2011-08-15T12:40:43-05:00 2010-09-30 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2009-10-01 391127163 Network Health System Inc dba Affinity Medical Group NETW 9207382000 1570 MIDWAY PLACE Menasha WI 54952 JEFF BADGER 9207382000 2011-08-11 1 Terri Rexrode CPA MST 9206620016 2011-08-11 2009 2016-02-24 21:20:13Z JEFF BADGER 1570 MIDWAY PLACE Menasha WI 54952 131124510 0 X www.affinityhealth.org X 1969 WI Network Health System Inc d/b/a Affinity Medical Group is a team of about 200 health care professionals, providing medical care through a network of 25 clinics in 14 Northeast Wisconsin communities. Our history of providing high-quality health care to the community goes back more than 50 years. 19 11 1399 0 115683 6332 30280 55347 185736625 130708874 159420 169363 15671 96617 185941996 131030201 0 0 114577334 117117463 0 0 95943901 37352212 210521235 154469675 -24579239 -23439474 119010453 129851451 111966467 130670361 7043986 -818910 Network Health System has adopted the mission statement of Affinity Health System. 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. 0 0 129384593 130593191 NETWORK HEALTH SYSTEM IS A REGIONAL HEALTH CARE ORGANIZATION FOCUSED ON COMMUNITY-BASED CARE INCLUDING OUTPATIENT, INPATIENT, ANCILLARY, AND LONG-TERM CARE AS WELL AS INSURANCE SERVICES. THE 22 CLINICS IN THE 13 COMMUNITIES AROUND THE FOX CITIES AND OSHKOSH AREA PROVIDE PRIMARY AND SPECIALTY CARE CLOSE TO HOME. 129384593 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 50 0 1 1399 1 1 1 0 0 0 0 0 0 0 0 19 11 0 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 DANIEL E NEUFELDER 13.00 X X 232819 506759 56150 NICHOLAS DESIEN 0.00 X X 0 0 0 JOHN OLIVERIO 0.00 X X 0 1737485 222799 DAVID GITTER 0.30 X X 0 0 0 CATHERINE TIERNEY 0.30 X X 0 0 0 SUSAN VETTE 0.30 X 0 0 0 CARLA ALTEPETER 0.30 X 0 0 0 MARY HARP-JIRSCHELE 0.30 X 0 0 0 JOHN RUSSO 0.30 X 0 0 0 RICHARD WELLS 0.30 X 0 0 0 FRED KLEIN MD 0.30 X 0 0 0 WAYNE TREMBLY 0.30 X 0 0 0 STEPHEN MORTON 0.30 X 0 0 0 MARK FAUSTICH MD 40.00 X 341378 0 35789 JAY MULLER MD 40.00 X 350620 0 38744 THOMAS SCHMIDT 0.30 X 0 0 0 JOSEPH MCCORMICKMD 40.00 X 1103090 0 40904 BARBARA STRAND MD 40.00 X 246725 0 44862 STACEY SENSOR DO 40.00 X 474712 0 37600 FRANK CHYBOWSKI MD 40.00 X 426681 0 46174 DAVID ROMOND MD 40.00 X 356995 0 73445 JEFF BADGER 13.00 X 127195 276855 58682 ERIK EMAUS 13.00 X 250895 0 34606 TIMOTHY LOCH 13.00 X 270525 0 36735 ZENOUN ABOUZELAM 40.00 X 2242353 0 48266 DOUGLAS HORAN 40.00 X 1273300 0 53990 MICHELE HOLDER 40.00 X 1099537 0 45287 TODD MEYER 40.00 X 1042657 0 38354 BRETT YOUNG 40.00 X 935801 0 31238 10775283 2521099 943625 16 0 1 0 UW MEDICAL FOUNDATION 600 HIGHLAND AVE Madison WI 53792 medical services 1116193 MARSHFIELD LABORATORIES 1000 N OAK AVENUE Marshfield WI 54449 lab services 1038468 WEATHERBY LOCUMS INC PO BOX 972633 Dallas TX 75397 physician services 1018629 ENVIRONMENT CONTROL OF MADISON INC 1001 FOURIER DRIVE Madison WI 537171924 cleaning services 495467 ST ELIZABETH HOSPITAL 1506 S ONEIDA ST Appleton WI 54915 salaries/lab services 413648 16 55347 55347 NET PATIENT REVENUE 621110 130119480 130119480 OTHER OPERATING REVENU 621110 473711 473711 COSMETIC SALES 900099 115683 115683 130708874 167879 167879 166947 70330 96617 96617 96617 25463 23979 1484 1484 1484 131030201 130593191 115683 265980 4606643 3617719 988924 91032241 