2025-08-13T13:25:43-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 061745397 OCONTO HOSPITAL AND MEDICAL CENTER OCON 9208351100 820 ARBUTUS AVENUE OCONTO WI 54153 JOHN CEELEN CFO 9208351100 2025-08-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-13 2023 2025-03-06 01:10:19Z BELLIN HEALTH OCONTO HOSPITAL JOHN CEELEN 820 ARBUTUS AVENUE OCONTO WI 54153 93316705 0 X WWW.OCONTOHOSPITAL.ORG 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. 0 0 398 10 0 0 721329 218199 90124476 90621783 -81 -17000 2502694 2307863 93348418 93130845 0 0 0 0 41974133 44733660 0 0 0 42283839 43928867 84257972 88662527 9090446 4468318 53844202 50170743 29969205 21940866 23874997 28229877 X 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. 0 0 41163120 0 51328211 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, 2023, TO SEPTEMBER 30, 2024, 267 INPATIENT DAYS WERE PROVIDED, AND 1,547 SWING BED DAYS WERE PROVIDED. THE NUMBER OF OUTPATIENTS REGISTERED DURING THE SAME 12-MONTH PERIOD WAS 22,767. 39485999 0 41580562 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 MULTI-SPECIALTY 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 19,216 URGENT CARE VISITS, 87,052 PRIMARY CARE VISITS AND 41,028 SPECIALTY PROVIDER VISITS TO THESE COMMUNITIES DURING THE PERIOD OF OCTOBER 1, 2023, TO SEPTEMBER 30, 2024. 80649119 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 398 1 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ERIC JACOBSON 9204457260 2020 SOUTH WEBSTER AVENUE GREEN BAY WI 54301 SCOTT RATHGABER MD BGHS CEO 2.00 48.00 X 0 1644221 68728 STEVE LITTLE BMH CFO (THRU 02/2024) 2.00 48.00 X 0 333317 0 JOHN CEELEN BMH CFO (BEG. 02/2024) 2.00 48.00 X 0 0 0 PAWNEET SINGH MD PHYSICIAN 50.00 X 523783 0 27745 DAVID HOYER MD PHYSICIAN 50.00 X 516470 0 36328 JON SIMMONS MD PHYSICIAN 50.00 X 368363 0 29513 MICHAEL BRENNER MD PHYSICIAN 50.00 X 330734 0 39234 IVY VACHON MD PHYSICIAN 50.00 X 348767 0 44731 JULIE BIEBER FORMER B.M./VP - OHMC 50.00 X 184636 0 24302 SHARLA BAENEN FORMER B.M./BMH COO 0.00 50.00 X 0 500435 86399 LAURA HIEB FORMER B.M./SVP - CNO 0.00 50.00 X 0 409402 65451 CHARLES HEYKA MD FORMER B.M./PRES.-MEDICAL STAFF 40.00 X 348976 0 49991 2621729 2887375 472422 48 1 1 0 BELLIN MEMORIAL HOSPITAL INC 744 S WEBSTER AVE GREEN BAY WI 54301 INTERCOMPANY SERVICES 7281787 RADIOLOGY ASSOCIATES OF APPLETON 2500 E CAPITAL DR APPLETON WI 54911 RADIATION ONCOLOGY PROVIDER SERVICES 796123 THARIO BUILDING SERVICES 2936 HOLMGREN WAY GREEN BAY WI 54304 HOUSEKEEPING SERVICES 598059 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 CONTRACTED NURSING SERVICES 446953 BAY TOWEL LINEN & UNIFORM RENT 2580 S BROADWAY GREEN BAY WI 54304 CONTRACTED LINEN SERVICES 328038 5 125934 92265 218199 NET PATIENT REVENUE 621300 89209540 89209540 CONTRACTED SERVICES 621300 1285677 1285677 RENT FROM AFFILIATES 900099 120000 120000 6566 6566 90621783 22 22 72524 58217 14307 14307 14307 110621 127643 -17022 -17022 -17022 INCENTIVE PAYMENTS 621110 2293556 2293556 2293556 93130845 92908773 0 3873 37408617 36665782 742835 1897082 1860257 36825 3179460 3115406 64054 2248501 2195236 53265 16625 16625 2905856 2778301 127555 1589 1589 607860 536315 71545 299074 273851 25223 4142222 4064768 77454 456063 448002 8061 101109 88601 12508 481855 96365 385490 4132205 4079707 52498 59799 19447 40352 MEDICAL SUPPLIES 25241103 19040492 6200611 BAD DEBT EXPENSE 2870602 2870602 EQUIPMENT RENT/REPAIRS 2133902 2133536 366 DUES & SUBSCRIPTIONS 192613 120268 72345 286390 260594 25796 88662527 80649119 8013408 0 5377016 5798492 9278661 9490853 1627448 1801133 3285 3789 62679952 37224710 25045218 25455242 12512574 7621234 53844202 50170743 3583938 4024361 9004500 8511442 17380767 9405063 29969205 21940866 X 22927068 27395386 947929 834491 23874997 28229877 53844202 50170743 X 4468318 -113438 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 682918 682918 28994970 11678340 17316630 32854402 25546370 7308032 147662 147662 25455242 INTEREST IN FOUNDATIONS - ALATU 834491 RIGHT OF USE ASSETS 4077449 DUE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 2709294 7621234 DUE