2015-08-14T13:11:27-05:00 2014-09-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-10-01 061745397 OCONTO HOSPITAL AND MEDICAL CENTER OCON 9208351100 PO BOX 357 OCONTO WI 54153 CHRISTINE WOLESKE CEO 9208351100 2015-08-14 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-08-14 2013 2016-03-07 17:11:31Z CHRISTINE WOLESKE PO BOX 357 OCONTO WI 54153 12401108 0 X WWW.OCONTOHOSPITAL.ORG X 2005 WI OCONTO HOSPTIAL & MEDICAL CENTER, INC. (THE ORGANIZATION) IS YOUR HOME TOWN HOSPITAL, CREATED TO MAKE OUTSTANDING HEALTHCARE CONVENIENT. BACKED BY THE RESOURCES OF BELLIN HEALTH, OCONTO HOSPITAL & MEDICAL CENTER, INC. OFFERS OUTSTANDING HOSPITAL-BASED, EMERGENCY AND PRIMARY CARE SERVICES. OCONTO HOSPITAL & MEDICAL CENTER, INC. OFFERS THE CARE YOU NEED WHERE YOU WANT IT. 8 3 80 8 0 0 423807 156074 9888992 12181000 3813 4539 37353 44387 10353965 12386000 0 800 0 0 4851357 5082511 0 0 0 6665493 7657164 11516850 12740475 -1162885 -354475 26480927 23406587 22771278 20131097 3709649 3275490 X THE MISSION OF OCONTO HOSPITAL & MEDICAL CENTER IS TO PROVIDE 24-HOUR LOCAL ACCESS TO EFFECTIVE, EFFICIENT HEALTH, WELLNESS AND PREVENTATIVE SERVICES TO OCONTO AND THE SURROUNDING RURAL COMMUNITIES. TOWARD THIS PURPOSE, OCONTO HOSPITAL & MEDICAL CENTER WORKS IN PARTNERSHIP WITH THE COMMUNITY, THE CITIZENS HOSPITAL FOUNDATION AND BELLIN HEALTH. 0 0 10171050 800 12178592 AS A KEY REGIONAL ASSET, THE ORGANIZATION IS A NOT-FOR-PROFIT HEALTHCARE PROVIDER. THE ORGANIZATION PROVIDES ACUTE HOSPITAL, EMERGENCY AND URGENT CARE TO RESIDENTS OF OCONTO WISCONSIN AND THE SURROUNDING COMMUNITIES. DURING THE PERIOD OF OCTOBER 1, 2013 TO SEPTEMBER 30, 2014, 377 INPATIENT DAYS WERE PROVIDED AND 148 SWING BED DAYS WERE PROVIDED. THE NUMBER OF OUTPATIENTS REGISTERED DURING THE SAME 12 MONTH PERIOD WAS 12,706. 10171050 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 80 1 0 0 0 0 0 0 0 0 0 0 X 8 3 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SARA ARNDT 9204457260 2020 SOUTH WEBSTER AVE GREEN BAY WI 54301 CHRISTINE WOLESKE CEO 0.50 50.00 X X 0 296082 32065 GEORGE KERWIN BOARD MEMBER 0.50 50.00 X 0 459412 29540 SARA ARNDT BOARD MEMBER 5.00 40.00 X 0 49156 20994 DAVID HONISH CHAIRPERSON 0.50 X X 0 0 0 RODNEY R JOHNSON SECRETARY/TREASURER 0.50 X X 0 0 0 LAURA CORMIER VP OF OPERATIONS 45.00 X 129501 0 18258 CHARLES HEYKA MD BOARD MEMBER 36.00 X 274235 0 23936 JOHN HONISH BOARD MEMBER 0.50 X 0 0 0 ROBERT BIVINS MD PHYSICIAN 40.00 X 226092 0 28753 LISA ALLEN PHYSICIAN 45.00 X 221469 0 26572 JENNIFER LAPLANT PHARMACIST 40.00 X 131707 0 29319 983004 804650 209437 5 0 1 0 BELLIN MEMORIAL HOSPITAL INC 744 S WEBSTER AVE GREEN BAY WI 54305 MANAGEMENT SERVICES 1096654 JIN KIM MD 333 W MIFFLIN ST 1167 MADISON WI 53703 CONTRACTED ED PHYSICIAN SERVICES 241749 THARIO BUILDING SERVICES 2936 HOLMGREN WAY GREEN BAY WI 54304 CLEANING SERVICES 120972 3 140000 16074 156074 NET PATIENT REVENUE 621300 12047761 12047761 RENT FROM AFFILIATES 900099 130831 130831 MISCELLANEOUS REVENUE 900099 2408 2408 12181000 4539 4539 59495 15108 44387 44387 44387 12386000 12178592 0 51334 X 800 800 445928 298171 147757 3806002 3647618 158384 198242 190003 8239 349119 333205 15914 283220 262208 21012 6233 6233 5682 5682 1433691 554097 879594 75088 75088 2076713 2027279 49434 39095 3400 35695 263875 257605 6270 33946 23309 10637 3755 3755 930957 930957 1619145 1476108 143037 34645 34593 52 BAD DEBT EXPENSE 1054066 1054066 DUES, LICENSES AND SUBS 80273 8588 