2026-08-14T10:03:22+00:00 2025-09-30 135565207 KPMG LLP 200 EAST RANDOLPH DRIVE SUITE 5500 CHICAGO IL 606016436 990 2024-10-01 390884478 BELLIN MEMORIAL HOSPITAL INC BELL 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 JOHN CEELEN CFO 2026-08-14 true RILEY KOBRICK P02401884 3126651000 2026-08-14 2024 2025-03-06 01:10:19Z JOHN CEELEN 744 S WEBSTER AVENUE GREEN BAY WI 54301 990540081 false X WWW.BELLIN.ORG X 1908 WI BELLIN MEMORIAL HOSPITAL, INC. (BMH) PROVIDES HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY AND IMPROVE THE HEALTH OF LOW-INCOME PATIENTS. CONSISTENT WITH THE MISSION OF BMH, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION, BMH PROVIDES SERVICES INTENDED TO BENEFIT THE POOR AND UNDERSERVED, INCLUDING THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR ARE UNINSURED OR UNDERINSURED. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID, ARE ALSO CONSIDERED PART OF THE BELLIN HEALTH BENEFITS PROVIDED TO THE COMMUNITY SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN COST. 5 0 5577 226 1926820 0 3082867 4407177 791592386 864785105 24081469 19431582 15949544 17934141 834706266 906558005 520025 383893 0 0 479526593 524322641 0 0 0 311700923 347606152 791747541 872312686 42958725 34245319 1148095932 1245049336 436573747 482361867 711522185 762687469 BELLIN HEALTH IS A COMMUNITY OWNED NOT-FOR-PROFIT ORGANIZATION RESPONSIBLE FOR IMPROVING THE HEALTH AND WELLBEING OF PEOPLE LIVING IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN, AND ALL OTHERS WE SERVE. WE CARRY OUT THIS RESPONSIBILITY THROUGH INDIVIDUALIZED CARE EXCELLENCE, COMMUNITY HEALTH IMPROVEMENT, AND EQUITABLE HEALTHCARE FINANCING PLANS ALL DESIGNED TO POSITIVELY IMPACT HEALTH AND WELLBEING. WE ARE STEADFAST IN OUR COMMITMENT TO PROVIDING COMPASSIONATE, SAFE, AND COORDINATED CARE THAT IS ACCESSIBLE AND AFFORDABLE FOR EVERYONE. WE BUILD TRUSTED RELATIONSHIPS AND ADVANCE TRUE COLLABORATION, FUELING OUR DESIRE TO CONSTANTLY IMPROVE AND INNOVATE. false false 720743555 383893 882286305 THE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2025 39,787 INPATIENT DAYS WERE PROVIDED AS COMPARED TO 37,488 IN FISCAL YEAR 2024. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2025 AND 2024 WERE 220,299 AND 199,208, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 748,462 (AS COMPARED TO 704,442 IN 2024) MEDICAL AND ASSOCIATE VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS. 720743555 true true false true false false false false false true true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 373 0 true 5577 true true true false false false false false false false false false true false X 5 0 false false false false true true true true true false false false true true true true true true false false true true WI X JOHN CEELEN 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 CHRISTINE WOLESKE BOARD OF DIRECTORS, PRESIDENT (END 6.30.25) 38.0 10.0 X X 1888539 0 201133 LAURA HIEB BOARD OF DIRECTORS, CHIEF NURSING OFFICER 42.0 6.0 X X 466684 0 66984 MICHAEL LANDRUM MD BOARD OF DIRECTORS, PHYSICIAN DIRECTOR 42.0 6.0 X X 507796 0 24867 PETER VANDENHOUTEN BOD, SECRETARY, SR VP LEGAL COUNSEL 34.0 16.0 X X 629937 0 85132 SCOTT RATHGABER MD BOARD OF DIRECTORS, CHAIR, CEO 2.0 48.0 X X 0 1324275 73275 SHARLA BAENEN BOARD OF DIRECTORS, CHIEF OPERATING OFFICER 42.0 6.0 X X 653831 0 93519 AMY DETTMAN VP PRIMARY CARE 48.0 2.0 X 339283 0 41732 CINDY LASECKI MD CHIEF CLINICAL OFFICER 46.0 4.0 X 507647 0 53017 DANIEL LILLY ASSISTANT SECRETARY, CHIEF LEGAL OFFICER 2.0 48.0 X 0 617635 74467 HEATHER SCHIMMERS RN PRESIDENT 2.0 48.0 X 0 841877 72275 JEN MACDONALD VP SPECIALTY SERVICES 48.0 2.0 X 277553 0 38391 JOHN CEELEN TREASURER, CHIEF FINANCIAL OFFICER 20.0 30.0 X 728316 0 54052 LEANNE ANDERSEN CHIEF PEOPLE OFFICER 2.0 48.0 X 0 680422 71814 MICHAEL DOLAN MD CHIEF CLINICAL OFFICER 2.0 48.0 X 0 737919 77390 MICHELLE MICKA ASST TREASURER, VP, FINANCE & ACCOUNTING 2.0 48.0 X 0 379411 72275 PRAVEEN CHOPRA CHIEF DIGITAL AND INFORMATION OFFICER 2.0 48.0 X 0 717801 77846 WILLIAM FARRELL CHIEF STRATEGY & INNOVATION OFFICER 2.0 48.0 X 0 595426 48639 ANDREA WERNER CHIEF POPULATION HEALTH OFFICER 46.0 4.0 X 388587 0 54949 LISA HARTON CHIEF QUALITY OFFICER 46.0 4.0 X 407895 0 61558 DAVID STAMPFL MD PHYSICIAN 50.0 0 X 1825564 0 45092 JAMES BAILEY MD PHYSICIAN 50.0 0 X 1043854 0 41124 KANWAR ARORA MD PHYSICIAN 50.0 0 X 1093816 0 20785 KEVIN SHEPET MD PHYSICIAN 50.0 0 X 1791390 0 44932 MATTHEW KASPAR MD PHYSICIAN 50.0 0 X 1061991 0 40426 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0.0 0.0 X 0 209856 0 13612683 6104622 1535674 812 true true false IEI GENERAL CONTRACTORS INC 1725 MIDWAY RD DE PERE WI 54115 FACILITY CONTRACTORS 31575166 MIRON CONSTRUCTION CO INC 1471 MCMAHON DR NEENAH WI 54956 GENERAL CONTRACTOR 21582870 COMPHEALTH MEDICAL STAFFING 6440 S MILLROCK DR STE 175 SALT LAKE CITY UT 84121 CONTRACTED PHYSICIAN/MANAGEMENT 4320686 APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 CONTRACTED PHYSICIAN/MANAGEMENT 4038365 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 CONTRACTED NURSING SERVICES 3651913 68 3745551 145323 516303 4407177 NET PATIENT SERVICE REVENUE 621500 852603396 851355911 1247485 CONTRACTED SERVICES 621110 4663405 4663405 CAFETERIA REVENUE 621110 2395257 2395257 ALL OTHER PROGRAM REVENUE 621110 5123047 4461983 647091 13973 0 0 0 0 864785105 12998738 12998738 0 0 0 0 623105 32244 222408 0 400697 32244 432941 32244 400697 89893517 298995 83170596 589072 6722921 -290077 6432844 6432844 EHR INCENTIVE 621110 16354010 16354010 GAIN FROM HEALTHCARE AFFILIATES 900099 1147190 1147190 0 0 0 0 17501200 906558005 877982499 1926820 22241509 383893 383893 0 0 0 0 0 0 6298421 251502 6046919 0 0 425352564 361742433 