2026-08-14T10:18:54+00:00 2025-09-30 135565207 KPMG LLP 200 EAST RANDOLPH DRIVE SUITE 5500 CHICAGO IL 606016436 990 2024-10-01 061745397 OCONTO HOSPITAL AND MEDICAL CENTER OCON 9208351100 820 ARBUTUS AVENUE OCONTO WI 54153 JOHN CEELEN CFO 2026-08-14 true ZELIJKO POPOVIC P01795951 3126651000 2026-08-12 2024 2025-03-06 01:10:19Z BELLIN HEALTH OCONTO HOSPITAL JOHN CEELEN 820 ARBUTUS AVENUE OCONTO WI 54153 101542274 false X WWW.BELLIN.ORG/LOCATIONS/BELLIN-HEALTH-OCONTO-HOSPITAL X 2005 WI OCONTO HOSPITAL & MEDICAL CENTER, INC. (THE ORGANIZATION) IS YOUR HOMETOWN HEALTHCARE SERVICE PROVIDER, CREATED TO MAKE OUTSTANDING HEALTHCARE CONVENIENT. BACKED BY THE RESOURCES OF BELLIN HEALTH, THE ORGANIZATION OFFERS OUTSTANDING HOSPITAL-BASED, EMERGENCY AND PRIMARY CARE SERVICES. THE ORGANIZATION OFFERS THE CARE YOU NEED WHERE YOU WANT IT. 6 0 414 6 0 218199 25846 90621783 98766763 -17000 3251 2307863 2678405 93130845 101474265 0 0 0 0 44733660 46027178 0 0 0 43928867 48469107 88662527 94496285 4468318 6977980 50170743 46274453 21940866 11066596 28229877 35207857 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, AND BELLIN HEALTH. false false 60119065 0 71938375 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, 2024 TO SEPTEMBER 30, 2025, 367 INPATIENT DAYS WERE PROVIDED AND 1,321 SWING BED DAYS WERE PROVIDED. THE NUMBER OF OUTPATIENTS REGISTERED DURING THE SAME 12 MONTH PERIOD WAS 23,036. 26438482 0 29495149 OCONTO HOSPITAL AND MEDICAL CENTER OPERATES A 10-BED CRITICAL ACCESS HOSPITAL (CAH) WHICH PROVIDES BOTH INPATIENT AND OUTPATIENT MEDICAL AND SURGICAL SERVICES. THE OCONTO HOSPITAL & MEDICAL CENTER ALSO OPERATES A MULTISPECIALTY CLINIC IN MARINETTE WISCONSIN. SERVICES OFFERED AT THE MARINETTE LOCATION INCLUDE PRIMARY CARE SERVICES, RADIATION ONCOLOGY SERVICES, CHEMOTHERAPY, AND INFUSION SERVICES. IN ADDITION, THE ORGANIZATION HAS PRIMARY CARE CLINICS IN OCONTO, OCONTO FALLS, CRIVITZ, LAKEWOOD, SURING, AND PESHTIGO WISCONSIN, AND DAGGETT AND MENOMINEE MICHIGAN. THESE PROGRAM SERVICES PROVIDED 21,567 URGENT CARE VISITS, 88,208 PRIMARY CARE VISITS AND 39,057 SPECIALTY PROVIDER VISITS TO THESE COMMUNITIES DURING THE PERIOD OF OCTOBER 1, 2024 TO SEPTEMBER 30, 2025. 86557547 true true false false false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false true false false false false true 0 0 414 true false false false false false false false false false false false false X 6 0 false false false false true true true true true false false false true true true true true true false false false false WI X ERIC JACOBSON 9204457260 2020 SOUTH WEBSTER AVENUE GREEN BAY WI 54301 CHRISTINE WOLESKE BOARD OF DIRECTORS, PRESIDENT 2.0 46.0 X X 0 1888539 201133 LAURA HIEB BOARD OF DIRECTORS, CHIEF NURSING OFFICER 2.0 46.0 X X 0 466684 66984 PETER VANDENHOUTEN BOARD OF DIRECTORS, SECRETARY, SR VP LEGAL COUNSEL 2.0 48.0 X X 0 629937 85132 SCOTT RATHGABER MD BOARD OF DIRECTORS, CEO 2.0 48.0 X X 0 1324275 73275 SHARLA BAENEN BOARD OF DIRECTORS, CHIEF OPERATING OFFICER 2.0 46.0 X X 0 653831 93519 MICHAEL LANDRUM MD BOARD OF DIRECTORS, PHYSICIAN DIRECTOR 2.0 46.0 X 0 507796 24867 DANIEL LILLY ASSISTANT