2012-08-13T10:13:19-05:00 2011-09-30 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2010-10-01 391568866 AFFINITY HEALTH SYSTEM AFFI 9207201300 1570 MIDWAY PL MENASHA WI 54952 JEFF BADGER 9207201300 2012-08-02 1 TERRI REXRODE CPA MST 9206620016 2012-08-02 2010 2016-02-24 21:20:13Z JEFF BADGER 1570 MIDWAY PL MENASHA WI 54952 63791738 0 X WWW.AFFINITYHEALTH.ORG X 1986 IL THE MISSION OF AFFINITY HEALTH SYSTEM 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. 18 10 511 0 0 0 70890 137049 53151258 60167451 1661191 3483058 0 0 54883339 63787558 0 49100 0 0 31121287 34640535 0 0 0 34622951 39801691 65744238 74491326 -10860899 -10703768 130707919 185013054 355293928 432420322 -224586009 -247407268 THE MISSION OF AFFINITY HEALTH SYSTEM IS TO LIVE OUT THE HEALING MINISTRY OF CHRIST BY PROVIDING SERVICES THAT PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITES WE SERVE, ESPECIALLY THE POOR. 0 0 13392773 49100 60187162 THE ENTITY BELIEVES IN MEETING THE HEALTHCARE NEEDS OF THE POOR, INDIGENT, AND UNDERSERVED. CARE IS PROVIDED TO THE PATIENTS WITHOUT REGARD FOR THE ABILITY TO PAY. THE ENTITY PROVIDES ADMINISTRATIVE SUPPORT TO THREE HOSPITALS, AND TWENTY-FIVE CLINIC LOCATIONS. THE ENTITY ALSO PROVIDES: FREE NEWSLETTERS FOCUSING ON WOMEN'S HEALTH ISSUES; CHILDREN'S HEALTH AND SAFETY ISSUES; HEALTH INFORMATION SPOTS ON TELEVISION AND RADIO; AND CLASSES ON A VARIETY OF HEALTH RELATED TOPICS INCLUDING PREGNANCY AND CHILD REARING. 13392773 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 76 0 1 511 1 0 0 0 0 0 0 0 0 0 0 X 18 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JEFF BADGER 9207201300 1570 MIDWAY PLACE MENASHA WI 54952 X CARLA ALTEPETER 0.30 X 0 0 0 FRED KLEIN MD 0.30 X 0 0 0 JOHN RUSSO 0.30 X X 0 0 0 MARY HARP-JIRSCHELE 0.30 X 0 0 0 RICHARD WELLS 0.30 X 0 0 0 STEPHEN MORTON 0.30 X X 0 0 0 SUSAN VETTE 0.30 X 0 0 0 THOMAS SCHMIDT 0.30 X 0 0 0 WAYNE TREMBLY 0.30 X 0 0 0 BARBARA STRAND MD 0.30 X 0 264298 43300 JOSEPH MCCORMICK MD 0.30 X 0 1097589 41533 STACEY SENSOR DO 0.30 X 0 482023 40878 CATHERINE TIERNEY 0.30 X X 0 0 0 DAVID GITTER 0.30 X X 0 0 0 MARK FAUSTICH MD 0.30 X 0 369720 35440 JAY MULLER MD 0.30 X 0 373057 37687 DAN NEUFELDER 0.30 X X 0 834152 65399 NICHOLAS DESIEN 0.30 X X 0 0 0 JOHN OLIVERIO 0.30 X X 0 0 0 CHRISTOPHER ROCKE DO 0.30 X 0 232694 35386 KATHRYN SIEMAN 0.30 X 0 0 0 MONICA VOMASTIC 0.30 X 0 0 0 JEFF BADGER 0.00 X 0 444491 62470 0 4098024 362093 0 0 1 0 MINISTRY HEALTHCARE MHC SSO 11925 LAKE PARK DR SUITE 100 MILWAUKEE WI 53224 I.S. SERVICES 5111439 STATE COLLECTION SERVICE 2509 S STOUGHTON MADISON WI 53716 COLLECTION AGENCY 1134919 VON BRISEN & ROPER 411 E WISCONSIN AVE SUITE 700 MILWAUKEE WI 53202 LEGAL 1092784 MEDICAL INFORMATION TECHNOLOGY PO BOX 74569 CHICAGO IL 60696 I.S. SERVICES 737786 NEW RESOURCES CONSULTINIG 1000 N WATER ST SUITE 950 MILWAUKEE WI 53202 I.S. SERVICES 583244 23 137049 137049 SERVICES TO AFFILIATES 561000 59815596 59815596 MISCELLANEOUS OPERATIN 561000 300156 300156 WOMEN'S CENTER 561000 34168 34168 LAMAZE CLASSES 561000 17531 17531 60167451 3484438 3484438 2800 4180 -1380 -1380 -1380 63787558 60167451 0 3483058 49100 49100 25723258 5539985 20183273 1201637 258795 942842 6068467 1306563 4761904 1647173 354750 1292423 961797 961797 