71685 12740475 10171050 2569425 0 707124 158799 2302668 1389887 308193 320176 23305 26895894 5806078 22648022 21089816 514920 424604 26480927 23406587 925797 507161 13649999 13183331 8195482 6440605 22771278 20131097 X 3479406 3124931 230243 150559 3709649 3275490 26480927 23406587 X -354475 -79684 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 661050 661050 15005641 2193818 12811823 171971 53742 118229 11057232 3558518 7498714 21089816 DUE TO AFFILIATE 6440605 6440605 X 12261108 0 12261108 124892 124892 12386000 12755583 15108 15108 12740475 0 12740475 PART X, LINE 2: IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, BELLIN HEALTH SYSTEMS DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. BELLIN HEALTH SYSTEMS HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF SEPTEMBER 30, 2014 OR 2013. BELLIN HEALTH SYSTEMS' FEDERAL INCOME TAX RETURNS FOR YEARS ENDED SEPTEMBER 30, 2011, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL DEPRECIATION -15,108. OCONTO MEMORIAL HOSPITAL CITIZENS FOUNDATION, INC. REVENUE 100,000. BELLIN FOUNDATION REVENUE 40,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL DEPRECIATION 15,108. 1 1 1 X 1 X 1 1 0 1 1 310024 310024 0.02650 1996833 1883390 113443 0.00970 2306857 1883390 423467 0.03620 11 1980 12593 12593 0.00110 3 700 1911 1911 0.00020 14 2680 14504 14504 0.00130 14 2680 2321361 1883390 437971 0.03750 1 1054066 2709616 2679291 30325 X 1 1 1 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVE OCONTO WI 54153 X X X OCONTO HOSPITAL & MEDICAL CENTER INC 1 1 X X X X X X X X 12 1 1 1 X WWW.OCONTOHOSPITAL.ORG X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X 0 0 1 X 0 0 OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 3: DEVELOPED COUNTY WIDE INDIVIDUAL PUBLIC OPINION SURVEY THAT GENERATED OVER 600 RESPONSES. ASSESSMENT TEAM INCLUDED PARTICIPATION FROM SCHOOLS, LAW ENFORCEMENT, EMPLOYERS, HEALTHCARE PROVIDERS, CHURCHES, COUNTY AGENICES, UNITED WAY, PUBLIC OFFICIALS, PUBLIC HEALTH AND HEALTHCARE MEDICAL PROVIDERS. OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 4: COMMUNITY MEMORIAL HOSPITAL, OCONTO FALLS, WISCONSIN OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 5D: MADE AND CONTINUE TO MAKE PRESENTATIONS TO COMMUNITY ENTITIES THROUGHOUT THE COUNTY INCLUDING SCHOOLS, GOVERNMENT BOARDS, CHAMBER OF COMMERCE, AND CIVIC GROUPS.THE CHNA IS AVAILABLE AT THE ORGANIZATION'S WEBSITE: WWW.BELLIN.ORG OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 7: AS A COUNTY ASSESSMENT TEAM, WE PRIORITIZED THREE HEALTH FOCUS AREAS FOR THE NEXT 5 YEARS.HEALTHY OCONTO COUNTY 2018 PROGRESS UPDATEGOAL: REDUCE ALCOHOL AND DRUG ABUSE AND RELATED SOCIAL AND PUBLIC HEALTH EFFECTS ON OCONTO COUNTY RESIDENTS.- WORKED WITH TRI-COUNTY UNITED WAY AND AURORA HEALTH CARE ON SPONSORSHIP OF 2 SEPARATE PRESCRIBER SUMMITS (2014 AND 2015). PURPOSE OF THE EVENTS WAS TO BRING AWARENESS OF APPROPRIATE AND INAPPROPRIATE PRESCRIBING PRACTICES FOR NARCOTICS, IMPACT IN COMMUNITIES ON NARCOTICS SOLD ON THE STREET AND ALTERNATIVE PRACTICE OPTIONS. PHYSICIANS, MID-LEVEL PRACTITIONERS, BEHAVIORAL HEALTH PROVIDERS, PHARMACISTS AND HOSPITALS PARTICIPATED.-HAVE CREATED A LINKAGE WITH BROWN COUNTY DRUG AND ALCOHOL TASK FORCE WORK TO IDENTIFY OPPORTUNITIES FOR OCONTO COUNTY.-INITIATED MEDICAL DETOX SERVICES AT HOSPITAL WITH OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES.GOAL: INCREASE THE PERCENTAGE OF OCONTO COUNTY RESIDENTS WHO EAT HEALTHY AND ARE PHYSICALLY ACTIVE.