SECRETARY, CHIEF LEGAL OFFICER 2.0 48.0 X 0 617635 74467 JOHN CEELEN TREASURER, CHIEF FINANCIAL OFFICER 1.0 49.0 X 0 728316 54052 JULIE BIEBER BULIN VP OCONTO HOSPITAL 50.0 0 X 184922 0 24833 MICHELLE MICKA ASSISTANT TREASURER, VICE PRESIDENT, FINANCE & ACCOUNTING 2.0 48.0 X 0 379411 72275 DAVID HOYER MD PHYSICIAN 40.0 0 X 502107 0 50615 JASON COISMAN MD PHYSICIAN 40.0 0 X 453996 0 46238 JON SIMMONS MD PHYSICIAN 50.0 0 X 379323 0 30839 MICHAEL BRENNER MD PHYSICIAN 50.0 0 X 366130 0 51372 PAWNEET SINGH PHYSICIAN 50.0 0 X 551948 0 29215 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0.0 0.0 X 0 209856 0 2438426 7406280 978816 62 true true false RADIOLOGY ASSOCIATES OF APPLETON 2500 E CAPITAL DR APPLETON WI 54911 RADIATION ONCOLOGY PROVIDER SERVICES 684517 4M BUILDING SOLUTIONS LLC 2936 HOLMGREN WAY GREEN BAY WI 54304 HOUSEKEEPING SERVICES 600777 BAY TOWEL LINEN & UNIFORM RENT 2580 S BROADWAY GREENBAY WI 54304 CONTRACTED LINEN SERVICES 337752 UROLOGY ASSOC OF GREEN BAY SC 720 S VAN BURENT ST GREEN BAY WI 54301 PROFESSIONAL SURGICAL SERVICES 276000 APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 PROFESSIONAL SURGICAL SERVICES 214148 7 12986 12860 25846 NET PATIENT SERVICE REVENUE 621300 97047104 97047104 CONTRACTED SERVICES 621110 1599659 1599659 RENT FROM AFFILIATES 900099 120000 120000 0 0 0 0 98766763 24592 17261 7331 0 7331 7331 53999 50748 0 3251 3251 3251 INCENTIVE PAYMENTS 621110 2666761 2666761 OTHER REVENUE 900099 4313 4313 0 0 0 0 2671074 101474265 101433524 0 14895 38469947 37825503 644444 2022290 1987887 34403 3186452 3143371 43081 2348489 2304378 44111 3083149 2866319 216830 0 297 297 360284 295500 64784 222738 215882 6856 4072553 3980653 91900 548249 531296 16953 95294 92133 3161 264874 156790 108084 3526539 3473968 52571 51541 12456 39085 MEDICAL SUPPLIES 30664499 24361567 6302932 BAD DEBT EXPENSE 2910303 2910303 FOOD 2057821 2057752 69 DUES & SUBSCRIPTIONS 244563 96469 148094 366403 245023 121380 0 94496285 86557547 7938738 0 5798492 2554072 9490853 7954827 0 0 1801133 1618531 3789 0 63189145 40378141 25455242 22811004 0 0 7621234 11336019 50170743 46274453 4024361 4483429 8511442 0 0 9405063 6583167 21940866 11066596 X 27395386 34358077 834491 849780 28229877 35207857 50170743 46274453 6977980 0 X X false true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 682918 682918 28770104 12965115 15804989 33650005 27413026 6236979 86118 86118 22811004 INTEREST IN FOUNDATION 849780 RIGHT OF USE ASSETS 2104299 DUE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 6844435 DUE FROM AFFILIATES 1537505 11336019 FEDERAL INCOME TAXES DUE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 856566 OPERATING LEASE LIAIBILITIES 2104299 FINANCE LEASE LIABILITIES 3622302 6583167 X 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE THE SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, AND HAVE BEEN FULLY RESERVED. true true X true X true X true true false true true 461689 0 461689 0.00504 9064252 7077194 1987058 0.02170 0 0 0 0.0 0 0 9525941 7077194 2448747 0.02674 21650 0 21650 0.00024 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 3611 0 3611 0.00004 0 0 25261 0 