63610131 20368040 16824878 3543162 47016691 37879916 9136775 25286925 20966682 4320243 561755 561755 536271 536271 35467 35467 550524 550524 14199792 11312857 2886935 0 7697190 1903 7695287 5692523 2674995 3017528 23212061 2910202 20301859 14299043 13203759 1095284 1634723 1066104 568619 2364633 1208374 1156259 11210004 1217973 9992031 40147327 32837572 7309755 2333746 216585 2117161 SUPPLIES 165901941 165901941 BAD DEBTS 24090352 24090352 EQUIPMENT RENT AND MAINT 15561668 12898771 2662897 WI MEDICAID ACCESS FEE 7300200 7300200 10276932 5852663 4424269 0 872312686 720743555 151569131 0 18317 18948 199226119 179632408 101245001 150333896 0 0 1582839 147573 11290079 12435918 12450298 10896956 853469090 367530972 462238604 485938118 283257244 314831247 39818402 46807380 0 125245 10125 36843784 43996767 1148095932 1245049336 100564657 105062411 0 0 212116829 206248556 0 0 0 123892261 171050900 436573747 482361867 X 703097742 746533344 8424443 16154125 0 0 0 711522185 762687469 1148095932 1245049336 X 34245319 11611223 5308742 X false true true false X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 35467 35467 false SCHEDULE C, PART II-B, LINE 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY BELLIN MEMORIAL HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) & AMERICAN HOSPITAL ASSOCIATION VIA WHA. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED THE HOSPITAL THAT $21,104 OF THE COMBINED ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 3394917 173964 178136 71637 3675380 2931853 263501 291555 91992 3394917 2628543 156644 170469 23803 2931853 2831774 55830 -229949 29112 2628543 2628725 22638 209789 29378 2831774 0.0 0.824 0.176 false true true 31810936 31810936 421058017 133612415 287445602 381522978 233918557 147604421 19077159 19077159 485938118 FEDERAL INCOME TAXES FINANCE LEASE OBLIGATIONS 124678691 OPERATING LEASE OBLIGATIONS 4836440 DUE TO AFFILIATES 13242126 DEFERRED COMPENSATION 28293643 171050900 X 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE D, PART V, LINE 4 INTENDED USES OF ENDOWMENT FUNDS A RELATED ORGANIZATION, THE BELLIN HEALTH FOUNDATION, INC., HAS SEVERAL ENDOWMENT FUNDS. THE ENDOWMENT FUNDS ARE DESIGNATED FOR SCHOLARSHIPS, HEALTH CARE SERVICES AND EMPLOYEE TRAINING AND DEVELOPMENT. 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 true false true true 4958088 0 4958088 0.00585 86467844 55619497 30848347 0.03637 0 0 0 0.0 0 0 91425932 55619497 35806435 0.04221 6150334 0 6150334 0.00725 8945838 0 8945838 0.01055 0 0 0 0.0 0 0 0 0.0 614636 0 614636 0.00072 0 0 15710808 0 15710808 0.01852 0 0 107136740 55619497 51517243 0.06074 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 668131 668131 0.00079 0 0 668131 0 668131 0.00079 true 7830269 288934314 294794130 -5859816 X true true 1 1 BELLIN MEMORIAL HOSPITAL 744 S WEBSTER AVE GREEN BAY WI 54301 WWW.BELLIN.ORG 147 X X X A 2 BELLIN PSYCHIATRIC CENTER INC 301 E JOSEPH STREET GREEN BAY WI 54301 WWW.BELLING.ORG 263 X PSYCHIATRIC B A 1 false false true X X X X X X X X X 23 true true true true X HTTPS://BELLIN.ORG/ABOUT-BELLIN-HEALTH/COMMUNITY-HEALTH-INITIATIVES X true 23 true https://bellin.org/sites/bellin/files/acquiadam/2024-09/Bellin-Health-Brown-County-Community-Health- 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 B 1 false true true X X X X X X X X X 23 true true true true X https://bellin.org/about-bellin-health/community-health-initiatives X X true 23 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 X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY A, 1 FACILITY A, 1 - BELLIN MEMORIAL HOSPITAL & BELLIN PSYCHIATRIC CENTER. IN THE 2023-2024 COMMUNITY HEALTH NEEDS ASSESSEMNT (CHNA), THE KEY IDENTIFIED PRIORITIES FOCUS ON MENTAL AND EMOTIONAL WELL-BEING, SUBSTANCE MISUSE, EQUITABLE ACCESS TO HEALTHCARE, AND SAFE AND ACCESSIBLE HOUSING. RECOGNIZING THE NEED TO UNDERSTAND THE UNDERLYING REASONS FOR HEALTH DISPARITIES, COMMUNITY FEEDBACK WAS GATHERED THROUGH THE COMMUNITY MEMBER CHNA SURVEY. FEEDBACK WAS GATHERED THROUGH VARIOUS METHODS, INCLUDING: * ONGOING CHNA/CHIP SURVEY: AVAILABLE ON THE BCHP WEBSITE, THIS SURVEY SOLICITS INPUT IN ENGLISH, HMONG, AND SPANISH. IT HAS BEEN PROMOTED VIA SOCIAL MEDIA AND THROUGH COMMUNITY PARTNERS AND STEERING COMMITTEE MEMBERS, YIELDING APPROXIMATELY 60 RESPONSES FROM THE GENERAL PUBLIC. * DOOR-TO-DOOR SURVEY: IN LATE 2023, BROWN COUNTY PUBLIC HEALTH CONDUCTED A DOOR-TO-DOOR SURVEY TO ASSESS COMMUNITY EMERGENCY PREPAREDNESS NEEDS USING THE CDC'S CASPER TOOL. THIS INVOLVED RANDOMLY SELECTING 30 CLUSTERS OF HOUSES, RESULTING IN VISITS TO 490 HOMES AND THE COMPLETION OF 142 SURVEYS. THIS EFFORT WAS SUPPORTED BY PARTNERS SUCH AS THE DE PERE HEALTH DEPARTMENT, GREEN BAY METRO FIRE DEPARTMENT, AND HOWARD FIRE DEPARTMENT. * DIVERSE ENGAGEMENT INITIATIVES: TO CAPTURE A BROADER RANGE OF PERSPECTIVES, WE PARTNERED WITH COMMUNITY ORGANIZATIONS TO ENGAGE AGING INDIVIDUALS, RURAL RESIDENTS, BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC), AS WELL AS THOSE EXPERIENCING HOMELESSNESS. THIS INITIATIVE INCLUDED A TWO-PART SERIES WHERE CONSULTANTS SHARED THEIR HEALTH EXPERIENCES AS MEMBERS OF THE BROWN COUNTY COMMUNITY, WITH APPROXIMATELY 45 PARTICIPANTS INVOLVED. GUIDED BY BROWN COUNTY'S 2022-2024 CHIP AND DATA FROM THE MOST RECENT CHNA, THE BEYOND HEALTH STEERING COMMITTEE RANKED THE WISCONSIN STATE HEALTH IMPROVEMENT PLAN'S PRIORITY AREAS. THIS RANKING ESTABLISHED THE THREE FOCUS AREAS FOR BROWN COUNTY'S 2025-2027 CHIP. WHILE THE SELECTED FOCUS AREAS MAY NOT ALIGN EXACTLY WITH THE SHIP'S PRIORITIES, THE STEERING COMMITTEE OPTED TO CONCENTRATE ON MORE SPECIFIC ISSUES WITHIN THOSE AREAS. THEY ALSO CHOSE NAMES FOR THE FOCUS AREAS THAT ARE STRAIGHTFORWARD AND RESONATE WITH THE BROWN