-DEVELOPED PERSONAL TRAINER PROGRAM AT BOND COMMUNITY CENTER TO ENGAGE MEMBERS IN IMPROVING PHYSICAL ACTIVITY.-ENGAGED WITH COMMUNITY GARDEN INITIATIVE TO REVITALIZE COMMUNITY SUPPORT AND RESOURCES.GOAL: IMPROVE THE MENTAL HEALTH OF OCONTO COUNTY RESIDENTS BY INCREASING ACCESS TO MENTAL HEALTH RESOURCES, PROVIDING EDUCATION, AND DECREASING THE STIGMA OF MENTAL HEALTH ISSUES.-INCREASED ACCESS TO BELLIN BEHAVIORAL HEALTH THERAPISTS BY 2 DAYS/WEEK.-INITIATED BELLIN BEHAVIORAL HEALTH APNP 1 DAY/WEEK IN OCONTO.-INCREASED ACCESS TO TELEMEDICINE FOR BELLIN BEHAVIORAL HEALTH PSYCHIATRY. OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 20D: 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. PART I, LINE 6A: OCONTO HOSPITAL AND MEDICAL CENTER IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. PART I, LINE 7: AMOUNTS ARE CALCULATED BASED ON THE COST TO CHARGE RATIOS AND WORKSHEET 2 PROVIDED BY THE IRS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $1,054,066 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: THE ORGANIZATION REPORTED NO COMMUNITY BUILDING ACTIVITIES REPORTED IN PART II. PART III, LINE 2: BAD DEBT EXPENSE OF $1,054,066 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 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 PAGE 12 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 SERVES 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, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT EXEMPT HOSPITALS, CMS WOULD NEED TO PROVIDE THESE 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 MATERICALS 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 CHRAGES WILL BE DETERMINED BASED ON WHERE THE PATIENT FALLS WITHIN OUR GUIDELINES. PART VI, LINE 2: THE ORGANIZATION ANNUALLY REVIEWS THE OCONTO COUNTY HEALTH RANKING THROUGH THE UW POPULATION HEALTH DEPARTMENT TO IDENTIFY AREAS THAT HAVE MADE IMPROVEMENTS AND AREAS FOR IMPROVEMENT OPPORTUNITIES WITHIN THE SCOPE OF THE ORGANIZATION'S SERVICES. PART VI, LINE 3: INFORMATION ON GOVERNMENT ASSISTANCE PROGRAMS AND THE CHARITY CARE PROGRAM IS MADE AVAILABLE TO PATIENTS IN THE EMERGENCY ROOM AND AT THE TIME OF REGISTRATION. ADDITIONALLY, THE INFORMATION IS INCLUDED IN PATIENT STATEMENTS AND LETTERS FROM THE BILLING OFFICE. PART VI, LINE 4: THE ORGANIZATION IS LOCATED IN THE CITY OF OCONTO, WISCONSIN. ITS PRIMARY SERVICE AREA IS THE CITY OF OCONTO AND ITS SECONDARY SERVICE AREA SPREADS TO THE NORTHERN PORTION OF OCONTO COUNTY AND SOUTHERN MARINETTE COUNTY. THE CITY OF OCONTO HAS A POPULATION OF 4,500. 17% OF THE POPULATION IS OVER AGE 65 AND 8.8% OF THE POPULATION IS BELOW THE POVERTY LINE. PART VI, LINE 5: THE ORGANIZATION IS INVOLVED IN THE OCONTO/MARINETTE WELLNESS COALITION, OCONTO AREA CHAMBER OF COMMERCE BUSINESS EXPO, COPPERFEST SPONSORSHIP, NEWCAP AND HUMANE SOCIETY FOOD DRIVES. IN ADDITION THE ORGANIZATION IS A SOLE COMMUNITY HOSPITAL WITH AN EMERGENCY ROOM AVAILABLE TO ALL. PART VI, LINE 6: THE ORGANIZATION, IN PARTNERSHIP WITH BELLIN HEALTH SYSTEMS, INC., CONTINUES TO SERVE IT'S COMMUNITY. X X 0 0 0 0 0 0 0 0 0 CHRISTINE WOLESKE CEO 0 290492 0 0 0 5590 0 13399 0 18666 0 328147 0 0 GEORGE KERWIN BOARD MEMBER 0 430687 0 0 0 28725 0 13554 0 15986 0 488952 0 0 CHARLES HEYKA MD BOARD MEMBER 271732 0 1729 0 774 0 5270 0 18666 0 298171 0 0 0 ROBERT BIVINS MD PHYSICIAN 225678 0 0 0 414 0 12587 0 16166 0 254845 0 0 0 LISA ALLEN PHYSICIAN 189162 0 32127 0 180 0 2906 0 23666 