25261 0.00028 0 0 9551202 7077194 2474008 0.02701 0 0.0 0 0.0 0 0.0 1 4 1289 1289 0.00001 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 4 1289 0 1289 0.00001 true 1064333 0 9900801 8552046 1348755 X true true 1 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVE OCONTO WI 54153 HTTPS://BELLIN.ORG/LOCATIONS/BELLIN 1061 X X X X OCONTO HOSPITAL & MEDICAL CENTER INC 1 false false true X X X X X X X X X 24 true true true true X https://bellin.org/about-bellin-health/community-health-initiatives X true 24 true https://bellin.org/about-bellin-health/community-health-initiatives false true X 200.0 400.0 X X X true true X X X X true X HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS X HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS X HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY , 1 FACILITY , 1 - OCONTO HOSPITAL & MEDICAL CENTER, INC.. THIS ASSESSMENT WAS BUILT ON COLLABORATION, ACTIVELY SEEKING INPUT FROM A BROAD CROSS SECTION OF COMMUNITY STAKEHOLDERS WITH THE GOAL OF REACHING CONSENSUS ON PRIORITIES TO MUTUALLY FOCUS HUMAN, MATERIAL AND FINANCIAL RESOURCES. BELOW IS A LISTING OF PARTICIPANTS IN A CHNA SUMMIT IN WHICH HEALTH PRIORITIES WERE DETERMINED: HEALTHY OCONTO COUNTY MEMBERS: - JODY ANDERSON, BELLIN HEALTH - JULIE BIEBER, BELLIN HEALTH OCONTO HOSPITAL - ELORA BLUM, OCONTO COUNTY PUBLIC HEALTH - STEFFANIE BISHOP, NORTHLAKES COMMUNITY CLINIC - DAVE HONISH, CESA 8 - DEBRA KONITZER, OCONTO COUNTY PUBLIC HEALTH - CHRISTOPHER BRABANT, HSHS - KEVIN MALNOR, TRI-COUNTY UNITED WAY - SCOTT SHACKELFORD, OCONTO COUNTY HEALTH & HUMAN SERVICES - JAELYN SCANLAN, OCONTO COUNTY PUBLIC HEALTH - SHERIFF TODD SKARBAN, OCONTO COUNTY - STAKEHOLDERS, PARTICIPANTS, AND PARTNERS: - SARA APPLEBEE, OCONTO COUNTY PUBLIC HEALTH - TOM BITTERS, OCONTO COUNTY HEALTH & HUMAN SERVICES BOARD - HEATHER BLUM, OCONTO COUNTY PUBLIC HEALTH - RON CHRISTENSEN, OCONTO COUNTY VETERANS SERVICES - AIMEE CLOUGH, OCONTO NON-PROFIT CHILDCARE - LISA DOLAN, UNITY RECOVERY SERVICES - AMANDA DORNFELD, UNIVERSITY OF WISCONSIN EXTENSION - BETH EARLEY, OCONTO COUNTY PUBLIC HEALTH - MELISSA FRANKEN, ENCOMPASS CHILDCARE - SUE HOFFMAN, OCONTO NON-PROFIT CHILDCARE - JESSICA HONISH, RAINBOW HOUSE - GABRIELLE LENTZ, WISCONSIN DEPARTMENT OF HEALTH SERVICES - AMY LONGSINE, OCONTO COUNTY PUBLIC HEALTH - EMILY MILLER, OCONTO UNIFIED SCHOOL DISTRICT - KARI OLSEN, GREATER GREEN BAY COMMUNITY FOUNDATION - TRACY ONDIK, EMERGENCY MEDICAL SERVICES - ERIK PRITZL, OCONTO COUNTY - BRENDA REHBERG, BELLIN HEALTH - ERIKA RITCHIE, GREATER GREEN BAY COMMUNITY FOUNDATION - FRANK SCHERSING, OCONTO COUNTY COMMISSION ON AGING - SARA SCHINDEL, UNIVERSITY OF WISCONSIN EXTENSION - TODD VANDER GALIEN, UNITY RECOVERY SERVICES - MARY WOEPSE, AGING AND DISABILITY RESOURCE CENTER SCHEDULE H, PART V, SECTION B, LINE 6A FACILITY , 1 FACILITY , 1 - OCONTO HOSPITAL & MEDICAL CENTER, INC.. HSHS ST. CLARE MEMORIAL HOSPITAL SCHEDULE H, PART V, SECTION B, LINE 6B FACILITY , 1 FACILITY , 1 - OCONTO HOSPITAL & MEDICAL CENTER, INC.. CESA 8 - HSHS ST. CLARE MEMORIAL HOSPITAL - OCONTO COUNTY ECONOMIC DEVELOPMENT CORPORATION - OCONTO COUNTY PUBLIC HEALTH - OCONTO COUNTY LAW ENFORCEMENT - OCONTO COUNTY VETERAN SERVICES - NORTHLAKES COMMUNITY CLINICS - TRI-COUNTY UNITED WAY SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY , 1 FACILITY , 1 - OCONTO HOSPITAL & MEDICAL CENTER, INC.:. THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2023 THROUGH 2026. THE NEEDS IDENTIFIED ARE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG ABUSE (AODA) AND TRANSPORTATION. A SUMMARY OF HOW THE HOSPITAL HAS BEEN ADDRESSING SOME OF THE NEEDS IDENTIFIED IN THE CHNA IS AS FOLLOWS: 1. MENTAL HEALTH - ANNUAL MEN'S EVENT - BELLIN OCONTO FITNESS HER/HIS PROGRAM - BELLIN OCONTO KIDS TRIATHLON - NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) - INCREASE RESOURCES AVAILABLE THROUGH FIND HELP 2. ALCOHOL AND OTHER DRUG ABUSE - DRUG TAKE BACK EVENTS - PARTNERING WITH THE TAVERN LEAGUE - DISTRIBUTED COASTERS AT TAVERN LEAGUE TO BE USED AT THE TAVERNS AND CONNECTED INDIVIDUALS WITH 988 - COMMUNITY FORUM ON FENTANYL AND DISTRIBUTED LOCK BOXES 3. TRANSPORTATION - PARTNERED WITH MENOMINEE REGIONAL TRANSIT TO A RURAL ROUTE IN OCONTO COUNTY - EDUCATED ONE ELECTED OFFICIAL ON THE NEED FOR TRANSPORTATION IN OUR RURAL AREA - CREATED A SUBCOMMITTEE TO IDENTIFY GAPS IN THE CITY OF OCONTO SCHEDULE H, PART V, SECTION B, LINE 13 FACILITY , 1 FACILITY , 1 - OCONTO HOSPITAL & MEDICAL CENTER, INC.. PRESUMPTIVE ELIGIBILITY INCLUDES FACTORS AS: HOMELESS, DECEASED WITH NO KNOWN ESTATE, APPROVED COURT BANKRUPTCY, PAYMENT ASSISTANCE RANK ORDER SCORE, ELIGIBLE FOR STATE OF WI FOOD SHARE PROGRAM. 9 BELLIN HEALTH MARINETTE 2820 ROOSEVELT ROAD MARINETTE WI 54143 RURAL HEALTH CLINIC, ASC BELLIN HEALTH OCONTO FALLS 107 E HIGHLAND DRIVE OCONTO FALLS WI 54154 RURAL HEALTH CLINIC BELLIN HEALTH CRIVITZ 218 S US HWY 141 SUITE 100 CRIVITZ WI 54114 RURAL HEALTH CLINIC BELLIN HEALTH OCONTO 820 ARBUTUS AVE SUITE 102 OCONTO WI 54153 RURAL HEALTH CLINIC BELLIN HEALTH PESHTIGO 441 FRENCH STREET PESHTIGO WI 54162 RURAL HEALTH CLINIC BELLIN HEALTH SURING 307 MANOR DRIVE SURING WI 54174 RURAL HEALTH CLINIC BELLIN HEALTH DAGGETT 106 S SCHOOL ROAD DAGGETT MI 49821 RURAL HEALTH CLINIC BELLIN HEALTH LAKEWOOD 15481 COMMERCIAL ROAD SUITE E LAKEWOOD WI 54138 RURAL HEALTH CLINIC BELLIN HEALTH MENOMINEE 1100 10TH STREET MENOMINEE MI 49858 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT PREPARED BY RELATED ORGANIZATION BELLIN HEALTH SYSTEMS, INC. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY USED TO CALCULATE FINANCIAL ASSISTANCE AMOUNTS ARE CALCULATED BASED ON THE COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES EARTH DAY CLEAN UP - REMOVED GARBAGE FROM 1 MILE STRIP ON ROOSEVELT RD MARINETTE COUNTY - PROVIDED COMMUNITY EDUCATION ON SUICIDE PREVENTION AT CITY OF OCONTO NATIONAL NIGHT OUT - DELIVERED OF MEALS 1X MONTH TO THE HOMEBOUND BY OCONTO LEADERSHIP FOR OCONTO COUNTY COMMISSION ON AGING - OCONTO LEADERSHIP VOLUNTEERING AT OCONTO COUNTY VETERANS SERVICE SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE - METHODOLOGY USED TO ESTIMATE AMOUNT THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS. SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE METHODOLOGY THE