391916 391916 6562988 256250 6306738 1199256 1199256 2772560 241955 2530605 5835965 274344 5561621 1308790 300365 1008425 945762 19495 926267 12641459 2901191 9740268 5875354 1348383 4526971 49861 49861 MISCELLAENOUS EXPENSES 587438 109560 477878 RELATED ORGANIZATION AL 409078 409078 DUES AND LICENSES 153362 22959 130403 RECRUITING EXPENSE 106105 106105 74491326 13392773 61098553 0 400 400 2761622 2358444 74046367 95717533 36677000 71156938 850982 870367 1127899 1473302 51014662 38985595 9926224 12029067 5317425 1407003 130707919 185013054 11152627 12408550 338644409 404717717 5496892 15294055 355293928 432420322 X -224586009 -247407268 -224586009 -247407268 130707919 185013054 X -10703768 -12117491 X X 0 1 1 X 0 X X X 0 0 0 MERCY MEDICAL CENTER OF OSHKOSH INC 390806268 3 1 1 1 0 MERCY HEALTH FOUNDATION 237140261 9 1 1 1 0 ST ELIZABETH HOSPITAL INC 390816818 3 1 1 1 0 ST ELIZABETH HOSPITAL COMMUNITY FOUNDATION INC 391256677 11A 1 1 1 0 NETWORK HEALTH SYSTEM INC 391127163 3 1 1 1 0 CALUMET MEDICAL CENTER 390905385 3 1 1 1 0 6 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 466337 212864 253473 3409694 3409694 0 44190636 34793920 9396716 2947995 569117 2378878 12029067 PENSION LIABILITY 6439501 457B PLAN LIABILITY 746258 NETWORK HEALTH SYSTEM LIABILITY 8108296 15294055 63787558 74491326 -10703768 -12117491 -12117491 -22821259 639838 -3253720 -3253720 3893558 59894000 59894000 63787558 14266652 0 14266652 60224674 60224674 74491326 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FASB ASC SUBTOPIC 740-10, INCOME TAXES OVERALL, PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE AMOUNT OF UNRECOGNIZED TAX EXPENSE RELATED TO THESE CRITERIA FOR THE CORPORATION WAS ZERO AS OF SEPTEMBER 30, 2011 AND 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: GAIN ON INVESTMENT IN NETWORK HEALTH PLAN 786,434. MINISTRY E.H.R 264,728. PENSION ADJUSTMENT -10,095,339. TWIN MED DISTRIBUTION -228,672. CHANGE IN INTEREST IN NETWORK HEALTH SYSTEM, INC. -2,844,642. PART XII, LINE 2D - OTHER ADJUSTMENTS: ALLOCATED REVENUE REIMBURSED TO RELATED PARTIES -409,078. SUBSIDIARY INCOME/LOSS - NHP -2,844,642. PART XII, LINE 4B - OTHER ADJUSTMENTS: ALLOCATED EXPENSES REIMBURSED BY RELATED PARTIES 59,815,596. DONATIONS REPORTED TO NET ASSETS 78,404. PART XIII, LINE 4B - OTHER ADJUSTMENTS: ALLOCATED EXPENSES REIMBURSED BY RELATED PARTIES 59,815,596. ALLOCATED REVENUE REIMBURSED TO RELATED PARTIES 409,078. 0 UNITED WAY 1455 MIDWAY RD MENASHA WI 54952 390912895 501 (C)(3) 40100 TO ASSIST ORGANIZATION'S PROGRAMS. OSHKOSH AREA UNITED WAY 36 BROAD ST OSHKOSH WI 54901 391017908 501 (C)(3) 8000 TO ASSIST ORGANIZATION'S PROGRAMS. ST NORBERT COLLEGE 100 GRANT ST DE PERE WI 54115 391399196 501 (C)(3) 1000 TO ASSIST ORGANIZATION'S PROGRAMS. 3 X X 0 1 X X X X X 0 0 0 0 0 0 0 0 0 BARBARA STRAND MD 0 262911 0 0 0 1387 0 22346 0 20954 0 307598 0 0 JOSEPH MCCORMICK MD 0 1096449 0 0 0 1140 0 18640 0 22893 0 1139122 0 0 STACEY SENSOR DO 0 480983 0 0 0 1040 0 22374 0 18504 0 522901 0 0 MARK FAUSTICH MD 0 368541 0 0 0 1179 0 28196 0 7244 0 405160 0 0 JAY MULLER MD 0 372671 0 0 0 386 0 18692 0 18995 0 410744 0 0 DAN NEUFELDER 0 614707 0 212462 0 6983 0 49920 0 15479 0 899551 0 0 CHRISTOPHER ROCKE DO 0 232298 0 0 0 396 0 17670 0 