DOOR COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- DOOR COUNTY MEMORIAL HOSPITAL (EIN 39-0806324)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-04
- IRS object ID
- 201122169349300622
- Schema version
- 2009v1.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-04T12:55:35-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806324 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOOR COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DOOR | NameControl |
| Phone | 9207435566 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH AVENUE | AddressLine1 |
| City | Sturgeon Bay | City |
| State | WI | State |
| ZIP Code | 54235 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Robert Scieszinski | Name |
| Title | cfo | Title |
| Phone | 9207435566 | Phone |
| Date Signed | 2011-07-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Terri Rexrode CPA MST | Name |
| Phone | 9206620016 | Phone |
| Date Prepared | 2011-07-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MINISTRY DOOR COUNTY MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Robert Scieszinski | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 s 18th ave | AddressLine1 |
| City | Sturgeon Bay | City |
| State | WI | State |
| ZIP Code | 54235 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 64690735 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.ministryhealth.org/DCMH/home.nws | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1944 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | Door County Memorial Hospital, Inc. is a fully accredited, acute-care hospital and outpatient medical center. The hospital offers a full range of services and specialties, including home health, a skilled nursing facility for long-term care and rehabilitation services, a rehab services department and North Shore Medical Clinic. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 661 | TotalNbrEmployees |
| Total Nbr Volunteers | 135 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 133939 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 164367 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 59415187 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 64035420 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 155940 | InvestmentIncomePriorYear |
| Investment Income Current Year | -151082 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 113521 | OtherRevenuePriorYear |
| Other Revenue Current Year | 138803 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 59818587 | TotalRevenuePriorYear |
| Total Revenue Current Year | 64187508 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 14002 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 22375 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 35626681 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 38638502 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 20031058 | OtherExpensePriorYear |
| Other Expenses Current Year | 21695788 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 55671741 | TotalExpensesPriorYear |
| Total Expenses Current Year | 60356665 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4146846 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3830843 | RevenuesLessExpensesCY |
| Total Assets BOY | 59785687 | TotalAssetsBOY |
| Total Assets EOY | 74283847 | TotalAssetsEOY |
| Total Liabilities BOY | 12955373 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22828722 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 46830314 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 51455125 | NetAssetsOrFundBalancesEOY |
| Mission Description | Our Mission as a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well being of all people, especially the poor, in the communities we serve. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 48848838 | Expense |
| Grants | 22375 | Grants |
| Revenue | 63695734 | Revenue |
| Description | DOOR COUNTY MEMORIAL HOSPITAL PROVIDES THE FOLLOWING HEALTH CARE PROGRAMS: HOSPITAL INPATIENT WITH DAYS TOTALING 5,290, OUTPATIENT SERVICES THAT SERVED 77,387 VISITS, 30 BED EXTENDED CARE FACILITY, CLINIC THAT SERVED 58,995 VISITS, AND A REHABILITATION AGENCY THAT HAD 40,795 VISITS. | Description |
| Total Program Service Expense | 48848838 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 86 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 661 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROBERT SCIENSZINSKI | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9207435566 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 323 SOUTH 18TH PLACE | AddressLine1 |
| City | STURGEON BAY | City |
| State | WI | State |
| ZIP Code | 542351495 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CHARLES BRANN | |||||||
| vice-CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| gregory CASPERSON | |||||||
| member-at-large | 1.00 | X | 0 | 0 | 0 | ||
| barth guilette | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| toM HERLACHE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DR JAMES LEWIS | |||||||
| secretary | 1.00 | X | X | 9350 | 0 | 374 | |
| josEph MCMAHON | |||||||
| trEASURER | 1.00 | X | X | 0 | 0 | 0 | |
| pATRICK O'HERN | |||||||
| chairman | 1.00 | X | X | 0 | 0 | 0 | |
| eric Paulsen | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| sally pfeifer | |||||||
| diRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| jeff rabas | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| dr george roenning | |||||||
| dirECTOR | 1.00 | X | 189433 | 0 | 35264 | ||
| grace Rossman | |||||||
| DiRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| dr kelton reitz | |||||||
| MEDICAL STAFF PRESIDENT | 40.00 | X | 293061 | 0 | 25377 | ||
| david ward | |||||||
| DiRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| cathy wiese | |||||||
| DiRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| GERALD WORRICK | |||||||
| DCMH PRESIDENT/CeO | 40.00 | X | X | 0 | 379309 | 49116 | |