0 248041 0 0 0 JENNIFER LAPLANT PHARMACIST 128627 0 0 0 3080 0 7817 0 21502 0 161026 0 0 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2011-08-18 14000000 FACILITY AND SERVICE EXPANSION 0 0 0 A 816669 36149 132033 13831818 2012 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 2 JOHN HONISH AND DAVID HONISH HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS, BELLIN MEMORIAL HOSPITAL, INC. AND OCONTO MEMORIAL HOSPITAL CITIZENS FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE POWER TO APPOINT/ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS ALSO HAVE THE POWER TO APPROVE, BUT NOT LIMITED TO, THE PHILOSOPHY, MISSION, AND VALUE OF THE ORGANIZATION, STRATEGIC PLANS, THE ANNUAL OPERATING AND CAPITAL BUDGET, AMENDMENTS OR RESTATEMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS. 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 THE ORGANIZATION REQUESTS AN ANNUAL UPDATE FROM ALL BOARD MEMBERS WHO SIGN THE POLICY. MEMBERS OF THE BOARD WHO HAVE A CONFLICT OF INTEREST WITH A BOARD DECISION ABSTAIN FROM VOTING ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD WITHOUT CONFLICT OF INTEREST AND IS SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANT'S REPORT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION CONSIDERS THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS PROPERTY OF THE ORGANIZATION AND THEREFORE ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G INTERCOMPANY IT SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 722,040. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 722,040. INTERCOMPANY MANGEMENT CHARGES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 157,554. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 157,554. CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 381,235. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 381,235. CONTRACTED LABOR - ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 172,862. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 172,862. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN THE BELLIN HEALTH FOUNDATION, INC. -40,000. CHANGE IN INTEREST IN OCONTO MEMORIAL HOSPITAL CITIZENS' FOUNDATION, INC. -39,684. 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) 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) LINE 2 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54305 391809171 FOUNDATION WI 501(C) LINE 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PPSYCHIATRIC HOSPITAL WI 501(C) LINE 3 BELLIN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC PO BOX 23400 GREEN BAY WI 54305 391900586 ACUTE CARE HOSPITAL WI 501(C) LINE 3 BELLIN HEALTH SYSTEMS INC 1 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54305 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C) LINE 11B, II N/A 0 BELLIN ORTHOPEDIC SURGERY CENTER LLC 2223 LIME KILN RD GREEN BAY WI 54311 264677834 AMBULATORY ORTHOPEDIC SURGERY WI N/A D1 SPORTS 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 UNITED PROVIDERS INC PO BOX 23400 GREEN BAY WI 54305 391907541 OTHER WI N/A C 0 0 0 1 0 1 0 0 0 0 1 0 0 1 0 1 1 0 0 0 OCONTO MEMORIAL HOSPITAL CITIZENS FOUNDATION C 100000 FMV BELLIN HEALTH FOUNDATION INC C 40000 FMV BELLIN MEMORIAL HOSPITAL INC E 13183331 FMV BEL-REGIONAL HOME MEDICAL INC J 120000 FMV BELLIN MEMORIAL HOSPITAL INC M 1096654 FMV BELLIN MEMORIAL HOSPITAL INC O 403007 FMV BELLIN MEMORIAL HOSPITAL INC P 2600000 FMV BELLIN MEMORIAL HOSPITAL INC E 6033756 FMV