIENT FALLS WITHIN OUR GUIDELINES. PART VI, LINE 2: BELLIN MEMORIAL HOSPITAL HAS COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IT IS POSTED ON BELLIN.ORG PART VI, LINE 3: FINANCIAL COUNSELORS ADVISE PATIENTS OF ASSISTANCE PROGRAMS AS WELL AS SERVICE CALLED HRS ERASE IS USED TO REVIEW SELF PAY ACCOUNTS FOR POSSIBLE COVERAGE THROUGH GOVERNMENT PROGRAMS. PART VI, LINE 4: BELLIN MEMORIAL HOSPITAL SERVES NORTHEAST WISCONSIN AND UPPER MICHIGAN. OUR CURRENT PAYOR SUPPLEMENTAL INFORMATION MIX IS 44.3% MEDICARE AND 10.98% MEDICAID. 12% OF THE POPULATION IS BELOW THE POVERTY LEVEL AND 13.5% OF THE POPULATION IS OVER AGE 65. PART VI, LINE 5: A MAJORITY OF BELLIN MEMORIAL HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSON WHO RESIDE IN BELLIN MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEROF. IN ADDITION, BELLIN MEMORIAL HOSPITAL EXTENDS MEDICAL STAFF PRIVELEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR ALL OF ITS DEPARTMENTS. BELLIN MEMORIAL HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE, EDUCATION AND FACILITIES. PART VI, LINE 6: BELLIN HEALTH IS A COMMUNITY-OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR THE PHYSICAL AND EMOTIONAL HEALTH OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. DIRECTLY, AND IN PARTNERSHIP WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE GUIDE INDIVIDUALS AND FAMILIES IN THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. WE ARE COMMITTED TO PROVIDING SAFE, RELIABLE, COST-EFFECTIVE TOTAL HEALTH SOLUTIONS WITH RESPECT AND COMPASSION. OUR INNOVATIVE WORK WILL IMPACT HEALTHCARE DELIVERY IN OUR REGION AS WELL AS THROUGHOUT THE WORLD. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 NEW COMMUNITY CLINIC 622 BODART STREET GREEN BAY WI 54301 391200636 501(C)3 100000 SUPPORT FREE COMMUNITY HEALTH CLINIC GREEN BAY PUBLIC SCHOOLS PO BOX 23387 GREEN BAY WI 543053387 396002329 GOVT - PUBLIC SCHOOL 63333 HEALTH & WELLNESS PROGRAM FESTIVAL FOODS TURKEY TROT 2250 WEST MASON STREET GREEN BAY WI 54303 391814712 15000 TURKET TROT RUN FOR CHARITY ENCOMPASS EARLY EDUCATION & CARE PO BOX 1627 GREEN BAY WI 54305 390824004 501(C)3 5000 DONATION KIWANIS SKI CLUB PO BOX 475 IRON MOUNTAIN MI 49801 383254313 501(C)3 25000 DONATION UW OSHKOSH 842 ALGOMA BOULEVARD OSHKOSH WI 54901 391805963 GOVT - STATE AGENCY 60000 SUPPORT ORGANIZATION'S ACTIVITIES NORTHEAST WISCONSIN TECHNICAL COLLEGE 2740 WEST MASON STREET GREEN BAY WI 54307 391087141 GOVT - STATE AGENCY 20000 HEALTH SCIENCE SIMULATION LAB SCHOOL DISTRICT OF WEST DEPERE 665 GRANT STREET DE PERE WI 54115 GOVT - PUBLIC SCHOOL 33333 DONATION GREATER GREEN BAY COMMUNITY FOUNDATION 310 WEST WALNUT STREET SUITE 350 GREEN BAY WI 54303 391699966 501(C)3 5000 GREEN BAY NEIGHBORHOOD LEADERSHIP COUNCIL BROWN COUNTY UNITED WAY 112 NORTH ADAMS STREET SUITE 201 GREEN BAY WI 54301 390806299 501(C)3 21069 DONATION UNIVERSITY OF WISCONSIN - GREEN BAY FOUNDATION 2420 NICOLET DRIVE GREEN BAY WI 543117001 391805963 GOVT - PUBLIC SCHOOL 20000 MEMORIAL SCHOLARSHIP BROWN COUNTY MEDICAL SOCIETY ALLIANCE 563 CARTER COURT SUITE B KIMBERLY WI 54136 391516026 501(C)3 5000 SPONSORSHIP