| ROBERT SCIESZINSKI | |||||||
| CFO | 40.00 | X | 0 | 205603 | 53019 | ||
| JODY BOES | |||||||
| VP OF PATIENT CARE SERVICES | 40.00 | X | 0 | 180866 | 39036 | ||
| SANDRA MCKUEN | |||||||
| VP OF BUSINESS AND HOSPITALITY | 40.00 | X | 0 | 23430 | 1815 | ||
| STEVEN QUADE | |||||||
| VP OF HUMAN RESOURCES | 40.00 | X | 0 | 131461 | 41891 | ||
| STEVEN DAVIS | |||||||
| physician | 40.00 | 441312 | 0 | 42637 | X | ||
| Dorene Dempster | |||||||
| Physician | 40.00 | 299190 | 0 | 40137 | X | ||
| Richard Hogan | |||||||
| physician | 40.00 | 348182 | 0 | 37637 | X | ||
| MICHAEL S BRUNO | |||||||
| physician | 40.00 | 329736 | 0 | 42137 | X | ||
| RICHARD L HECKER | |||||||
| physician | 40.00 | 312725 | 0 | 14047 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2222989 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 920669 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 422487 | TotalOtherCompensation |
| Number Individuals GT100 K | 33 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| THE BOLDT COMPANY | |||||
| po box 419 | appleton | WI | 54912 | construction services | 1119371 |
| BERNER SCHOBER ASSOCIATES | |||||
| 310 PINE STREET | GREEN BAY | WI | 54301 | ARCHITECTURAL AND DESIGN SERVICES | 859041 |
| infinity healthcare inc | |||||
| 111 e wisconsin ave | milwaukee | WI | 54302 | ER PHYSICIANS | 495000 |
| MARSHFIELD LABORATORIES | |||||
| 1000 N OAK AVE | MARSHFIELD | WI | 54449 | LABORATORY TEST | 464059 |
| ARAMARK SERVICES | |||||
| 2300 WARRENVILLE ROAD | DOWNERS GROVE | IL | 60515 | MANAGEMENT OF DIETARY, HOUSEKEEPING AND | 369951 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 16 | NumberOfContractorsGT100K |
| All Other Contributions | 164367 | AllOtherContributions |
| Total Contributions | 164367 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| net PATIENT SERVICE R | 624100 | 62917051 | 62917051 | |
| oncology clinic revenu | 624100 | 600637 | 600637 | |
| cafeteria sales | 624100 | 213630 | $213,630 | |
| WASHINGTON ISLAND SUB | 624100 | 135000 | 135000 | |
| lifeline revenue | 624100 | 108179 | $108,179 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 60923 | TotalRevenueColumn |
| Related Or Exempt Function Income | 43046 | RelatedOrExemptFunctionIncome |
| Exclusion | $17,877 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 64035420 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 104406 | TotalRevenueColumn |
| Exclusion | $104,406 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 341097 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 202294 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 138803 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 138803 | TotalRevenueColumn |
| Exclusion | $138,803 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 45445 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 300933 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -255488 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -255488 | TotalRevenueColumn |
| Exclusion | -$255,488 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64187508 | TotalRevenueColumn |
| Related Or Exempt Function Income | 63695734 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $327,407 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22375 | Total |
| Program Services | 22375 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1672559 | Total |
| Management And General | 1672559 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28816887 | Total |
| Program Services | 24684385 | ProgramServices |
| Management And General | 4132502 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1427533 | Total |
| Program Services | 1199147 | ProgramServices |
| Management And General | 228386 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4881558 | Total |
| Program Services | 3977498 | ProgramServices |
| Management And General | 904060 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1839965 | Total |
| Program Services | 1542107 | ProgramServices |
| Management And General | 297858 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 353489 | Total |
| Management And General | 353489 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 309920 | Total |
| Management And General | 309920 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1542 | Total |
| Management And General | 1542 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3941719 | Total |
| Program Services | 3406464 | ProgramServices |
| Management And General | 535255 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 654975 | Total |
| Program Services | 3407 | ProgramServices |
| Management And General | 651568 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8094427 | Total |
| Program Services | 7610443 | ProgramServices |
| Management And General | 483984 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 760310 | Total |
| Program Services | 150209 | ProgramServices |
| Management And General | 610101 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1075108 | Total |
| Program Services | 919756 | ProgramServices |
| Management And General | 155352 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 369042 | Total |
| Program Services | 265564 | ProgramServices |
| Management And General | 103478 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 320398 | Total |
| Program Services | 320398 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3107929 | Total |
| Program Services | 2424746 | ProgramServices |
| Management And General | 683183 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 254399 | Total |
| Program Services | 279323 | ProgramServices |
| Management And General | -24924 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 1501836 | 1501836 | |
| Recruitment | 422039 | 376702 | 45337 |
| Dues & Subscriptions | 137259 | 60266 | 76993 |
| Planning, Research, and | 104035 | 104035 | |
| Permits & Licenses | 103359 | 95609 | 7750 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 184002 | Total |