COUNTY COMMUNITY. THE 2025-2027 CHIP REPRESENTS A COLLABORATIVE EFFORT, INVOLVING PARTNERSHIPS ACROSS MULTIPLE SECTORS, INCLUDING GOVERNMENT, HEALTHCARE, AND NON-PROFIT ORGANIZATIONS. BEYOND HEALTH STEERING COMMITTEE, WHICH INCLUDES REPRESENTATION FROM LOCAL PUBLIC HEALTH AGENCIES, AREA HEALTH SYSTEMS, AND COMMUNITY AGENCIES. THE FOLLOWING ARE REPRESENTED ON THE BEYOND HEALTH STEERING COMMITTEE: - BROWN COUNTY PUBLIC HEALTH - DE PERE HEALTH DEPARTMENT - WI DEPARTMENT OF HEALTH SERVICES, DIVISION OF PUBLIC HEALTH - BROWN COUNTY UNITED WAY - ONEIDA COMMUNITY HEALTH SERVICES DEPARTMENT - N.E.W COMMUNITY CLINIC - PREVEA HEALTH - HOSPITAL SISTERS HEALTH SYSTEM - AURORA BAYCARE MEDICAL CENTER - EMPLIFY HEALTH BY BELLIN BEYOND HEALTH STRATEGY LEADS REPRESENTATION: - BROWN COUNTY UNITED WAY - BROWN COUNTY PUBLIC HEALTH - EMPLIFY HEALTH BY BELLIN - GREATER GREEN BAY BLUEPRINT TO PREVENT AND END HOMELESSNESS - NEIGHBORWORKS GREEN BAY - UW MADISON - EXTENSION, BROWN COUNTY - WELLO - WI DEPARTMENT OF HEALTH SERVICES - DIVISION OF PUBLIC HEALTH COMMUNITY ORGANIZATIONS/COMMUNITIES REPRESENTED THROUGH COMMUNITY CONSULTANTS MEETINGS: - DENMARK COMMUNITY MEMBERS - HOUSE OF HOPE - PULASKI COMMUNITY MEMBERS - WE ALL RISE - WRIGHTSTOWN COMMUNITY MEMBERS SCHEDULE H, PART V, SECTION B, LINE 6A FACILITY A, 1 FACILITY A, 1 - BELLIN MEMORIAL HOSPITAL & BELLIN PSYCHIATRIC CENTER. AURORA BAYCARE MEDICAL CENTER (GREEN BAY), AND ST. MARY'S AND ST. VINCENT HOSPITALS (HSHS, GREEN BAY) SCHEDULE H, PART V, SECTION B, LINE 6B FACILITY A, 1 FACILITY A, 1 - BELLIN MEMORIAL HOSPITAL & BELLIN PSYCHIATRIC CENTER. BEYOND HEALTH IS A STEERING COMMITTEE COMPOSED OF LEADERS FROM BOTH THE PUBLIC AND PRIVATE SECTORS, INCLUDING HEALTHCARE PARTNERS, PUBLIC HEALTH AGENCIES, AND NON-PROFIT ORGANIZATIONS. THIS COLLABORATIVE GROUP WORKS TOGETHER TO IDENTIFY ACTIONABLE PRIORITIES, REDUCE HEALTH DISPARITIES, AND ADAPT TO NEW AND EMERGING HEALTH CONCERNS AS THEY ARISE. BY LEVERAGING DIVERSE EXPERTISE AND RESOURCES, BEYOND HEALTH STRIVES TO CULTIVATE A MORE EQUITABLE AND RESPONSIVE COMMUNITY HEALTH LANDSCAPE FOR THE POPULATIONS WE SERVE. SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY A, 1 FACILITY A, 1 - BELLIN MEMORIAL HOSPITAL & BELLIN PSYCHIATRIC CENTER. THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2025 THROUGH 2027. AS DETAILED IN THE CHNA REPORT, BELLIN MEMORIAL HOSPITAL, IN COLLABORATION WITH COMMUNITY PARTNERS, IDENTIFIED THE FOLLOWING HEALTH PRIORITIES IN BROWN COUNTY: MENTAL AND EMOTIONAL WELL-BEING SUBSTANCE MISUSE EQUITABLE ACCESS TO HEALTHCARE SAFE AND ACCESSIBLE HOUSING UNDER THE BROAD UMBRELLAS OF THESE PRIORITIES, BASED ON THE HEALTH OUTCOME DATA AND OBSERVED COMMUNITY NEEDS, BELLIN MEMORIAL HOSPITAL HAS CHOSEN TO FOCUS SPECIFICALLY ON THE AREAS OUTLINED IN THE ACTION PLAN. IDENTIFIED PRIORITY: MENTAL AND EMOTIONAL WELL-BEING TACTIC: ROUTINE SCREENING FOR DEPRESSION/RISK FOR DEPRESSION FOR ADULT AND YOUTH POPULATION. TACTIC: MONITOR AND IMPROVE COMMUNITY RESOURCES CONNECTOR REFERRALS FOR PATIENT EXPERIENCING STRESS/TOXIC STRESS (INITIATED WITH THE SOCIAL DETERMINANTS OF HEALTH SURVEY) TACTIC: INCREASE THE NUMBER OF CAREGIVERS AND STAFF TRAIN IN MENTAL HEALTH FIRST AID. TACTIC: BEHAVIORAL HEALTH CONSULTANTS (BHCS) IN PRIMARY CARE TACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMS IDENTIFIED PRIORITY: SUBSTANCE MISUSE TACTIC: DEVELOP AND PROMOTE REFERRAL FOR WELLNESS COACHING PROCESS FOR PATIENTS WHO USE NICOTINE PRODUCTS TACTIC: PARTICIPATE IN DRUG TAKE-BACK EVENTS TACTIC: REGIONAL SUSPECTED OPIOID-RELATED OVERDOSES. TACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMS IDENTIFIED PRIORITY: EQUITABLE ACCESS TO HEALTHCARE TACTIC: EPIC CAMPAIGNS TO HELP ADDRESS GAPS IN CARE. TACTIC: TARGETED OUTREACH TO ALL MEDICAID PATIENTS OVERDUE FOR MAMMOGRAPHY, COLORECTAL CANCER SCREENING, WELL CHILD VISITS, AND BLOOD PRESSURE FOLLOW UP. TACTIC: IDENTIFY BARRIERS TO HEALTHCARE ACCESS THROUGH SDOH SCREENING AND INTERVENING. TACTIC: LEVERAGE COMMUNITY EDUCATION/EVENT OPPORTUNITIES TO INCREASE AWARENESS AND ALIGN TO RESOURCES. IDENTIFIED PRIORITY: SAFE AND ACCESSIBLE HOUSING TACTIC: MONITOR AND IMPROVE SOCIAL DETERMINANTS OF HEALTH SCREENING AND REFERRALS FOR PATIENTS AND FAMILIES. TACTIC: PARTICIPATE BIANNUALLY IN POINT IN TIME COUNT. PARTNER WITH COMMUNITY BASED ORGANIZATIONS TO ADDRESS NEEDS AND IMPLEMENT STRATEGIES. TACTIC: CONTINUE SUPPORT OF COMMUNITY INITIATIVES AND POLICIES THAT IMPROVE AFFORDABLE HOUSING AND ACCESS TO HOUSING RESOURCES FOR ALL POPULATIONS. HEALTH NEEDS THAT WILL NOT BE ADDRESSED AT THIS TIME: IN ADDITION TO THE HEALTH NEEDS BELLIN SELECTED AS TOP PRIORITIES, THE CHNA IDENTIFIED OTHER SIGNIFICANT HEALTH NEEDS IN BROWN COUNTY. STRATEGY OWNERS/ORGANIZATIONS ARE ASSIGNED TO LEAD WORK WITHIN THIS SPACE AND CAPITALIZE ON COMMUNITY RESOURCES AND PARTNERS COLLABORATING TO ADDRESS THE NEEDS. SCHEDULE H, PART V, SECTION B, LINE 13 FACILITY A, 1 FACILITY A, 1 - BELLIN MEMORIAL HOSPITAL & BELLIN PSYCHIATRIC CENTER. 