BELLIN COLLEGE 3201 EATON ROAD GREEN BAY WI 54311 391620530 501(C)3 774446 BUILD OUT LAB AND LEARNING SPACE BELLIN COLLEGE 3201 EATON ROAD GREEN BAY WI 54311 391620530 501(C)3 12500 NURSING CAMPS ALZHEIMERS NE WISCONSIN CHAPTER 2900 CURRY LANE SUITE A GREEN BAY WI 54311 133039601 501(C)3 6200 FUNDRAISER EVENTS GREATER GREEN BAY COMMUNITY FOUNDATION 310 WEST WALNUT STREET SUITE 350 GREEN BAY WI 54303 391699966 501(C)3 60000 ACHIEVE BROWN COUNTY 15 1 PART I, LINE 2: THE ORGANIZATION REQUIRES A COMPREHENSIVE REQUEST OF THE GRANTEE TO PROVIDE RATIONALE FOR THE REQUEST. REQUIRED INFORMATION TO BE PROVIDED BY THE GRANTEE INCLUDES, TAX-EXEMPT STATUS, IDENTIFICATION OF USE OF RESOURCES AND FOLLOW UP INFORMATION AS TO THE UTILIZATION OF THE RESOURCES. THE ORGANIZATION REVIEWS EACH GRANTEE REQUEST IN RELATIONSHIP TO THE MISSION OF THE ORGANIZATION AND COMMUNITY SUPPORT. ALL REQUESTS REQUIRE APPROVAL BY SENIOR LEADERSHIP OF THE ORGANIZATION. X X X X X 0 0 0 0 0 0 0 0 0 ROBERT MEAD MD - TERMED BOARD MEMBER/PRESIDENT BMG 203948 0 46683 0 774 0 14345 0 20188 0 285938 0 0 0 WILLIAM WITTMAN MD BOARD MEMBER/BMG PHYSICIAN 222927 0 70732 0 1188 0 9847 0 15747 0 320441 0 0 0 LOREN FUGLESTAD MD BOARD MEMBER/BMG PHYSICIAN 186428 0 112087 0 270 0 39184 0 19630 0 357599 0 0 0 GEORGE KERWIN PRESIDENT/CEO 499437 0 305100 0 42641 0 18141 0 17105 0 882424 0 0 0 PATRICK MANSKY MD - TERMED BOARD MEMBER/PHYSICIAN 603874 0 132794 0 414 0 13050 0 9822 0 759954 0 0 0 CYNTHIA LASECKI MD BOARD MEMBER/PHYSICIAN 117516 0 149306 0 270 0 13611 0 3577 0 284280 0 0 0 MARK RINGWELSKI MD BOARD MEMBER/PHYSICIAN 201100 0 52612 0 774 0 8991 0 17793 0 281270 0 0 0 SABINA SINGH MD BOARD MEMBER/PHYSICIAN 162189 0 78722 0 270 0 9371 0 7322 0 257874 0 0 0 JAMES DIETSCHE CFO 300908 0 60000 0 270 0 9514 0 21472 0 392164 0 0 0 PETER KNOX EXECUTIVE VP 302459 0 120000 0 774 0 18988 0 17247 0 459468 0 0 0 CHRISTINE WOLESKE EXECUTIVE VP 301793 0 60000 0 17101 0 16385 0 20188 0 415467 0 0 0 CHRISTOPHER WOLFRAM MD PHYSICIAN 536182 0 407492 0 180 0 11767 0 18630 0 974251 0 0 0 TIMOTHY TANKE MD PHYSICIAN 531121 0 343819 0 414 0 12956 0 17630 0 905940 0 0 0 RICHARD TIMMONS MD PHYSICIAN 533224 0 318350 0 774 0 13621 0 21403 0 887372 0 0 0 JAMES RIDER MD PHYSICIAN 502207 0 280144 0 180 0 11957 0 22141 0 816629 0 0 0 PAUL HUDSON MD PHYSICIAN 651134 0 171700 0 180 0 13354 0 23998 0 860366 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2011-11-23 12944000 REFINANCING OF 2001 BONDS 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DLH7 2015-04-09 44994006 REFUND AND LEGALLY DEFEASE 0 0 0 A 2815000 12944000 79844 2001 1 0 1 1 B 44994006 528236 44465770 2009 0 1 1 1 A 0 1 0 0 0.00970 0.00970 0 0 1 B 0 1 1 1 0 0.01000 0.01000 1 0 1 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 1 B 1 INTEGRYS ENERGY GROUP INC BOARD MEMBER LARRY BORGARD IS PRESIDENT & COO - UTILITIES AT INTEGRYS 3232227 INTEGRYS ENERGY GROUP PROVIDES UTILITY SERVICES TO BELLIN MEMORIAL HOSPITAL 0 ASSOCIATED BANK BOARD MEMBER DENIS HOGAN IS MARKET PRESIDENT 211539 BANKING SERVICES 0 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 PRESENTED TO THE EXECUTIVE COMMITTEE IN ITS ENTIRETY FOR A REVIEW OF THE DOCUMENT. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR A CONFLICT OF INTEREST REQUEST DOCUMENT IS PROVIDED TO EACH BOARD MEMBER. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. ALL EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AS PART OF ANNUAL MANDATORY EDUCATION. IF THERE IS A CONFLICT OF INTEREST, THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE WHICH IS A COMMITTEE OF THE BOARD OF DIRECTORS IS NOTIFIED. THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE ADDRESSES THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. CEO COMPENSATION: CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA TO THE RESULTS AND COMES UP WITH A RECOMMENDATION. THE CHAIR FACILITATES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. SENIOR LEADERS: COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 288,278. INTEREST RATE SWAP AGREEMENT -1,632,401. NON-CONTROLLING INTEREST IN CONSOLIDATED AFFILIATE -1,928,003. FORM 990, PART XI, LINE 2B-2C BELLIN MEMORIAL HOSPITAL, INC. IS INCLUDED IN THE CONSOLIDATED AUDIT OF BELLIN HEALTH SYSTEMS, INC. THE BOARD OF DIRECTORS OF BELLIN HEALTH SYSTEMS, INC. ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. NORTHREACH HEALTHCARE LLC 3120 RIVERSIDE AVE GATE B BLDG 1 MARINETTE WI 54143 391999260 PRIMARY AND SPECIALTY PHYSICIAN CLINICS WI 14043902 4393213 BELLIN MEMORIAL HOSPITAL LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 11B, II BELLIN HEALTH SYSTEMS INC 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54305 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PPSYCHIATRIC HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 OCONTO HOSPITAL & MEDICAL CENTER INC PO BOX 357 OCONTO WI 54153 061745397 HOSPITAL WI 501(C)(3) LINE 3 BELLIN MEMORIAL HOSPITAL INC 1 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) LINE 11B, II N/A 0 UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HOSPICE, PALLIATIVE & BEREAVEMENT SERVICES WI 501(C)(3) LINE 9 BELLIN MEMORIAL HOSPITAL INC 1 BELLIN ORTHOPEDIC SURGERY CENTER LLC 2223 LIME KILN RD GREEN BAY WI 54311 264677834 AMBULATORY ORTHOPEDIC SURGERY WI BELLIN MEMORIAL HOSPITAL INC RELATED 2717271 708968 0 0 0.55000 D1 SPORTS TRAINING OF GREEN BAY LLC SOUTH SPRINGS DRIVE FRANKLIN TN 37067 454848172 SPORTS TRAINING TN N/A BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI N/A C 0 BELLIN INVESTMENTS INC PO BOX 23400 GREEN BAY WI 54305 391564939 OTHER WI N/A C 0 1 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 OCONTO HOSPITAL & MEDICAL CENTER D 12716664 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER D 3058756 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER O 688551 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER M 1105247 ACTUAL OCONTO HOSPITAL & MEDICAL CENTER Q 4050000 ACTUAL BELLIN COLLEGE B 786946 ACTUAL BELLIN HEALTH FOUNDATION C 622793 ACTUAL BELLIN PSYCHIATRIC CENTER L 1926768 ACTUAL BELLIN PSYCHIATRIC CENTER J 5818 ACTUAL BELLIN PSYCHIATRIC CENTER D 3291878 ACTUAL BELLIN COLLEGE L 297638 ACTUAL BELLIN COLLEGE N 329760 ACTUAL BELLIN HEALTH FOUNDATION Q 422207 ACTUAL