| Program Services | 8603 | ProgramServices |
| Management And General | 175399 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60356665 | Total |
| Program Services | 48848838 | ProgramServices |
| Management And General | 11507827 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23251 | BOY |
| EOY | 22218 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8804395 | BOY |
| EOY | 7180719 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8093902 | BOY |
| EOY | 8714090 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1107977 | BOY |
| EOY | 1367938 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 667076 | BOY |
| EOY | 913762 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1166218 | BOY |
| EOY | 1288649 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 68988679 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 30249962 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22837550 | BOY |
| EOY | 38738717 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2210701 | BOY |
| EOY | 2409008 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14874617 | BOY |
| EOY | 13648746 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59785687 | BOY |
| EOY | 74283847 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5639029 | BOY |
| EOY | 7026271 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7316344 | BOY |
| EOY | 15802451 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12955373 | BOY |
| EOY | 22828722 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46595671 | BOY |
| EOY | 51221755 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 234643 | BOY |
| EOY | 233370 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46830314 | BOY |
| EOY | 51455125 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59785687 | BOY |
| EOY | 74283847 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,003 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5003 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | LOBBYING PORTION OF DUES PAID TO WHA - $2,055 LOBBYING PORTION OF DUES PAID TO RHWC - $2,948 | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 598339 | OtherCostOrOtherBasis |
| Book Value | 598339 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 44239343 | OtherCostOrOtherBasis |
| Depreciation | 13766983 | Depreciation |
| Book Value | 30472360 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 668425 | OtherCostOrOtherBasis |
| Depreciation | 479427 | Depreciation |
| Book Value | 188998 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23304655 | OtherCostOrOtherBasis |
| Depreciation | 15870408 | Depreciation |
| Book Value | 7434247 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 177917 | OtherCostOrOtherBasis |
| Depreciation | 133144 | Depreciation |
| Book Value | 44773 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38738717 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Third Party Settlement | 2440671 |
| Other A/R | 589065 |
| Foundation | 230743 |
| LSHS Investment | 8290941 |
| Due from affiliate | 2097326 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 13648746 | TotalBookValueOtherAssets |
| Total Revenue | 64187508 | TotalRevenue |
| Total Expenses | 60356665 | TotalExpenses |
| Excess Or Deficit For Year | 3830843 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 944730 | NetUnrealizedGLOnInvestments |
| Other | -$150,762 | OtherAmount |
| Total Adjustments | 793968 | TotalAdjustments |
| Excess Or Deficit Per FS | 4624811 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part XI, Line 8 - Other Adjustments: | Identifier |
| Explanation | NET TRANSFER FROM AFFILIATE: -38446. Ministry Home Care Loss Funding: -140299. Restricted Fund Activity for Katies's Fund: 27983. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1545471 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1545471 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02630 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6300808 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4303529 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1997279 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03390 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7846279 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4303529 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3542750 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06020 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1468063 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 258273 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1209790 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02060 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 73295 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 73295 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 181485 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 181485 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1722843 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 258273 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1464570 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02490 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9569122 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4561802 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5007320 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08510 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1653 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1653 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 580 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 580 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3501 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3501 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 131711 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 131711 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2474 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2474 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 159842 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 159842 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 299761 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 299761 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00500 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $853,923 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 16147609 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 20715270 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4567661 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| Door County Memorial Hospital | ||||||||