17716 0 268080 0 0 JEFF BADGER 0 325066 0 97103 0 22322 0 42515 0 19955 0 506961 0 0 PART I, LINE 1B BUSINESS TRAVEL EXPENSES FOR SPOUSES OF EXECUTIVES AND GOLF CLUB MEMBERSHIP FOR EXECUTIVES ARE REIMBURSED AS PART OF THEIR TAXABLE EXECUTIVE FLEX CREDIT ACCOUNT. RECEIPTS ARE PROVIDED TO SR. ADMINISTRATIVE ASSISTANT IN HR WHO REVIEWS FOR ACCURACY, COMPLETES A REIMBURSEMENT FORM WITH SUBSTANTIATION TO PAYROLL FOR REIMBURSEMENT. THESE REIMBURSEMENTS ARE TAXABLE AND, WHEN ADDED TO THE COMPENSATION PACKAGE TAKEN AS A WHOLE, HAVE BEEN INCLUDED WHEN COMPARED TO THE COMPENSATION STUDIES. FORM 990, PART VI, SECTION A, LINE 2 DAN NEUFELDER AND KATHERINE SIEMAN HAVE A BUISNESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 CORPORATE MEMBERS ARE MINISTRY HEALTH CARE AND WHEATON FRANCISCAN SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A MINISTRY HEALTH CARE AND WHEATON FRANCISCAN SERVICES, INC. HAVE JOINT POWER TO ELECT AND REMOVE THE BOARD OF DIRECTORS OF AHS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS MUST BE APPROVED BY CORPORATE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE CONTROLLER AND CFO OF AFFINITY HEALTH SYSTEM PERFORM A DETAIL REVIEW OF THE 990. AFTER MANAGEMENT REVIEW, A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS RECEIVES A CONFLICT OF INTEREST QUESTIONAIRE EVERY YEAR. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR THE ORGANIZATION ENGAGES AN INDEPENDENT COMPENSATION FIRM TO PROVIDE MARKET DATA FOR CEO, EXECUTIVES AND KEY EMPLOYEE POSTIONS. THIS STUDY IS SHARED WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW AND RECOMMENDATIONS REGARDING ANY COMPENSATION CHANGES. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS. THE CEO REVIEWS EACH EXECUTIVE AND KEY EMPLOYEE'S ANNUAL PERFORMANCE APPRAISAL RATINGS IN MAKING HIS COMPENSATION RECOMMENDATIONS TO THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE HAS THE FINAL AUTHORITY TO APPROVE ANY AND ALL AMOUNTS OF COMPENSATION FOR MEMBERS OF THE EXECUTIVE TEAM. THE FINAL APPROVAL OF COMPENSATION AMOUNTS ARE DOCUMENTED. WAGES FOR AFFINITY HEALTH SYSTEM ARE ALLOCATED TO AFFILIATED RELATED ORGANIZATIONS. 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. HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII MARK FAUSTICH, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. JOSEPH MCCORMICK, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. JAY MULLER, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. CHRISTOPHER ROCKE WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. STACEY SENSOR, DO WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. BARBARA STRAND, MD WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR A RELATED ORGANIZATIONS. DANIEL NEUFELDER WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. JEFF BADGER WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. MARK KEHRBERG WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. VINCENT GALLUCCI WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. SHEILA JENKINS WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. TRAVIS ANDERSEN WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. WILLIAM CALHOUN WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. TIMOTHY LOCH WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. THOMAS