TO AFFILIATES 310298 DUE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 586670 OPERATING LEASE LIABILITIES 4077449 FINANCE LEASE LIABILITIES 4430646 9405063 1 1 X 1 X 220.000000000000 1 X 1 1 0 1 1 360828 360828 0.00420 9223227 5445219 3778008 0.04400 9584055 5445219 4138836 0.04820 30584 30584 0.00040 1492 1492 0.00000 32076 32076 0.00040 9616131 5445219 4170912 0.04860 1 1074370 0 10185181 8411515 1773666 X 1 1 1 1 OCONTO HOSPITAL & MEDICAL CENTER INC 820 ARBUTUS AVE OCONTO WI 54153 HTTPS://BELLIN.ORG/LOCATIONS/BELLIN-HE 1061 X X X X OCONTO HOSPITAL & MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 22 1 SEE PART V, SECTION C, LINE 7D 0 1 X 220.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C, LINES 16A-C X SEE PART V, SECTION C, LINES 16A-C X SEE PART V, SECTION C, LINES 16A-C X X X X X X 1 X 0 X X X X 1 X 0 0 OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: 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 OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: HSHS ST. CLARE MEMORIAL HOSPITAL OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B: - 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 OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 7D: FULL URL FOR PART V, SECTION B, LINE 7A & 10A:HTTPS://BELLIN.ORG/ABOUT-BELLIN-HEALTH/COMMUNITY-HEALTH-INITIATIVES OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: 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 HELP2. 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 BOXES3. 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 OCONTO HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 13H: 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. PART V, SECTION B, LINES 16A-C: LINE 16A:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONSLINE 16B:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONSLINE 16C:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS 9 1 - BELLIN HEALTH MARINETTE 2820 ROOSEVELT ROAD MARINETTE WI 54143 RURAL HEALTH CLINIC, ASC 2 - BELLIN HEALTH OCONTO FALLS 107 E HIGHLAND DRIVE OCONTO FALLS WI 54154 RURAL HEALTH CLINIC 3 - BELLIN HEALTH CRIVITZ 218 S US HWY 141 SUITE 100 CRIVITZ WI 54114 RURAL HEALTH CLINIC 4 - BELLIN HEALTH OCONTO 820 ARBUTUS AVE SUITE 102 OCONTO WI 54153 RURAL HEALTH CLINIC 5 - BELLIN HEALTH PESHTIGO 441 FRENCH STREET PESHTIGO WI 54162 RURAL HEALTH CLINIC 6 - BELLIN HEALTH SURING 307 MANOR DRIVE SURING WI 54174 RURAL HEALTH CLINIC 7 - BELLIN HEALTH DAGGETT 106 S SCHOOL ROAD DAGGETT MI 49821 RURAL HEALTH CLINIC 8 - BELLIN HEALTH LAKEWOOD 15481 COMMERCIAL ROAD SUITE E LAKEWOOD WI 54138 RURAL HEALTH CLINIC 9 - BELLIN HEALTH MENOMINEE 1100 10TH STREET MENOMINEE MI 49858 RURAL HEALTH CLINIC PART I, LINE 6A: OCONTO HOSPITAL AND MEDICAL CENTER IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. PART I, LINE 7: AMOUNTS ARE CALCULATED BASED ON THE COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $2,870,602 INCLUDED ON FORM 990, PART IX, LINE 24 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: - EVENT SPONSOR OF LEOWSTRONG BIKE RIDE. PROVIDED CLINICAL STAFF FOR MEDICAL TENT. CHRIS WOLESKE WAS A KEYNOTE SPEAKER.- PROVIDED COMMUNITY EDUCATION ON SUICIDE PREVENTION AT CITY OF OCONTO NATIONAL NIGHT OUT.- DELIVERY OF MEALS 1X MONTH TO THE HOMEBOUND BY OCONTO LEADERSHIP FOR OCONTO COUNTY COMMISSION ON AGING.- OCONTO LEADERSHIP VOLUNTEERING AT OCONTO COUNTY VETERANS SERVICE. PART III, LINE 2: THE BAD DEBT EXPENSE AT COST IS CALCULATED BASED ON THE COST TO CHARGE RATIOS. PART III, LINE 3: THE HOSPITAL UTILIZED HFMA #15, THEREFORE NONE OF THE BAD DEBT WOULD BE DEEMED CHARITY CARE PART III, LINE 4: 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 21 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 2023. PART III, LINE 8: 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 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. PART III, LINE 9B: 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. PART VI, LINE 2: 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. PART VI, LINE 3: 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. PART VI, LINE 