| 323 S 18th Ave | Sturgeon Bay | WI | 54235 | X | X | X | X | |
| North Shore Medical Clinic | ||||||||
| 3711 Hwy 42 | Fish Creek | WI | 54212 | OP Phys Clinic | ||||
| north Shore Medical Clinic | ||||||||
| 815 Jefferson St | Algoma | WI | 54201 | oP Phys Clinic | ||||
| north Shore Medical Clinic | ||||||||
| 910 Main Rd | Washington Island | WI | 54246 | oP Phys Clinic | ||||
| north Shore Medical Clinic | ||||||||
| 323 S 18th Ave | Sturgeon Bay | WI | 54235 | oP Phys Clinic | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Annual Community Benefit Expln | Part I, Line 6a: As part of Ministry Health Care, Inc., the organization files an annual community benefit report on its webpage. The report can be viewed by visiting www.ministryhealth.org/MinistryHealth/Community.nws. | AnnualCommunityBenefitExpln |
| Costing Method Used | Part I, Line 7: 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 Charge. Prior year cost report settlements are excluded from the shortfall calculation in order to get a true fiscal year shortfall amount. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: In the calculation of Part I, line 7, column (f), the total expenses from Part IX, line 25 were reduced by bad debt expense of $1,501,836. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: The calculation above started with the actual patient charges written off to bad debt and contractual reserves multiplied by ratio of patient care cost to charge ratio. These accounts are considered uncollectable. | BadDebtFootnote |
| Debt Collection Policy | Part III, Line 9b: DCMH 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. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: The organization performs community needs assessments as needed. Planning workgroups consisting of community partners are formed to define the community and its needs through review of Health 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 underserved. 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 develops a plan to implement a program either through community collaboration or individually. Outcomes from the programs are measured and considered in subsequent community needs assessments. Community benefit plans are presented to senior leadership and board members to ensure the findings are incorporated into the organization's strategy and policy development. For example, senior leaders are required to provide direct service to the poor hours as part of their performance goals. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: The organization 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 charity care policy. The charity care policy and application is posted on the organization's website. Admissions and other key areas contain summary information of the charity 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, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to the organization's community care program. Patients may be identified as needed financial assistance at any time during the course of an encounter. A referral for consideration of community care financial assistance can be initiated by any member of the hospital's workforce, including medical staff members, who become aware of the patient's potential need for community care financial assistance. The charity care policy was also translated into dialects prevalent in the community in order to reach out to those that may speak another language. Patient Registration staff and Financial Counselors are provided with scripts to follow when interacting with patients. As part of the charity care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: 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. DCMH 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. Our hospital, like most rural hospitals, was created and is maintained in order to provide care locally - care that without our hospital, would not be available locally. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: Some of the things included in this area are working with community organizations such as Rotary, Leadership of Door County, and Loaves and Fishes. Workforce development includes Health Care Career Presentations and school/community programs that allow job shadowing and mentoring. Support a community garden and work with local emergency agencies regarding disaster readiness. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: -The local Board for Door County Memorial Hospital is made up of community members that live in our primary service area.-Door County Memorial Hospital partners with the local YMCA on various events promoting health and well being in the community.-Door County Memorial Hospital extends medical privileges to all qualified physicians in the community. -Door County Memorial Hospital participates in Medicare, Medicaid, and other government sponsored programs. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: The organization is part of an affiliated health care system called Ministry Health Care, Inc. The mission of Ministry as a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well being of all people, especially the poor, in the communities served. Ministry supports such non-hospital facilities as the Agape Community Center. As a community center, it has the unique advantage of welcoming youth, adults, families and seniors into the facility through a broad range of educational, social, recreational, cultural, health and life-long learning opportunities in an impoverished portion of Milwaukee. Our Catholic Identity expects leaders to initiate and support efforts to reach out to the poor and vulnerable people, especially where no one else wants to go. Health care can become very bureaucratic and burdened with oversight of finances, regulatory requirements and strategic planning. Our focus on these issues may cause us to lose touch with those for whom we have a primary responsibility, those who are poor and vulnerable. Tithing of time allows us to look into the face of the poor, hear the voice of the poor, and help us better understand the daily challenges and barriers they face. As an affiliated health system, all leaders with direct reports are required to provide service to the poor. This also includes physician leaders and hourly supervisory staff. The organization also participates in the Ministry Health Care Fund which provides monies for special projects within the communities we serve. All organizations sponsored or co-sponsored by Ministry Health Care, Inc. set aside monies each year to assist with the needs of the community and the poor. As the Ministry Health Care Fund, these dollars are funneled back into our communities for a variety of programs and services through a community assets and needs assessment process. | AffiliatedHealthCareSystem |
| Reports Filed With States | WI | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: Our organization did not issue "grants". We did provide assistance to the Community Clinic by providing free lab services up to $12000 for the year. The other type of assistance we provide is community care or charity care for patients who are eligible. Documentation is kept in the patient records and patient financial services office. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| dr george roenning | |||||||||||||
| 188128 | 0 | 100 | 0 | 1205 | 0 | 11724 | 0 | 23540 | 0 | 224697 | 0 | 0 | 0 |
| dr kelton reitz | |||||||||||||
| 226402 | 0 | 66476 | 0 | 183 | 0 | 14700 | 0 | 10677 | 0 | 318438 | 0 | 0 | 0 |
| GERALD WORRICK | |||||||||||||
| 0 | 231019 | 0 | 70711 | 0 | 77579 | 0 | 30480 | 0 | 18636 | 0 | 428425 | 0 | 0 |
| ROBERT SCIESZINSKI | |||||||||||||
| 0 | 149281 | 0 | 30666 | 0 | 25656 | 0 | 31743 | 0 | 21276 | 0 | 258622 | 0 | 0 |
| JODY BOES | |||||||||||||
| 0 | 138154 | 0 | 24038 | 0 | 18674 | 0 | 17952 | 0 | 21084 | 0 | 219902 | 0 | 0 |
| STEVEN QUADE | |||||||||||||
| 0 | 99590 | 0 | 16992 | 0 | 14879 | 0 | 16007 | 0 | 25884 | 0 | 173352 | 0 | 0 |
| STEVEN DAVIS | |||||||||||||
| 440892 | 0 | 0 | 0 | 420 | 0 | 14700 | 0 | 27937 | 0 | 483949 | 0 | 0 | 0 |
| Dorene Dempster | |||||||||||||
| 298916 | 0 | 0 | 0 | 274 | 0 | 14700 | 0 | 25437 | 0 | 339327 | 0 | 0 | 0 |
| Richard Hogan | |||||||||||||
| 299382 | 0 | 48015 | 0 | 785 | 0 | 14700 | 0 | 22937 | 0 | 385819 | 0 | 0 | 0 |
| MICHAEL S BRUNO | |||||||||||||
| 281399 | 0 | 48063 | 0 | 274 | 0 | 14700 | 0 | 27437 | 0 | 371873 | 0 | 0 | 0 |
| RICHARD L HECKER | |||||||||||||
| 180491 | 0 | 129914 | 0 | 2320 | 0 | 9800 | 0 | 4247 | 0 | 326772 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Ministry Health Care, Inc. is the corporate member of Door County Memorial Hospital, Inc. | |
| Form 990, Part VI, Section A, line 7a | Ministry Health Care, Inc. has the power to appoint and remove members of the Board of directors. | |
| Form 990, Part VI, Section A, line 7b | Ministry Health Care, Inc. has the power to initiate and approve all amendments to the Articles of Incorporation and Bylaws. | |
| Form 990, Part VI, Section B, line 11 | THE FORM 990 WAS PROVIDED TO THE ORGANIZATION'S Finance committee after It WAS FILED. THE EXECUTIVE COMMITTEE HAS DESIGNATED THE DETAIL REVIEW OF THE FORM 990 TO MANAGEMENT, BUT HAS FINAL APPROVAL OF THE RETURN. | |
| Form 990, Part VI, Section B, line 12c | Jerry Worrick, CEO, Robert Scieszinski, CFO, and Ron Mohorek watch for proposals that are being voted on at the Board meetings in the event that the particular proposal might be considered a conflict of interest for any of the voting members. | |
| Form 990, Part VI, Section B, line 15 | Ministry Health Care and Door County Memorial Hospital use Comparability data to determine compensation. The Ministry Board of Directors has a compensation committee that is assisted by an independent outside consulting firm; Sillivan Cotter. Sullivan Cotter, in partnership with the compensation committee of the Board of Directors, reviews market data for compensation and benefits and comparability data on every Ministry Health Care executive. Gerald Worrick, CEO, and Greg Holub, VP Clinic, uses AMGA data by region and specialty to determine compensation for the Physicians. This process is documented with the Ministry Health Care compensation committee. | |
| Form 990, Part VI, Section C, line 19 | UPON REQUEST | |
| Form 990 Part XI line 2b-c and Form 990 Part IV line 12 | Door County Memorial Hospital's financial statements are audited as part of Ministry Health Care's consolidated statements. THERE HAS BEEN NO CHANGE IN THE OVERSIGHT OR SELECTION PROCESS BETWEEN THE CURRENT AND PRIOR YEAR. | Audited Financial Statements |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| Ministry Health Care | |||||||||
| 11925 W Lake PArk Drive | Milwaukee | WI | 53224 | 391490371 | Support related Healthcare organizations | WI | 501(c)(3) | 11B-II | N/A |
| Door County Memorial Hospital Foundation Inc | |||||||||
| 1843 Michigan Street | Sturgeon Bay | WI | 54235 | 391649104 | Raise Funds in support of Door County Memorial Hospital, Inc. | WI | 501(c)(3) | 11a-I | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Ministry Health Care Inc | |
| D | 322328 |
| Ministry Health Care Inc | |
| L | 2076216 |
| Ministry Health Care Inc | |
| P | 384225 |
| ministry Health Care Inc | |
| O | 370974 |
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