HOSPITAL UTILIZED HFMA #15, THEREFORE NONE OF THE BAD DEBT WOULD BE DEEMED CHARITY CARE SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE - FINANCIAL STATEMENT FOOTNOTE THE ATTACHED FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC BAD DEBT EXPENSE FOOTNOTE. HOWEVER, THE SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES DESCRIBES THE HOSPITAL'S POLICY ON PAGE 9 OF THE FINANCIAL STATEMENTS. CONSISTENT WITH BELLIN HEALTH SYSTEMS' MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, BELLIN HEALTH SYSTEMS HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS BELLIN HEALTH SYSTEMS EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. BELLIN HEALTH SYSTEMS' POLICY IS TO PROVIDE A 35% DISCOUNT FROM ESTABLISHED CHARGES TO UNINSURED PATIENTS. THIS POLICY DID NOT CHANGE IN 2024 AND 2025. SCHEDULE H, PART III, LINE 8 COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTS THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RULE 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. SCHEDULE H, PART III, LINE 9B COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE FOR PATIENTS WHO CANNOT MEET THE EXPECTATIONS OF THE DEBT COLLECTION POLICY, THE ORGANIZATION OFFERS FINANCIAL ASSISTANCE. THE ORGANIZATION WILL NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE DETERMINING WHETHER A GUARANTOR IS ELIGIBLE FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. ALL PATIENTS ARE OFFERED A PLAIN LANGUAGE SUMMARY EXPLAINING THE FINANCIAL ASSISTANCE PROGRAM AS PART OF THE REGISTRATION PROCESS IN ADDITION, ALL STATEMENTS INCLUDE INFORMATION REGARDING FINANCIAL ASSISTANCE AVAILABILITY. SCHEDULE H, PART V, SECTION B, LINE 16A FAP WEBSITE - OCONTO HOSPITAL & MEDICAL CENTER, INC.: LINE 16A URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; SCHEDULE H, PART V, SECTION B, LINE 16B FAP APPLICATION WEBSITE - OCONTO HOSPITAL & MEDICAL CENTER, INC.: LINE 16B URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; SCHEDULE H, PART V, SECTION B, LINE 16C FAP PLAIN LANGUAGE SUMMARY WEBSITE - OCONTO HOSPITAL & MEDICAL CENTER, INC.: LINE 16C URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT BELLIN HEALTH OCONTO HOSPITAL (BHOH) CREATES TRUSTED RELATIONSHIPS BY LISTENING WITH INTENT, COMMUNICATING CLEARLY, AND VIEWING ALL WE DO THROUGH THE EYES OF THE PEOPLE WE SERVE. OUR SERVICES WILL BE EASY TO ACCESS AND EASY TO NAVIGATE. OUR PRICES AND OUTCOMES WILL BE READILY AVAILABLE AND EASY TO UNDERSTAND. WE DELIVER THE BELLIN PROMISE TO ALL "I WILL KNOW YOU. I WILL SHOW YOU RESPECT. I WILL GO WITH YOU ON YOUR JOURNEY. I AM HERE TO HELP YOU." BHOH AIMS TO INCREASE YEARS OF QUALITY LIFE BY PROVIDING THE HIGHEST QUALITY, RELIABLE CARE THAT IS INNOVATIVE, EQUITABLE, COORDINATED, AND AFFORDABLE FOR EVERYONE. THROUGH COLLABORATIVE RELATIONSHIPS, WE WILL ADDRESS THE SOCIAL DETERMINANTS OF HEALTH TO POSITIVELY IMPACT THE HEALTH AND WELL-BEING OF OUR PATIENTS AND COMMUNITIES. BHOH CONTINUES TO GROW RELATIONSHIPS WITH INDIVIDUALS, EMPLOYERS, SCHOOLS, AND COMMUNITIES TO INCREASE THE NUMBER OF PEOPLE WHO CHOOSE BELLIN HEALTH AS THEIR HEALTHCARE PARTNER. OUR PARTNERSHIPS, STEWARDSHIP AND