80383860 10648381 4664760 4097118 567642 12344991 10842950 1502041 4468828 3925028 543800 11091952 3961803 7130149 10109743 9979876 129867 6286910 5718419 568491 181367 139387 41980 63209 63209 1341749 1220992 120757 1697919 1545106 152813 1627027 1627027 BAD DEBT EXPENSE 2947103 2947103 MISCELLANEOUS 1106461 53128 1053333 RECRUITMENT 446814 446814 GAIN SHARE EXPENSE 337917 337917 DUES & LICENSES 114041 104164 9877 154469675 129384593 25085082 0 3192978 3433010 16678519 16586882 614780 711970 827855 833205 49154942 28195972 22003664 20958970 55858554 61959577 19834103 25367837 119010453 129851451 72535357 86957945 39431110 43712416 111966467 130670361 X 7043986 -818910 7043986 -818910 119010453 129851451 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1460578 1460578 21783977 6139714 15644263 25910387 22056258 3854129 20958970 INVESTMENT IN NHP 60338813 C INVESTMENT IN TWIN MEDICAL 979206 C INVESTMENT FOR UNEMPLOYMENT RESERVE 641558 C 61959577 DUE FROM AFFILIATES 20637118 DEPOSITS 44385 457B PLAN 4686334 25367837 RETIREMENT PLAN CONTRIBUTION 4686334 DEFERRED COMPENSATION 1711525 PENSION LIABILITY 20923406 ASSET RETIREMENT OBLIGATION 66913 LONG-TERM DEBT 16324238 43712416 131030201 154469675 -23439474 19105540 -3528962 15576578 -7862896 150168462 19105540 70330 19175870 130992592 37609 37609 131030201 154540005 70330 70330 154469675 0 154469675 Part X: Description of Uncertain Tax Positions Under FIN 48: 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, 2010 and 2009. Part XI, Line 8 - Other Adjustments: PENSION ADJUSTMENT: -5714890. ADJUSTMENT TO INVESTMENT IN SUBSIDIARY: 2185928. Part XII, Line 2d - Other Adjustments: EXPENSE ALLOCATION TO RENTAL INCOME: 70330. Part XII, Line 4b - Other Adjustments: DONATION FROM ST. ELIZABETH COMMUNITY FOUNDATION: 37609. Part XIII, Line 2d - Other Adjustments: EXPENSE ALLOCATION TO RENTAL INCOME: 70330. X X 0 1 X X X X X 0 1 0 0 0 0 0 0 0 DANIEL E NEUFELDER 166850 363168 62965 137052 3004 6539 13887 30227 3789 8247 250495 545233 0 0 JOHN OLIVERIO 0 897790 0 477700 0 361995 0 158482 0 64317 0 1960284 0 0 MARK FAUSTICH MD 339519 0 0 0 1859 0 28691 0 7098 0 377167 0 0 0 JAY MULLER MD 350236 0 0 0 384 0 18826 0 19918 0 389364 0 0 0 JOSEPH MCCORMICKMD 1102035 0 0 0 1055 0 18759 0 22145 0 1143994 0 0 0 BARBARA STRAND MD 245788 0 0 0 937 0 22625 0 22237 0 291587 0 0 0 STACEY SENSOR DO 474503 0 0 0 209 0 19676 0 17924 0 512312 0 0 0 FRANK CHYBOWSKI MD 425275 0 0 0 1406 0 25758 0 20416 0 472855 0 0 0 DAVID ROMOND MD 356995 0 0 0 0 0 56169 0 17276 0 430440 0 0 0 JEFF BADGER 91110 198312 29783 64827 6302 13716 12347 26874 6126 13335 145668 317064 0 0 ERIK EMAUS 236886 0 0 0 14009 0 19891 0 14715 0 285501 0 0 0 TIMOTHY LOCH 222986 0 38814 0 8725 0 15051 0 21684 0 307260 0 0 0 ZENOUN ABOUZELAM 2237451 0 0 0 4902 0 27151 0 21115 0 2290619 0 0 0 DOUGLAS HORAN 1269106 0 0 0 4194 0 28619 0 25371 0 1327290 0 0 0 MICHELE HOLDER 1097588 0 0 0 1949 0 23193 0 22094 0 1144824 0 0 0 TODD MEYER 1042177 0 0 0 480 0 13487 0 24867 0 1081011 0 0 0 BRETT YOUNG 935074 0 0 0 727 0 18759 0 12479 0 967039 0 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 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. Supplemental Information Part III Schedule J Part I Line 4b John Oliverio received a 2009 taxable payout of $346,993 related to a supplemental nonqualified retirement