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. SCHEDULE H, PART V, SECTION B, LINE 2 BELLIN SPYCHIATRIC CENTER, INC. MERGED INTO BELLIN MEMORIAL HOSPITAL INC. AS OF 07/26/2025. THE PSYCHIATRIC AND ALCOHOL AND OTHER DRUG ABUSE SERVICES ARE NOW PROVIDED BY BELLIN MEMORIAL HOSPITAL. SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY B, 1 FACILITY B, 1 - BELLIN PSYCHIATRIC CENTER, INC.. IN THE 2023-2024 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE KEY IDENTIFIED PRIORITIES FOCUS ON MENTAL AND EMOTIONAL WELL-BEING, SUBSTANCE MISUSE, EQUITABLE ACCESS TO HEALTHCARE, AND SAFE AND ACCESSIBLE HOUSING. RECOGNIZING THE NEED TO UNDERSTAND THE UNDERLYING REASONS FOR HEALTH DISPARITIES, COMMUNITY FEEDBACK WAS GATHERED THROUGH THE COMMUNITY MEMBER CHNA SURVEY. FEEDBACK WAS GATHERED THROUGH VARIOUS METHODS, INCLUDING: - ONGOING CHNA/CHIP SURVEY: AVAILABLE ON THE BCHP WEBSITE, THIS SURVEY SOLICITS INPUT IN ENGLISH, HMONG, AND SPANISH. IT HAS BEEN PROMOTED VIA SOCIAL MEDIA AND THROUGH COMMUNITY PARTNERS AND STEERING COMMITTEE MEMBERS, YIELDING APPROXIMATELY 60 RESPONSES FROM THE GENERAL PUBLIC. - DOOR-TO-DOOR SURVEY: IN LATE 2023, BROWN COUNTY PUBLIC HEALTH CONDUCTED A DOOR-TO-DOOR SURVEY TO ASSESS COMMUNITY EMERGENCY PREPAREDNESS NEEDS USING THE CDC'S CASPER TOOL. THIS INVOLVED RANDOMLY SELECTING 30 CLUSTERS OF HOUSES, RESULTING IN VISITS TO 490 HOMES AND THE COMPLETION OF 142 SURVEYS. THIS EFFORT WAS SUPPORTED BY PARTNERS SUCH AS THE DE PERE HEALTH DEPARTMENT, GREEN BAY METRO FIRE DEPARTMENT, AND HOWARD FIRE DEPARTMENT. - DIVERSE ENGAGEMENT INITIATIVES: TO CAPTURE A BROADER RANGE OF PERSPECTIVES, WE PARTNERED WITH COMMUNITY ORGANIZATIONS TO ENGAGE AGING INDIVIDUALS, RURAL RESIDENTS, BLACK, INDIGENOUS, AND PEOPLE OF COLOR (BIPOC), AS WELL AS THOSE EXPERIENCING HOMELESSNESS. THIS INITIATIVE INCLUDED A TWO-PART SERIES WHERE CONSULTANTS SHARED THEIR HEALTH EXPERIENCES AS MEMBERS OF THE BROWN COUNTY COMMUNITY, WITH APPROXIMATELY 45 PARTICIPANTS INVOLVED. GUIDED BY BROWN COUNTY'S 2022-2024 CHIP AND DATA FROM THE MOST RECENT CHNA, THE BEYOND HEALTH STEERING COMMITTEE RANKED THE WISCONSIN STATE HEALTH IMPROVEMENT PLAN'S PRIORITY AREAS. THIS RANKING ESTABLISHED THE THREE FOCUS AREAS FOR BROWN COUNTY'S 2025-2027 CHIP. WHILE THE SELECTED FOCUS AREAS MAY NOT ALIGN EXACTLY WITH THE SHIP'S PRIORITIES, THE STEERING COMMITTEE OPTED TO CONCENTRATE ON MORE SPECIFIC ISSUES WITHIN THOSE AREAS. THEY ALSO CHOSE NAMES FOR THE FOCUS AREAS THAT ARE STRAIGHTFORWARD AND RESONATE WITH THE BROWN COUNTY COMMUNITY. THE 2025-2027 CHIP REPRESENTS A COLLABORATIVE EFFORT INVOLVING PARTNERSHIPS ACROSS MULTIPLE SECTORS, INCLUDING GOVERNMENT, HEALTHCARE, AND NON-PROFIT ORGANIZATIONS. THE BEYOND HEALTH STEERING COMMITTEE INCLUDES REPRESENTATION FROM LOCAL PUBLIC HEALTH AGENCIES, AREA HEALTH SYSTEMS, AND COMMUNITY AGENCIES. THE FOLLOWING ARE REPRESENTED ON THE BEYOND HEALTH STEERING COMMITTEE: - BROWN COUNTY PUBLIC HEALTH - DE PERE HEALTH DEPARTMENT - WI DEPARTMENT OF HEALTH SERVICES, DIVISION OF PUBLIC HEALTH - BROWN COUNTY UNITED WAY - ONEIDA COMMUNITY HEALTH SERVICES DEPARTMENT - N.E.W. COMMUNITY CLINIC - PREVEA HEALTH - HOSPITAL SISTERS HEALTH SYSTEM - AURORA BAYCARE MEDICAL CENTER - EMPLIFY HEALTH BY BELLIN BEYOND HEALTH STRATEGY LEADS REPRESENTATION: - BROWN COUNTY UNITED WAY - BROWN COUNTY PUBLIC HEALTH - EMPLIFY HEALTH BY BELLIN - GREATER GREEN BAY BLUEPRINT TO PREVENT AND END HOMELESSNESS - NEIGHBORWORKS GREEN BAY - UW MADISON - EXTENSION, BROWN COUNTY - WELLO - WI DEPARTMENT OF HEALTH SERVICES - DIVISION OF PUBLIC HEALTH COMMUNITY ORGANIZATIONS/COMMUNITIES REPRESENTED THROUGH COMMUNITY CONSULTANTS MEETINGS: - DENMARK COMMUNITY MEMBERS - HOUSE OF HOPE - PULASKI COMMUNITY MEMBERS - WE ALL RISE - WRIGHTSTOWN COMMUNITY MEMBERS SCHEDULE H, PART V, SECTION B, LINE 7 FACILITY B, 1 FACILITY B, 1 - BELLIN PSYCHIATRIC CENTER, INC.. HTTPS://BELLIN.ORG/ABOUT-BELLIN-HEALTH/COMMUNITY-HEALTH-INITIATIVES SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY B, 1 FACILITY B, 1 - BELLIN PSYCHIATRIC CENTER, INC.. THE MOST RECENT CHNA IDENTIFIED COMMUNITY NEEDS FOR FISCAL YEARS 2025 THROUGH 2027. AS DETAILED IN THE CHNA REPORT, EMPLIFY HEALTH BY BELLIN, IN COLLABORATION WITH COMMUNITY PARTNERS, IDENTIFIED THE FOLLOWING HEALTH PRIORITIES IN BROWN COUNTY: MENTAL AND EMOTIONAL WELL-BEING SUBSTANCE MISUSE EQUITABLE ACCESS TO HEALTHCARE SAFE AND ACCESSIBLE HOUSING UNDER THE BROAD UMBRELLAS OF THESE PRIORITIES, BASED ON THE HEALTH OUTCOME DATA AND OBSERVED COMMUNITY NEEDS, EMPLIFY HEALTH BY BELLIN HAS CHOSEN TO FOCUS SPECIFICALLY ON THE AREAS OUTLINED IN THE ACTION PLAN. IDENTIFIED PRIORITY: MENTAL AND EMOTIONAL WELL-BEING TACTIC: ROUTINE SCREENING FOR DEPRESSION/RISK FOR DEPRESSION FOR ADULT AND YOUTH POPULATION. TACTIC: MONITOR AND IMPROVE COMMUNITY RESOURCES CONNECTOR REFERRALS FOR PATIENTS EXPERIENCING STRESS/TOXIC STRESS (INITIATED WITH THE SOCIAL DETERMINANTS OF HEALTH SURVEY) TACTIC: INCREASE THE NUMBER OF CAREGIVERS AND STAFF TRAIN IN MENTAL HEALTH FIRST AID. TACTIC: BEHAVIORAL HEALTH CONSULTANTS (BHCS) IN PRIMARY CARE TACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMS IDENTIFIED PRIORITY: SUBSTANCE MISUSE TACTIC: DEVELOP AND PROMOTE REFERRAL FOR WELLNESS COACHING PROCESSES FOR PATIENTS WHO USE NICOTINE PRODUCTS TACTIC: PARTICIPATE IN DRUG TAKE-BACK EVENTS TACTIC: REGIONAL SUSPECTED OPIOID-RELATED OVERDOSES. TACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMS IDENTIFIED PRIORITY: EQUITABLE ACCESS TO HEALTHCARE TACTIC: EPIC CAMPAIGNS TO HELP ADDRESS GAPS IN CARE. TACTIC: TARGETED OUTREACH TO ALL MEDICAID PATIENTS OVERDUE FOR MAMMOGRAPHY, COLORECTAL CANCER SCREENING, WELL CHILD VISITS, AND BLOOD PRESSURE FOLLOW UP. TACTIC: IDENTIFY BARRIERS TO HEALTHCARE ACCESS THROUGH SDOH SCREENING AND INTERVENING. TACTIC: LEVERAGE COMMUNITY EDUCATION/EVENT OPPORTUNITIES TO INCREASE AWARENESS AND ALIGN TO RESOURCES. IDENTIFIED PRIORITY: SAFE AND ACCESSIBLE HOUSING TACTIC: MONITOR AND IMPROVE SOCIAL DETERMINANTS OF HEALTH SCREENING AND REFERRALS FOR PATIENTS AND FAMILIES. TACTIC: PARTICIPATE BIANNUALLY IN POINT IN TIME COUNT. PARTNER WITH COMMUNITY BASED ORGANIZATIONS TO ADDRESS NEEDS AND IMPLEMENT STRATEGIES. TACTIC: CONTINUE SUPPORT OF COMMUNITY INITIATIVES AND POLICIES THAT IMPROVE AFFORDABLE HOUSING AND ACCESS TO HOUSING RESOURCES FOR ALL POPULATIONS. HEALTH NEEDS THAT WILL NOT BE ADDRESSED AT THIS TIME: IN ADDITION TO THE HEALTH NEEDS EMPLIFY HEALTH BY BELLIN SELECTED AS TOP PRIORITIES, THE CHNA IDENTIFIED OTHER SIGNIFICANT HEALTH NEEDS IN BROWN COUNTY. STRATEGY OWNERS/ORGANIZATIONS ARE ASSIGNED TO LEAD WORK WITHIN THIS SPACE AND CAPITALIZE ON COMMUNITY RESOURCES AND PARTNERS COLLABORATING TO ADDRESS THE NEEDS. SCHEDULE H, PART V, SECTION B, LINE 13 FACILITY B, 1 FACILITY B, 1 - BELLIN PSYCHIATRIC CENTER, INC.. PRESUMPTIVE ELIGIBILITY INCLUDES FACTORS SUCH AS: HOMELESSNESS, DECEASED WITH NO KNOWN ESTATE, APPROVED COURT BANKRUPTCY, PAYMENT ASSISTANCE RANK ORDER SCORE, ELIGIBLE FOR STATE OF WI FOOD SHARE PROGRAM. 