POSITIVE FINANCIAL PERFORMANCE WILL DRIVE BETTER HEALTH, BETTER COMMUNITIES, AND LOWER TOTAL COST OF CARE. TOGETHER, WE WILL DESIGN SERVICES AND SUPPORT POLICIES THAT SOCIALLY, ECONOMICALLY, AND ENVIRONMENTALLY SHAPE A BETTER FUTURE." SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE NO SURPRISE BILLING ACT WENT INTO EFFECT ON JANUARY 1, 2022. THE ACT REQUIRES HEALTHCARE PROVIDERS TO PROVIDE NOTICE OF THE ACT TO ALL PATIENTS, NOTIFY, PATIENTS IF THEIR INSURANCE IS OUT-OF-NETWORK AND OBTAIN CONSENT TO BALANCE BILL, AS WELL AS PROVIDE AN ESTIMATE OF CHARGES TO UNINSURED PATIENTS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION OCONTO COUNTY MARKET IS DEFINED BY THE BORDER OF BROWN AND MARINETTE COUNTY. - THE POPULATION IS JUST OVER 37,863, OF WHICH 11,106 HAVE A PRIMARY CARE PROVIDER ALIGNMENT WITH BELLIN HEALTH. - OCONTO COUNTY FALLS IN THE NATIONAL AVERAGE FOR DEPRIVATION SITTING AT 98%. THE COUNTY HAS TWO SPECIFIC AREAS; ONE THAT CIRCLES AROUND OCONTO AND THEN ANOTHER THAT STARTS NORTHWEST OF SURING AND CONTINUES TO THE LAKEWOOD AREA. BROADBAND ACCESS FOLLOWS THE PATTERN AS WELL. - BELLIN HEALTH OCONTO HOSPITAL (BHOH) IS ONE OF THE MAJOR PLAYERS IN THIS MARKET. NORTHLAKES COMMUNITY CLINIC IS LOCATED IN LAKEWOOD AND THEIR DENTAL PRACTICE IS HOUSED ON BHOH CAMPUS. - 20% OF OCONTO COUNTY ARE SENIORS OVER AGE 65. - 21% OF OUR COMMUNITY IS 18 AND YOUNGER. - OVER 55% OF OCONTO COUNTY HAS MEDICARE OR MEDICAID -16% OF PEOPLE IN OCONTO COUNTY ARE LOW INCOME SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH THE ORGANIZATION IS A STEERING TEAM MEMBER OF THE HEALTHY OCONTO COUNTY IMPROVEMENT WORK ALONG WITH HSHS ST. CLARE HOSPITAL, NORTHLAKES COMMUNITY CLINIC, AND OCONTO COUNTY PUBLIC HEALTH. THE ORGANIZATION HAS A 24/7 EMERGENCY ROOM AVAILABILITY TO THE COMMUNITY. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM THE ORGANIZATION, IN PARTNERSHIP WITH BELLIN HEALTH SYSTEMS, INC., CONTINUES TO SERVE ITS COMMUNITY. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT WI false true false false false false false false false SHARLA BAENEN BOARD OF DIRECTORS, CHIEF OPERATING OFFICER 0 406815 0 203988 0 43028 0 65300 0 28219 0 747350 0 40237 LAURA HIEB BOARD OF DIRECTORS, CHIEF NURSING OFFICER 0 314619 0 115915 0 36150 0 43792 0 23192 0 533668 0 32940 SCOTT RATHGABER MD BOARD OF DIRECTORS, CEO 0 1278368 0 0 0 45907 0 48300 0 24975 0 1397550 0 0 PETER VANDENHOUTEN BOARD OF DIRECTORS, SECRETARY, SR VP LEGAL COUNSEL 0 407252 0 182656 0 40029 0 69350 0 15782 0 715069 0 39255 CHRISTINE WOLESKE BOARD OF DIRECTORS, PRESIDENT 0 947182 0 728601 0 212756 0 185351 0 15782 0 2089672 0 201125 MICHAEL LANDRUM MD BOARD OF DIRECTORS, PHYSICIAN DIRECTOR 0 439467 0 67915 0 414 0 21893 0 2974 0 532663 0 0 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0 209856 0 0 0 0 0 0 0 0 0 209856 0 0 JOHN CEELEN TREASURER, CHIEF FINANCIAL OFFICER 0 598104 0 129468 0 744 0 29147 0 24905 0 782368 0 0 DANIEL LILLY ASSISTANT SECRETARY, CHIEF LEGAL OFFICER 0 514649 0 97000 0 5986 0 48300 0 26167 0 692102 0 0 MICHELLE MICKA ASSISTANT TREASURER, VICE PRESIDENT, FINANCE & ACCOUNTING 0 374568 0 0 0 4843 0 48300 0 23975 