2025-08-13T15:11:09-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 390884478 BELLIN MEMORIAL HOSPITAL INC BELL 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 JOHN CEELEN CFO 9204457260 2025-08-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-13 2023 2025-03-06 01:10:19Z JOHN CEELEN 744 S WEBSTER AVENUE GREEN BAY WI 54301 942501834 0 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. 6 0 5399 238 -208657 0 3162165 3082867 709523707 791592386 18193165 24081469 15215240 15949544 746094277 834706266 370153 520025 0 0 448123218 479526593 0 0 0 270228938 311700923 718722309 791747541 27371968 42958725 1083165495 1148095932 435967534 436573747 647197961 711522185 X 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. 0 0 660822303 520025 804998083 THE HOSPITAL PROVIDES ACUTE HOSPITAL CARE TO RESIDENTS OF NORTHEASTERN WISCONSIN. DURING FISCAL YEAR 2024 37,488 INPATIENT DAYS WERE PROVIDED (29,645 ADULTS AND PEDIATRICS), AS COMPARED TO 35,889 (27,406 ADULTS AND PEDIATRICS) IN FISCAL YEAR 2023. THE NUMBER OF OUTPATIENTS REGISTERED FOR 2024 AND 2023 WERE 199,208 AND 188,613, RESPECTIVELY. BELLIN MEMORIAL HOSPITAL ALSO PROVIDED 1,546,455 (AS COMPARED TO 1,443,533 IN 2023) PHYSICIAN CLINIC VISITS THROUGH BELLIN MEDICAL AND SPECIALTY GROUPS. 660822303 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 351 0 5399 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 6 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JOHN CEELEN 9204457260 744 S WEBSTER AVENUE GREEN BAY WI 54301 CHRISTINE WOLESKE BOARD MEMBER/EXECUTIVE VICE PRES. 48.00 2.00 X X 1775439 0 238231 SCOTT RATHGABER MD BOARD MEMBER/BGHS CEO 2.00 48.00 X X 0 1644221 68728 PETER VANDENHOUTEN BOARD MEMBER/SR VP-GENERAL COUNSEL 50.00 2.00 X 612071 0 75483 SHARLA BAENEN BOARD MEMBER/COO 50.00 2.00 X X 500435 0 86399 MICHAEL LANDRUM MD BOARD MEMBER/COO 50.00 2.00 X 471136 0 24683 LAURA HIEB BOARD MEMBER/CNO 50.00 2.00 X X 409402 0 65451 STEVE LITTLE BOARD MEMBER/CFO (THRU 2/24) 2.00 48.00 X X 0 333317 0 TERRY FULWILER CHAIR (THRU 01/24) 2.00 2.00 X X 0 0 0 JOHN CEELEN CHIEF FINANCIAL OFFICER (BEG. 02/24) 2.00 48.00 X 0 0 0 LISA HARTON CHIEF QUALITY OFFICER 50.00 X 397926 0 29182 ANDREA WERNER CHIEF POPULATION OFFICER 50.00 X 365199 0 27093 WILLIAM FARRELL CHIEF INNOVATION & STRATEGY OFFICER 2.00 48.00 X 0 628350 45544 LEANNE ANDERSEN CHIEF PEOPLE OFFICER 0.50 40.00 X 0 564301 63599 PRAVEEN CHOPRA CHIEF DIGITAL & INFORMATION OFFICER 2.00 48.00 X 0 654982 70974 DAVID STAMPFL MD PHYSICIAN 40.00 X 1933014 0 47375 KEVIN SHEPET PHYSICIAN 40.00 X 1290394 0 43555 YOON CHUN PHYSICIAN 40.00 X 1181234 0 22155 JAMES SPEARS MD PHYSICIAN 40.00 X 1125470 0 44218 KANWAR ARORA MD PHYSICIAN 40.00 X 1132026 0 21866 CINDY LASECKI MD FORMER BOARD MEMBER/COO 0.00 50.00 X 383276 0 21152 GERALD OETZEL FORMER CHIEF FINANCIAL OFFICER 0.00 X 0 555068 18108 11577022 4380239 1013796 582 1 1 0 MIRON CONSTRUCTION CO INC 1471 MCMAHON DR NEENAH WI 54956 GENERAL CONTRACTOR 54323193 IEI GENERAL CONTRACTORS INC 1725 MIDWAY RD DE PERE WI 54115 FACILITY CONTRACTORS 21492701 STAFFENCY LLC 221 W COLLEGE AVE FL 2 APPLETON WI 54911 CONTRACTED NURSING SERVICES 9677487 APOGEE MEDICAL MANAGEMENT 15059 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 4616058 COMPHEALTH MEDICAL STAFFING 6440 S MILLROCK DR STE 175 SALT LAKE CITY UT 84121 CONTRACTED PHYSICIAN/MANAGEMENT SERVICES 3482387 62 2395118 295360 392389 3082867 NET PATIENT SERVICE REVENUE 621500 771905987 772646786 -740799 CONTRACTED SERVICES 621110 4041832 4041832 CAFETERIA REVENUE 621110 2194610 2194610 13449957 12934426 494453 21078 791592386 14303977 14303977 883054 37689 346238 0 536816 37689 574505 37689 536816 116554431 672391 106994731 454599 9559700 217792 9777492 9777492 EHR INCENTIVE 621110 13646215 13646215 GAIN FROM HEALTHCARE AFFILIATES 900099 1728824 1728824 15375039 834706266 804998083 -208657 26833973 520025 520025 5851269 1945108 3906161 388166803 330104705 58062098 18297273 15067170 3230103 43680675 36007218 7673457 23530573 19536248 3994325 520481 520481 182418 182418 21104 21104 611845 611845 10719584 10504188 215396 7137491 44073 7093418 5771590 3011306 2760284 19610328 3054956 16555372 11146194 9951377 1194817 1296538 897762 398776 2009166 884415 1124751 7651183 1025251 6625932 35084627 27804118 7280509 2892254 286407 2605847 SUPPLIES 154910424 