36 BELLIN HEALTH SURGERY AND SPECIALTY CENTER 933 WAUBE LN ASHWAUBENON WI 54304 HOSPITAL BASED SITE THE CANCER TEAM OF BELLIN HEALTH 1580 COMMANCHE AVE GREEN BAY WI 54313 HOSPITAL BASED SITE FAMILY MEDICAL CENTER ASHWAUBENON 1630 COMMANCHE AVE GREEN BAY WI 54313 PROVIDER CLINIC SITE BELLIN HEALTH TITLETOWN SPORTS MEDICINE 1970 S RIDGE ROAD GREEN BAY WI 54304 PROVIDER CLINIC SITE BELLIN HEALTH GENERATIONS 704 S WEBSTER AVE SUITE 300 GREEN BAY WI 54301 PROVIDER CLINIC SITE NEUROLOGY CONSULTANTS OF BELLIN HEALTH 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH IRON MOUNTAIN 440 WOODWARD AVE IRON MOUNTAIN MI 49801 PROVIDER CLINIC SITE CARDIOLOGY ASSOCIATES OF BELLIN HEALTH 744 S WEBSTER AVE GREEN BAY WI 54301 HOSPITAL BASED SITE FAMILY MEDICAL CENTER DE PERE EAST 555 REDBIRD CIRCLE DE PERE WI 54115 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER BELLEVUE 3263 EATON RD GREEN BAY WI 54311 PROVIDER CLINIC SITE BELLIN HEALTH SURGICAL ASSOCIATES 720 S VAN BUREN ST SUITE 201 GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER HOWARD 2714 RIVERVIEW GREEN BAY WI 54313 PROVIDER CLINIC SITE BELLIN HEALTH ESCANABA 610 S LINCOLN ROAD ESCANABA MI 49829 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER DE PERE WEST 1800 LAWRENCE DR DE PERE WI 54115 PROVIDER CLINIC SITE GASTROENTEROLOGY ASSOCIATES OF GREEN BAY 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH NEPHROLOGY 2020 RIVERSIDE DR SUITE 200 GREEN BAY WI 54301 PROVIDER CLINIC SITE BELLIN HEALTH ENDOCRINOLOGY 704 S WEBSTER SUITE 501 GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER GREEN BAY 704 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER BRILLION 964 W RYAN ST SUITE B BRILLION WI 54110 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER KEWAUNEE 575 4TH STREET KEWAUNEE WI 54216 PROVIDER CLINIC SITE BELLIN HEALTH CARDIOVASCULAR & THORACIC 720 S VAN BUREN ST SUITE 303 GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER MANITOWOC 3415 CUSTER ST SUITE D MANITOWOC WI 54221 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER MARQUETTE 1414 WEST FAIR AVENUE SUITE 390 MARQUETTE MI 49855 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER LUXEMBURG 140 B SCHOOL CREEK TRAIL LUXEMBURG WI 54217 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER ALGOMA 831 PARKER AVE ALGOMA WI 54201 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER PULASKI 723 S WISCONSIN ST PULASKI WI 54162 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER SEYMOUR 405 COMMERCIAL ST SEYMOUR WI 54165 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER DENMARK 595 COUNTY ROAD R DENMARK WI 54208 PROVIDER CLINIC SITE BELLIN HEALTH CHILDREN & ADOLESCENT CENTER 2550 S ASHLAND AVE GREEN BAY WI 54304 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER WRIGHTSTOWN 555 QUALITY CT WRIGHTSTOWN WI 54180 PROVIDER CLINIC SITE BPC ST JOSEPH CLINIC 301 E ST JOSEPH ST GREEN BAY WI 54301 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER STURGEON BAY 311 N 3RD AVE STURGEON BAY WI 43235 PROVIDER CLINIC SITE BPC RIVERSIDE CLINIC 1325 ANGELS PATH DE PERE WI 54115 PROVIDER CLINIC SITE FAMILY MEDICAL CENTER TWO RIVERS 1516 WASHINGTON STREET TWO RIVERS WI 54241 PROVIDER CLINIC SITE BELLIN HEALTH FASTCARE - GREEN BAY WEST 2015 SHAWANO AVE GREEN BAY WI 54303 CONVENIENT CARE CENTER BELLIN HEALTH FASTCARE - GREEN BAY EAST 1976 LIME KILN RD GREEN BAY WI 54311 CONVENIENT CARE CENTER SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT PREPARED BY RELATED ORGANIZATION BELLIN MEMORIAL HOSPITAL IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES BAD DEBT EXPENSE OF $24,090,352 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. SCHEDULE H, PART I, LINE 7 BAD DEBT EXPENSE EXCLUDED FROM FINANCIAL ASSISTANCE CALCULATION 24090352 SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY USED TO CALCULATE FINANCIAL ASSISTANCE AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES COMMUNITY BUILDING ACTIVITIES FOCUS ON SOCIAL CONDITIONS THAT CONTRIBUTE TO HEALTH PROBLEMS, SUCH AS HOMELESSNESS, POVERTY, AND OTHER LIVING CONDITIONS AFFECTING THE QUALITY OF LIFE. THESE RANGE FROM DEVELOPING COMMUNITY LEADERS, DISASTER READINESS, AND SUPPORT OF LOCAL ECONOMIC DEVELOPMENT, TO HEALTH IMPROVEMENT ADVOCACY. BELLIN MEMORIAL HOSPITAL IS ACTIVE IN THE GREEN BAY PUBLIC SCHOOLS WITH OUR THRIVE PROGRAM THAT ASSISTS IN SETTING AND MEETING HEALTH AND WELLNESS GOALS FOR STUDENTS IN THIS SCHOOL SYSTEM. BELLIN ALSO HOLDS AN ANNUAL BELLIN RUN/WALK 10K/5K EVENT EACH YEAR WITH OVER 7,500 PARTICIPANTS OF ALL AGES LEARNING FIRST-HAND THE VALUE OF EXERCISE IN DAILY LIFE. 