0 451686 0 0 JULIE BIEBER BULIN VP OCONTO HOSPITAL 156374 0 20803 0 7745 0 11345 0 13488 0 209755 0 0 0 MICHAEL BRENNER MD PHYSICIAN 335428 0 30435 0 267 0 20222 0 31150 0 417502 0 0 0 JASON COISMAN MD PHYSICIAN 453582 0 0 0 414 0 20357 0 25881 0 500234 0 0 0 DAVID HOYER MD PHYSICIAN 501693 0 0 0 414 0 22370 0 28245 0 552722 0 0 0 JON SIMMONS MD PHYSICIAN 214412 0 164137 0 774 0 18647 0 12192 0 410162 0 0 0 PAWNEET SINGH PHYSICIAN 390396 0 161372 0 180 0 17082 0 12133 0 581163 0 0 0 SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CERTAIN INDIVIDUALS LISTED IN SCHEDULE J, PART II PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTURE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN FOR CALENDAR YEAR 2024: CHRISTINE WOLESKE SHARLA BAENEN PETER VANDENHOUTEN LAURA HEIB JOHN CEELEN LISA HARTON BELLIN MEMORIAL HOSPITAL, A RELATED PARTY, HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. CHRISTINE WOLESKE,SHARLA BAENEN, PETER VANDENHOUTEN, AND LAURA HIEB PARTICIPATED IN THE 457(F) PLAN. THE FOLLOWING INDIVIDUAL, LISTED ON PART VII OF FORM 990, HAD THE FOLLOWING AMOUNTS DISTRIBUTED DURING CALENDAR YEAR 2024: CHRISTINE WOLESKE $201,125 SHARLA BAENEN $40,237 PETER VANDENHOUTEN $39,255 LAURA HIEB $32,940 SCHEDULE J, PART I, LINE 3 ALL PERSONNEL SERVICES ARE PERFORMED BY EMPLOYEES OF GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION FORM 990, PART VI, LINE 15A COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. FORM 990, PART VI, LINE 15B SENIOR LEADERS: COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS THE ORGANIZATION IS WHOLLY OWNED BY BELLIN MEMORIAL HOSPITAL, INC. FORM 990, PART VI, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC. HAS THE POWER TO APPOINT AND REMOVE BOARD MEMBERS. FORM 990, PART VI, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC., HAS THE POWER TO APPROVE MAJOR EXPENDITURES AND LONG-TERM BORROWINGS. FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY THE FORM 990 IS REVIEWED BY THE ACCOUNTING MANAGER AND PRINCIPAL OFFICER. IT WILL BE MADE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) ANNUALLY REQUIRES EXECUTIVE LEADERSHIP (VICE PRESIDENTS AND ABOVE), BOARD MEMBERS, MEDICAL GOVERNORS AND FOUNDATION BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED DISCLOSURE STATEMENTS ARE REVIEWED BY A CONFLICT OF INTEREST REVIEW PANEL WHICH INCLUDES REPRESENTATIVES FROM LEGAL, COMPLIANCE, MEDICAL LEADERSHIP, HUMAN RESOURCES AND SUPPLY CHAIN. INDIVIDUALS REPORTING A POTENTIAL CONFLICT OF INTEREST ARE SENT A RESOLUTION THANKING THEM FOR THEIR SERVICE TO THE ORGANIZATION, ADVISING THEM OF ANY RESTRICTIONS RELATED TO THEIR CONFLICT (I.E. INDIVIDUALS WITH A RELATIONSHIP TO ANOTHER ORGANIZATION ARE ADVISED THAT THEY MUST ABSTAIN FROM DECISION MAKING THAT WOULD DIRECTLY AND SOLELY IMPACT GLAS) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO GLAS' HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC 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 XII, LINE 2C CHANGE OF OVERSIGHT PROCESS OR SELECTION PROCESS 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. 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