VEESER WORKED AN AVERAGE OF 40 HOURS PER WEEK FOR RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: GAIN ON INVESTMENT IN NETWORK HEALTH PLAN 786,434. MINISTRY E.H.R 264,728. PENSION ADJUSTMENT -10,095,339. TWIN MED DISTRIBUTION -228,672. CHANGE IN INTEREST IN NETWORK HEALTH SYSTEM, INC. -2,844,642. TOTAL TO FORM 990, PART XI, LINE 5: -12,117,491. PROCESS FOR OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT FORM 990, PART XI, LINE 2B-2C AFFINITY HEALTH SYSTEM (ORGANIZATION) DOES NOT RECEIVE SEPARATELY AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS AUDITED AND REPORTED THROUGH CONSOLIDATED FINANCIAL STATEMENTS. THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE AUDITOR SELECTION. THE AUDITED STATEMENTS ARE REVIEWED BY THE CONTROLLER, CFO, MINISTRY HEALTH CFO, AND THE AUDIT COMMITTEE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MERCY MEDICAL CENTER OF OSHKOSH INC 500 S OAKWOOD OSHKOSH WI 54904 390806268 HOSPITAL WI 501(C)(3) 3 AFFINITY HEALTH SYSTEM 1 CALUMET MEDICAL CENTER INC 614 MEMORIAL DRIVE CHILTON WI 53014 390905385 HOSPITAL WI 501(C)(3) 3 AFFINITY HEALTH SYSTEM 1 NETWORK HEALTH SYSTEM INC 1570 APPLETON ROAD MENASHA WI 54952 391127163 CLINICAL HEALTHCARE SERVICES WI 501(C)(3) 3 AFFINITY HEALTH SYSTEM 1 MERCY HEALTH FOUNDATION INC PO BOX 3370 OSHKOSH WI 54903 237140261 PUBLIC WELFARE THROUGH COMMUNITY HEALTH DEVELOPMENT WI 501(C)(3) 9 AFFINITY HEALTH SYSTEM 1 ST ELIZABETH HOSPITAL FOUNDATION INC 1506 S ONEIDA STREET APPLETON WI 54915 391256677 RAISE FUNDS IN SUPPORT OF ST. ELIZABETH HOSPITAL AND RELATED ENTITIES WI 501(C)(3) 7 AFFINITY HEALTH SYSTEM 1 ST ELIZABETH HOSPITAL INC 1506 S ONEIDA STREET APPLETON WI 54915 390816818 HOSPITAL WI 501(C)(3) 3 AFFINITY HEALTH SYSTEM 1 TWIN MED LLP PO BOX 8005 MENASHA WI 54952 391180341 RENTAL PROPERTY WI NETWORK HEALTH SYSTEM INC RELATED 373376 988602 0 1 0.64000 NETWORK HEALTH PLAN INC 1570 MIDWAY PLACE MENASHA WI 54952 391442058 INSURANCE WI NETWORK HEALTH SYSTEM INC C 30544538 103113529 1.00000 NETWORK HEALTH INSURANCE CORPORATION 1570 MIDWAY PLACE MENASHA WI 54952 392020474 INSURANCE WI NETWORK HEALTH PLAN INC C -4320742 51574868 1.00000 0 0 1 1 1 0 0 0 0 1 1 0 0 1 1 1 0 0 ST ELIZABETH HOSPITAL FOUNDATION C 85242 FAIR MARKET VALUE NETWORK HEALTH SYSTEM INC D 1000000 FAIR MARKET VALUE MERCY MEDICAL CENTER INC E 13350000 FAIR MARKET VALUE ST ELIZABETH HOSPITAL E 13350000 FAIR MARKET VALUE NETWORK HEALTH PLAN J 85757 FAIR MARKET VALUE MERCY MEDICAL CENTER INC K 10118181 FAIR MARKET VALUE ST ELIZABETH HOSPITAL K 12642479 FAIR MARKET VALUE CALUMET MEDICAL CENTER K 1762689 FAIR MARKET VALUE NETWORK HEALTH PLAN K 2806030 FAIR MARKET VALUE NETWORK HEALTH SYSTEM INC K 12582198 FAIR MARKET VALUE ST ELIZABETH HOSPITAL N 177055 FAIR MARKET VALUE MERCY MEDICAL CENTER INC O 324805 FAIR MARKET VALUE ST ELIZABETH HOSPITAL O 501786 FAIR MARKET VALUE NETWORK HEALTH SYSTEM INC O 581276 FAIR MARKET VALUE NETWORK HEALTH PLAN O 145418 FAIR MARKET VALUE MERCY MEDICAL CENTER INC P 4916410 FAIR MARKET VALUE ST ELIZABETH HOSPITAL P 6214424 FAIR MARKET VALUE NETWORK HEALTH SYSTEM INC P 6252734 FAIR MARKET VALUE NETWORK HEALTH PLAN P 1281320 FAIR MARKET VALUE CALUMET MEDICAL CENTER P 830051 FAIR MARKET VALUE