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 UTILIZES 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 19 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 2025 AND 2024. SCHEDULE H, PART III, LINE 8 COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTS THE AMOUNTS REPORTED FOR MEDICARE WERE CALCULATED USING A COST TO CHARGE RATIO. THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT FOR THE FOLLOWING REASONS. IRS REV RULE 69-545 WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS STATES THAT IF A HOSPITAL SERVICES PATIENT WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. IN ADDITION, FOR-PROFIT HOSPITALS HAVE CARVED OUT HIGH-MARGIN SERVICES (I.E. ONCOLOGY, ORTHO, ETC.) LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS MEANS THAT THE SHORTFALL IS NOT NECESSARILY FROM INEFFICIENT OPERATIONS. MEDICARE CAN BE THE LARGEST PAYOR AND HOSPITALS HAVE NO ABILITY TO DENY COVERAGE. THIS, IN TURN, IS A PROMOTION OF ACCESS TO HEALTHCARE SERVICES (A COMMUNITY BENEFIT). ALSO, ELDERLY PATIENTS ARE OFTEN UNDERSERVED AND EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE 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 A - BELLIN MEMORIAL HOSPITAL: LINE 16A URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; B - BELLIN PSYCHIATRIC 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 A - BELLIN MEMORIAL HOSPITAL: LINE 16B URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; B - BELLIN PSYCHIATRIC 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 A - BELLIN MEMORIAL HOSPITAL: LINE 16C URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; B - BELLIN PSYCHIATRIC CENTER, INC.: LINE 16C URL: HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS; SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT IN FY2024, BELLIN MEMORIAL HOSPITAL CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT WITHIN OUR COMMUNITIES IN COLLABORATION WITH THE BEYOND HEALTH COLLABORATIVE OF BROWN COUNTY, WI. ALIGNED WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PRIORITY OF ENHANCING EQUITABLE ACCESS TO HEALTHCARE, WE ARE DEDICATED TO ADDRESSING DISPARITIES IN DEPRESSION SCREENINGS (PHQ-9), BREAST CANCER SCREENINGS, AND COLORECTAL CANCER SCREENINGS AMONG OUR POPULATIONS. TO EFFECTIVELY TACKLE THESE DISPARITIES, BELLIN MEMORIAL HOSPITAL HAS IMPLEMENTED TARGETED IMPROVEMENT INITIATIVES THAT STRATIFY OUR DATA BY RACE, ETHNICITY, GENDER, AND PAYER. THIS DATA-DRIVEN APPROACH ENABLES US TO IDENTIFY AND UNDERSTAND THE UNDERLYING CAUSES OF THESE DISPARITIES. OUR INTERVENTIONS INCLUDE: - TARGETED OUTREACH AND EDUCATION PROVIDED IN PATIENTS' PREFERRED LANGUAGES. - COLLECTION AND ANALYSIS OF BOTH QUANTITATIVE AND QUALITATIVE DATA FROM COMMUNITY POPULATIONS. - INITIATIVES DESIGNED TO ELIMINATE BARRIERS TO SCREENING, SUCH AS EXTENDED SERVICE HOURS AND TRANSPORTATION ASSISTANCE. - FOCUSED STRATEGIES AIMED AT PAYER AND EMPLOYER POPULATIONS. ADDITIONALLY, ONGOING DATA COLLECTION REGARDING THE SOCIAL DETERMINANTS OF HEALTH CONTINUES TO INFORM OUR TEAMS AND GUIDE DECISIONS ON CONNECTING PATIENTS TO LOCAL RESOURCES. REGULAR MEETINGS ARE CONVENED TO ADDRESS THESE DISPARITIES AND ENGAGE A DIVERSE ARRAY OF INTERNAL AND EXTERNAL STAKEHOLDERS, INCLUDING EMPLOYER PARTNERS, ENSURING A COLLABORATIVE APPROACH TO IMPROVING HEALTH OUTCOMES. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FINANCIAL COUNSELORS PLAY A CRUCIAL ROLE IN GUIDING PATIENTS THROUGH AVAILABLE ASSISTANCE PROGRAMS. ONE VALUABLE SERVICE THEY UTILIZE IS HRS ERASE, WHICH HELPS REVIEW SELF-PAY ACCOUNTS TO IDENTIFY POTENTIAL COVERAGE OPTIONS THROUGH GOVERNMENT PROGRAMS. THIS PROACTIVE APPROACH ENSURES THAT PATIENTS RECEIVE THE FINANCIAL SUPPORT THEY NEED, MAKING HEALTHCARE MORE ACCESSIBLE AND MANAGEABLE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION BELLIN MEMORIAL HOSPITAL IS DEDICATED TO MEETING THE HEALTHCARE NEEDS OF NORTHEAST WISCONSIN AND THE UPPER MICHIGAN REGION, SERVING A DIVERSE POPULATION OF OVER 925,000 RESIDENTS. WITHIN THE BELLIN REGION, THE DEMOGRAPHIC COMPOSITION IS PREDOMINANTLY WHITE NON-HISPANIC AT 86%, WITH 7% IDENTIFYING AS OTHER NON-HISPANIC, 1% AS BLACK NON-HISPANIC, AND 6% AS HISPANIC. NOTABLY, 36% OF RESIDENTS ARE COVERED BY PUBLIC HEALTH INSURANCE, WHILE 5% LACK ANY HEALTH INSURANCE COVERAGE. BROWN COUNTY, WHERE BELLIN MEMORIAL HOSPITAL IS LOCATED, HAS AN URBAN-RURAL DIVIDE OF 86% URBAN AND 14% RURAL. THE MEDIAN AGE OF RESIDENTS IS 37.6 YEARS, AND THE MEDIAN LIFE EXPECTANCY IS 79.5 YEARS, REFLECTING THE COMMUNITY'S OVERALL HEALTH AND VITALITY. HOWEVER, CHALLENGES REMAIN, WITH 8% OF ADULTS UNDER 65 UNINSURED AND 7% REPORTING UNMET MEDICAL NEEDS. ADDITIONALLY, 5% OF CHILDREN IN BROWN COUNTY ARE WITHOUT HEALTH INSURANCE, HIGHLIGHTING THE ONGOING NEED FOR INITIATIVES AIMED AT IMPROVING ACCESS TO HEALTHCARE SERVICES. THE PAYER MIX FOR EMPLIFY HEALTH BY BELLIN CONSISTS OF 46.06% MEDICARE AND 10.67% MEDICAID, FURTHER EMPHASIZING THE IMPORTANCE OF ADDRESSING THESE HEALTHCARE ACCESS ISSUES. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH BELLIN MEMORIAL HOSPITAL GRANTS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY ACROSS ALL ITS DEPARTMENTS. THE HOSPITAL IS COMMITTED TO ENHANCING PATIENT CARE, EDUCATION, AND FACILITIES BY APPLYING SURPLUS FUNDS TOWARDS CONTINUOUS IMPROVEMENTS IN THESE AREAS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM EMPLIFY HEALTH BY BELLIN IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN NORTHEAST WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT WI true ACHIEVE BROWN COUNTY 340 N BROADWAY SUITE 400 GREEN BAY WI 54303 474100686 501(C)(3) 33333 0 CAMPAIGN PLEDGE ENCOMPASS EARLY EDUCATION 2589 S WEBSTER AVE GREEN BAY WI 54301 390824004 501(C)(3) 10000 0 DONATION GREATER GREEN BAY COMMUNITY FOUNDATION 310 W WALNUT GREEN BAY WI 54303 391699966 501(C)(3) 10000 0 GREEN BAY NEIGHBORHOOD LEADERSHIP COUNCIL, ACHIEVE BROWN COUNTY BROWN COUNTY UNITED WAY 112 N ADAMS ST SUITE 201 GREEN BAY WI 54301 390806299 501(C)(3) 25000 0 SPONSORSHIP/CAMPAIGN CURATIVE CONNECTIONS 2900 CURRY LANE GREEN BAY WI 54311 390806435 501(C)(3) 10000 0 CAMPAIGN PLEDGE 5 0 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS THE ORGANIZATION REQUIRES A COMPREHENSIVE REQUEST OF THE GRANTEE TO PROVIDE RATIONALE FOR THE REQUEST. REQUIRED INFORMATION TO BE PROVIDED BY THE GRANTEE INCLUDES