4: 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 PART VI, LINE 5: 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. PART VI, LINE 6: THE ORGANIZATION, IN PARTNERSHIP WITH BELLIN HEALTH SYSTEMS, INC., CONTINUES TO SERVE ITS COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X 0 1 0 0 0 0 0 0 0 SCOTT RATHGABER MD BGHS CEO 0 1274504 0 200000 0 169717 0 45225 0 23503 0 1712949 0 0 SHARLA BAENEN FORMER B.M./BMH COO 0 387636 0 78025 0 34774 0 59243 0 27156 0 586834 0 34504 DAVID HOYER MD PHYSICIAN 514056 0 2000 0 414 0 9048 0 27280 0 552798 0 0 0 PAWNEET SINGH MD PHYSICIAN 391502 0 132101 0 180 0 17034 0 10711 0 551528 0 0 0 LAURA HIEB FORMER B.M./SVP - CNO 0 311452 0 66025 0 31925 0 53011 0 12440 0 474853 0 31151 CHARLES HEYKA MD FORMER B.M./PRES.-MEDICAL STAFF 346675 0 15 0 2286 0 19960 0 30031 0 398967 0 0 0 JON SIMMONS MD PHYSICIAN 216566 0 151023 0 774 0 17730 0 11783 0 397876 0 0 0 IVY VACHON MD PHYSICIAN 220652 0 127953 0 162 0 17575 0 27156 0 393498 0 0 0 MICHAEL BRENNER MD PHYSICIAN 306227 0 24327 0 180 0 9284 0 29950 0 369968 0 0 0 STEVE LITTLE BMH CFO (THRU 02/2024) 0 258317 0 75000 0 0 0 0 0 0 0 333317 0 0 JULIE BIEBER FORMER B.M./VP - OHMC 152060 0 20025 0 12551 0 11238 0 13064 0 208938 0 0 0 PART I, LINE 4B BELLIN MEMORIAL HOSPITAL, A RELATED PARTY, HAS A DEFERRED COMPENSATION PLAN FOR SELECTED EXECUTIVES. SHARLA BAENEN AND LAURA HIEB PARTICIPATED IN THE 457(F) PLAN. THE FOLLOWING DISTRIBUTIONS WERE MADE DURING CALENDAR YEAR 2023: LAURA HIEB $31,151 SHARLA BAENEN $34,504 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2011-08-18 14000000 FACILITY AND SERVICE EXPANSION 0 0 0 A 4472224 14000000 36149 132033 13831818 2012 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS WHOLLY OWNED BY BELLIN MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION HAVE THE POWER TO APPOINT/ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS ALSO HAVE THE POWER TO APPROVE, BUT NOT LIMITED TO, THE PHILOSOPHY, MISSION, AND VALUE OF THE ORGANIZATION, STRATEGIC PLANS, THE ANNUAL OPERATING AND CAPITAL BUDGET, AMENDMENTS OR RESTATEMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED IN DETAIL BY SENIOR ADMINISTRATION AND IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUESTS AN ANNUAL UPDATE FROM ALL BOARD MEMBERS WHO SIGN THE POLICY. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. IF THERE IS A CONFLICT OF INTEREST, THE CORPORATE COMPLIANCE OFFICER IS NOTIFIED. MEMBERS OF THE BOARD WHO HAVE A CONFLICT OF INTEREST WITH A BOARD DECISION ABSTAIN FROM VOTING ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY EXECUTIVES IS SET UP BY THE EXECUTIVE COMMITTEE OF THE BOARD WITHOUT CONFLICT OF INTEREST AND IS SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANT'S REPORT. FORM 990, PART VI, SECTION C, LINE 19 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 XI, LINE 9: CHANGE IN INTEREST IN THE BELLIN HEALTH FOUNDATION, INC. -113,438. FORM 990, PART XI, LINE 2B-2C 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. BELLIN GUNDERSEN HEALTH SYSTEM INC 1836 SOUTH AVENUE LA CROSSE WI 54601 920504278 PARENT WI 501(C)(3) LINE 12B, II N/A 0 BELLIN HEALTH SYSTEMS INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512904 SUPPORT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) LINE 12B, II BELLIN GUNDERSEN HEALTH SYSTEM INC 1 LAKE MICHIGAN HEALTH SERVICES INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391512903 SUPPORT PURPOSES OF BELLIN MEMORIAL HOSPITAL WI 501(C)(3) LINE 12B, II BELLIN HEALTH SYSTEMS INC 1 BELLIN COLLEGE INC 3201 EATON ROAD GREEN BAY WI 54311 391620530 NURSING COLLEGE WI 501(C)(3) LINE 2 BELLIN HEALTH SYSTEMS INC 1 THE BELLIN HEALTH FOUNDATION INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391809171 FOUNDATION WI 501(C)(3) LINE 7 BELLIN HEALTH SYSTEMS INC 1 BELLIN PSYCHIATRIC CENTER INC PO BOX 23725 GREEN BAY WI 54305 391657627 PSYCHIATRIC HOSPITAL WI 501(C)(3) LINE 3 BELLIN HEALTH SYSTEMS INC 1 BELLIN MEMORIAL HOSPITAL INC 744 SOUTH WEBSTER AVE GREEN BAY WI 54301 391900586 ACUTE CARE HOSPITAL WI 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