plan known as the Wheaton Franciscan Services Benefit Restoration Plan. Form 990, Part VI, Section A, line 6 Network Health System has one corporate member, Affinity Health System. Form 990, Part VI, Section A, line 7a Network Health System's corporate member, Affinity Health System, has the power to elect and remove members of the Board of Directors. Form 990, Part VI, Section A, line 7b Amendments of the articles of incorporation and bylaws must be approved by Network Health System's corporate member, Affinity Health System. 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 receive a conflict of interest questionnaire every year. Form 990, Part VI, Section B, line 15 EACH YEAR THE ORGANIZATION ENGAGES AN INDPENDENT COMPENSATION FIRM TO PROVIDE MARKET DATA FOR CEO, EXECUTIVES AND KEY EMPLOYEE POSITIONS. 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. Form 990, Part VI, Section C, line 19 The organization believes the financial statements, governing documents, and policies are the property of the organization and are not available for public inspection. Form 990 Part XI line 2b-2c Audited Financial Statements The 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 audit statements are reviewed by the Controller, CFO, Ministry Health CFO, and the audit committee. This process has not changed from the prior year. FORM 990, SCHEDULE A, PART 1, LINE 3 NETWORK HEALTH SYSTEM IS A CLINIC AND NOT A LICENSED HOSPITAL. SCHEDULE H IS NOT REQUIRED. Form 990, Part VII Hours Worked for Related Organizations Nicholas Desien worked an average of 40 hours per week for a related organization. John Oliverio worked an average of 40 hours per week for a related organization. Daniel Neufelder worked an average of 27 hours per week for related organizations. Jeff Badger worked an average of 27 hours per week for related organizations. Erik Emaus worked an average of 27 hours per week for related organizations. Timothy Loch worked an average of 27 hours per week for related organizations. Affinity Health System Inc 1570 MIDWAY PLACE MENASHA WI 54952 391568866 SUPPORT RELATED HEALTHCARE ORGANIZATIONS IL 501(C)(3) 11a-1 N/A Mercy Medical center of Oshkosh Inc 500 S OAKWOOD OSHKOSH WI 54904 390806268 HEALTH CARE SERVICES WI 501(C)(3) 3 N/A St Elizabeth Hospital Inc 1506 S ONEIDA STREET APPLETON WI 54915 390816818 HEALTH CARE SERVICES WI 501(C)(3) 3 N/A St Elizabeth Hospital Foundation 1506 S ONEIDA STREET APPLETON WI 54915 391256677 RAISE FUNDS IN SUPPORT OF ST. ELIZABETH HOSPITAL AND RELATED ENTITIES WI 501(C)(3) 11a-1 N/A Ministry Health Care Inc 11925 W LAKE PARK DRIVE MILWAUKEE WI 53224 391490371 SUPPORT RELATED HEALTHCARE ORGANIZATIONS WI 501(C)(3) 11a-1 N/A Wheaton Franciscan Services Inc 26 W171 ROOSEVELT ROAD WHEATON IL 60187 363262111 SUPPORT RELATED HEALTHCARE ORGANIZATIONS IL 501(C)(3) 11a-1 N/A Twin Med LLP 22 W College Ave Suite 3B Appleton WI 54911 391180341 RENTAL PROPERTY WI N/A RELATED 369938 1081728 0 1 Network Health Plan 1570 MIDWAY PLACE MENASHA WI 54952 391442058 INSURANCE WI N/A C 12392977 80298598 1.00000 Network Health Insurance Corporation 1570 MIDWAY PLACE mENASHA WI 54952 392020474 INSURANCE WI NETWORK HEALTH PLAN C 9997616 35259179 1.00000 1 0 1 0 1 1 0 0 1 1 0 1 0 1 1 1 0 0 NETWORK HEALTH PLAN A 10300000 TWIN MED LLP A 414070 TWIN MED LLP J 642360 NETWORK HEALTH PLAN N 12690539