TAX-EXEMPT STATUS, IDENTIFICATION OF USE OF RESOURCES AND FOLLOW UP INFORMATION AS TO THE UTILIZATION OF THE RESOURCES. THE ORGANIZATION REVIEWS EACH GRANTEE REQUEST IN RELATIONSHIP TO THE MISSION OF THE ORGANIZATION AND COMMUNITY SUPPORT. ALL REQUESTS REQUIRE APPROVAL BY SENIOR LEADERSHIP OF THE ORGANIZATION. X true true false true false false false false false true false SHARLA BAENEN BOARD OF DIRECTORS, CHIEF OPERATING OFFICER 406815 0 203988 0 43028 0 65300 0 28219 0 747350 0 40237 0 LAURA HIEB BOARD OF DIRECTORS, CHIEF NURSING OFFICER 314619 0 115915 0 36150 0 43792 0 23192 0 533668 0 32940 0 MICHAEL LANDRUM MD BOARD OF DIRECTORS, PHYSICIAN DIRECTOR 439467 0 67915 0 414 0 21893 0 2974 0 532663 0 0 0 SCOTT RATHGABER MD BOARD OF DIRECTORS, CHAIR, CEO 0 1278368 0 0 0 45907 0 48300 0 24975 0 1397550 0 0 PETER VANDENHOUTEN BOD, SECRETARY, SR VP LEGAL COUNSEL 407252 0 182656 0 40029 0 69350 0 15782 0 715069 0 39255 0 CHRISTINE WOLESKE BOARD OF DIRECTORS, PRESIDENT (END 6.30.25) 947182 0 728601 0 212756 0 185351 0 15782 0 2089672 0 201125 0 STEVE LITTLE FORMER CHIEF FINANCIAL OFFICER 0 209856 0 0 0 0 0 0 0 0 0 209856 0 0 LEANNE ANDERSEN CHIEF PEOPLE OFFICER 0 558734 0 116418 0 5270 0 43827 0 27987 0 752236 0 0 JOHN CEELEN TREASURER, CHIEF FINANCIAL OFFICER 598104 0 129468 0 744 0 29147 0 24905 0 782368 0 0 0 PRAVEEN CHOPRA CHIEF DIGITAL AND INFORMATION OFFICER 0 602977 0 106400 0 8424 0 48300 0 29546 0 795647 0 0 AMY DETTMAN VP PRIMARY CARE 242590 0 94407 0 2286 0 18498 0 23234 0 381015 0 0 0 MICHAEL DOLAN MD CHIEF CLINICAL OFFICER 0 636335 0 100000 0 1584 0 48300 0 29090 0 815309 0 0 WILLIAM FARRELL CHIEF STRATEGY & INNOVATION OFFICER 0 487426 0 103225 0 4775 0 48300 0 339 0 644065 0 0 CINDY LASECKI MD CHIEF CLINICAL OFFICER 392261 0 114612 0 774 0 49237 0 3780 0 560664 0 0 0 DANIEL LILLY ASSISTANT SECRETARY, CHIEF LEGAL OFFICER 0 514649 0 97000 0 5986 0 48300 0 26167 0 692102 0 0 JEN MACDONALD VP SPECIALTY SERVICES 191362 0 74622 0 11569 0 10167 0 28224 0 315944 0 0 0 MICHELLE MICKA ASST TREASURER, VP, FINANCE & ACCOUNTING 0 374568 0 0 0 4843 0 48300 0 23975 0 451686 0 0 HEATHER SCHIMMERS RN PRESIDENT 0 638010 0 198913 0 4954 0 48300 0 23975 0 914152 0 0 LISA HARTON CHIEF QUALITY OFFICER 336819 0 70662 0 414 0 47759 0 13799 0 469453 0 0 0 ANDREA WERNER CHIEF POPULATION HEALTH OFFICER 321155 0 66658 0 774 0 43757 0 11192 0 443536 0 0 0 KANWAR ARORA MD PHYSICIAN 543317 0 549725 0 774 0 19132 0 1653 0 1114601 0 0 0 JAMES BAILEY MD PHYSICIAN 562872 0 447820 0 33162 0 9723 0 31401 0 1084978 0 0 0 MATTHEW KASPAR MD PHYSICIAN 589032 0 472779 0 180 0 20775 0 19651 0 1102417 0 0 0 KEVIN SHEPET MD PHYSICIAN 616148 0 1175080 0 162 0 18416 0 26516 0 1836322 0 0 0 DAVID STAMPFL MD PHYSICIAN 996891 0 827485 0 1188 0 21755 0 23337 0 1870656 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES BELLIN MEMORIAL HOSPITAL PAYS FOR A PORTION OF MEMBERSHIP DUES AT A LOCAL COUNTRY CLUB FOR CHRISTINE WOLESKE TO HOLD VARIOUS EVENTS AT THE CLUB. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION. SCHEDULE J, PART I, LINE 3 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. 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 CONTRIBUTION. 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 JOHN CEELEN LISA HARTON LAURA HIEB CINDY LASECKI, MD PETER VANDENHOUTEN ANDREA WERNER THE HOSPITAL HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. LAURA HIEB, PETER VANDENHOUTEN, SHARLA BAENEN AND CHRISTINE WOLESKE PARTICIPATED IN THE 457(F) PLAN. THE FOLLOWING DISTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2024: CHRISTINE WOLESKE $201,125 PETER VANDENHOUTEN $39,255 LAURA HIEB $32,940 SHARLA BAENEN $40,237 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS BELLIN MEMORIAL HOSPITAL PROVIDES ANNUAL LEADERSHIP BONUSES BASED ON OPERATIONAL GOALS THAT ARE DEPENDENT ON OUTCOME AND COMPLETION OF GOALS. 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 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (SERIES 2019A) 391337855 2019-08-29 35000000 FUNDING OF NICU EXPANSION PROJECT AND VARIOUS RENOVATION AND EQUIPMENT PURCHASES false false false B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (SERIES 2019B) 391337855 2019-08-29 8000000 FUNDING OF IT INFRASTRUCTURE false false false C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (SERIES 2022A) 391337855 2022-12-14 106130278 AMBULATORY SURGERY CENTER BUILDING COMPONENTS false false false D WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (SERIES 2022B) 391337855 97712JGU1 2022-12-14 31617523 AMBULATORY SURGERY CENTER MOVEABLES AND EQUIPMENT false false false A 1115000 41624205 0 0 0 314452 0 41309753 0 0 2023 false false true true B 380000 8351848 74748 8277100 2023 false false true true C 0 0 106130278 982522 105147756 2023 false false true true D 31617523 314546 31302977 2024 false false true true A false true true true false false 0.01 0 0.01 false false 0 false true B false true true true false false 0.01 0 0.01 false false 0 false true C false true true true false false 0.01 0 0.01 false false 0 false true D false true true true false false 0.01 0 0.01 false false 0 false true A true false false false false false 0 false false false 0 false false true B true false false false false false 0 false false false 0 false false true C false true false false false false 0 false false false 0 false false true D false true false false false false 0 false false false 0 false false true A true B true C true D true SCHEDULE K, PART II, LINE 13 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (SERIES 2024) THE UNDERLYING PROJECT WAS SUBSTANTIALLY COMPLETED IN 2009, AND THE ORIGINAL BOND WAS SUBSEQUENTLY REFUNDED IN 2024 BY THE SERIES 2024 BOND. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY (SERIES 2024) 391337855 2024-06-03 28980000 REFUND AND LEGALLY DEFEASE false false false A 4255000 27461326 235689 27225637 2009 false true true true A false true true true false false 0.01 0 0.01 false false 0 false true A false true false false false false 0 false false false 0 false false true A true 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. CEO COMPENSATION: CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA TO THE RESULTS AND COMES UP WITH A RECOMMENDATION. THE CHAIR FACILITIES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. 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 HAS ONE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, 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 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 BELLIN HEALTH 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 AND COMPLIANCE. 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 BELLIN HEALTH) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO BELLIN HEALTH'S HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC REQUESTS FOR ALL DOCUMENTS ARE MADE THROUGH THE LEGAL DEPARTMENT, AND THE APPROPRIATE DOCUMENTS ARE MADE AVAILABLE FOR INSPECTION IN THE LEGAL DEPARTMENT FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHANGE IN INTEREST IN THE FOUNDATION - 5308742; TOTAL - 5308742; ASHWAUBENON WEST PROPERTIES LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 871079621 REAL ESTATE WI 0 0 BMH WEST GB LLC 744 S WEBSTER AVENUE GREEN BAY WI 54301 REAL ESTATE WI 0 0 BMH BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 SUPPORT ORG WI 501(C)(3) TYPE III-FI NA false GUNDERSEN LUTHERAN HEALTH SYSTEM INC 1836 SOUTH AVE LA CROSSE WI 54601 391866425 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false GUNDERSEN LUTHERAN MEDICAL CENTER INC 1910 SOUTH AVE LA CROSSE WI 54601 390813416 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN CLINIC LTD 1836 SOUTH AVENUE LA CROSSE WI 54601 391028657 HEALTHCARE WI 501(C)(3) 3 GLHS false GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC 1910 SOUTH AVE LA CROSSE WI 54601 391606449 SUPPORT ORG WI 501(C)(3) TYPE II GLHS false GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC 1836 SOUTH AVENUE LA CROSSE WI 54601 391249705 FOUNDATION WI 501(C)(3) 7 GLHS false TRI-COUNTY MEMORIAL HOSPITAL INC 18601 LINCOLN STREET WHITEHALL WI 54773 390704510 HEALTHCARE WI 501(C)(3) 3 GLHS false HARMONY COUMMUNITY HEALTHCARE INC 815 MAIN AVE SOUTH HARMONY MN 55939 410711606 HEALTHCARE MN 501(C)(3) 10 GLHS false TWEETEN LUTHERAN HEALTHCARE CENTER INC 125 FIFTH AVE SE SPRING GROVE MN 55974 411565003 HEALTHCARE MN 501(C)(3) 10 GLHS false TRI STATE AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391965415 MEDICAL TRANSPORT WI 501(C)(3) 3 GLHS false TRI-STATE REGIONAL AMBULANCE INC 235 CAUSEWAY BOULEVARD LA CROSSE WI 54603 391962965 MEDICAL TRANSPORT WI 501(C)(3) 10 GLHS false LUTHERAN REAL ESTATE HOLDING CORPORATION 1910 SOUTH AVENUE LA CROSSE WI 54601 391480826 HOUSING WI 501(C)(3) TYPE III-FI GLHS false COMMUNITY HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391586700 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false LUTHERAN HOUSING OF LA CROSSE INC 1900 SOUTH AVENUE LA CROSSE WI 54601 391751934 INDEPENDENT LIVING WI 501(C)(3) 10 LREH CORP false ST JOSEPH'S HEALTH SERVICES INC 400 WATER AVE HILLSBORO WI 54634 390929538 HEALTHCARE WI 501(C)(3) 3 GLHS false ST JOSEPH MEMORIAL FOUNDATION INC 400 WATER AVE HILLSBORO WI 54634 391455787 FOUNDATION WI 501(C)(3) TYPE I STJ HLTH SVC false TRI-COUNTY MEMORIAL FOUNDATION INC 18601 LINCOLN STREET WHITEHALL WI 54773 300093022 FOUNDATION WI 501(C)(3) TYPE I TCH false MEMORIAL HOSPITAL OF BOSCOBEL 205 PARKER STREET BOSCOBEL WI 53805 390845590 HEALTHCARE WI 501(C)(3) 3 GLHS false PALMER LUTHERAN HEALTH CENTER INC 112 JEFFERSON STREET WEST UNION IA 52175 421320763 HEALTHCARE IA 501(C)(3) 3 GLHS false MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS 402 WEST LAKE STREET FRIENDSHIP WI 53934 390944012 HEALTHCARE WI 501(C)(3) 3 GLHS false MEMORIAL HEALTHCARE FOUNDATION INC 402 WEST LAKE STREET FRIENDSHIP WI 53934 391775074 FOUNDATION WI 501(C)(3) TYPE I MDV HOSP false SAINT ELIZABETH'S HOSPITAL OF WABASHA INC 1200 FIFTH GRANT BLVD WEST WABASHA MN 55981 410693877 HEALTHCARE MN 501(C)(3) 3 GLHS false BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT ORG WI 501(C)(3) TYPE II BGHS false LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT ORG WI 501(C)(3) TYPE II BHS false BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 EDUCATION WI 501(C)(3) 2 BHS false BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54301 391657627 HEALTHCARE WI 501(C)(3) 3 BHS false THE BELLIN HEALTH FOUNDATION INC PO BOX 23400 GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) 7 BHS false OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVENUE OCONTO WI 54153 061745397 HEALTHCARE WI 501(C)(3) 3 BMH true BEL-REGIONAL HOME MEDICAL INC 617 S ROOSEVELT GREEN BAY WI 54301 391504766 DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS WI NA C CORPORATION false GUNDERSEN LUTHERAN ENVISION LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 264706546 RENEWABLE ENERGY WI NA C CORPORATION false GUNDERSEN EDGE LLC 1836 SOUTH AVENUE LA CROSSE WI 54601 921783811 INNOVATION WI NA C CORPORATION false BG ASSURANCE COMPANY 20 GENESIS CLOSE PO BOX 30600 GEORGE TOWN GRAND CAYMAN CJ 1203 SELF INSURANCE CJ NA C CORPORATION false false false true true true false false false false true true true false true true true true true true OCONTO HOSPITAL & MEDICAL CENTER INC J 2004087 COST OCONTO HOSPITAL & MEDICAL CENTER INC O 9121120 COST OCONTO HOSPITAL & MEDICAL CENTER INC L 7392450 COST