154910424 BAD DEBTS 19639735 19639735 EQUIPMENT RENT & MAINT 15317777 12992127 2325650 WI MEDICAID ACCESS FEE 6960147 6960147 10218037 5675543 4542494 791747541 660822303 130925238 0 18550 18317 210714059 199226119 101931900 101245001 8826274 1582839 9708728 11290079 8827986 12450298 788327939 326089335 404941643 462238604 271503593 283257244 36926044 39818402 0 125245 29766718 36843784 1083165495 1148095932 93132598 100564657 215703875 212116829 127131061 123892261 435967534 436573747 X 641329740 703097742 5868221 8424443 647197961 711522185 1083165495 1148095932 X 42958725 21673363 -307864 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21104 21104 0 PART II-B, LINE 1: 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. 2931853 263501 291555 91992 3394917 2628543 156644 170469 23803 2931853 2831774 55830 -229949 29112 2628543 2628725 22638 209789 29378 2831774 2570504 29310 68422 39511 2628725 0.00000 0.84067 0.15933 0 1 1 28666937 28666937 348948566 117819839 231128727 340039093 208269496 131769597 70673343 70673343 462238604 DEFERRED COMPENSATION 25167800 FINANCE LEASE OBLIGATIONS 90308167 OPERATING LEASE OGLIGATIONS 6106383 DUE TO RELATED PARTIES 2309911 123892261 PART V, LINE 4: 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. 1 1 X 1 X 220.000000000000 1 X 1 1 1 0 1 1 4844390 4844390 0.00630 78764293 42031765 36732528 0.04760 83608683 42031765 41576918 0.05390 5752251 5752251 0.00750 7044300 7044300 0.00910 2558573 2558573 0.00330 15355124 15355124 0.01990 98963807 42031765 56932042 0.07380 657768 657768 0.00090 657768 657768 0.00090 1 4937814 0 239970401 273819550 -33849149 X 1 1 1 1 BELLIN MEMORIAL HOSPITAL 744 S WEBSTER AVE GREEN BAY WI 54305 WWW.BELLIN.ORG 147 X X X BELLIN MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 23 1 SEE PART V, SECTION B, 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, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: 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.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 BELLINBEYOND 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 HEALTHCOMMUNITY ORGANIZATIONS/COMMUNITIES REPRESENTED THROUGH COMMUNITY CONSULTANTS MEETINGS:- DENMARK COMMUNITY MEMBERS- HOUSE OF HOPE- PULASKI COMMUNITY MEMBERS- WE ALL RISE- WRIGHTSTOWN COMMUNITY MEMBERS BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: AURORA BAYCARE MEDICAL CENTER (GREEN BAY), AND ST. MARY'S AND ST. VINCENT HOSPITALS (HSHS, GREEN BAY). BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: 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. BELLIN MEMORIAL HOSPITAL 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 BELLIN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: 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 HOUSINGUNDER 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-BEINGTACTIC: 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 CARETACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMSIDENTIFIED PRIORITY: SUBSTANCE MISUSETACTIC: DEVELOP AND PROMOTE REFERRAL FOR WELLNESS COACHING PROCESS FOR PATIENTS WHO USE NICOTINE PRODUCTSTACTIC: PARTICIPATE IN DRUG TAKE-BACK EVENTSTACTIC: REGIONAL SUSPECTED OPIOID-RELATED OVERDOSES.TACTIC: ADDITIONAL TACTICS DETERMINED BY EMPLIFY HEALTH POPULATION HEALTH PRIORITY TEAMSIDENTIFIED PRIORITY: EQUITABLE ACCESS TO HEALTHCARETACTIC: 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 HOUSINGTACTIC: 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. BELLIN MEMORIAL HOSPITAL 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: PART V, SECTION B, LINE 16A:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONSPART V, SECTION B, LINE 16B:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONSPART V, SECTION B, LINE 16C:HTTPS://BELLIN.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-SERVICES/FINANCIAL-ASSISTANCE-OPTIONS 35 1 - FAMILY MEDICAL CENTER ASHWAUBENON 1630 COMMANCHE AVE GREEN BAY WI 54313 PROVIDER CLINIC SITE 2 - BELLIN HEALTH TITLETOWN SPORTS MEDICINE 1970 S RIDGE ROAD GREEN BAY WI 54304 PROVIDER CLINIC SITE 3 - BELLIN HEALTH IRON MOUNTAIN 440 WOODWARD AVE IRON MOUNTAIN MI 49801 PROVIDER CLINIC SITE 4 - NEUROLOGY CONSULTANTS OF BELLIN HEALTH 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 5 - FAMILY MEDICAL CENTER DE PERE EAST 555 REDBIRD CIRCLE DE PERE WI 54115 PROVIDER CLINIC SITE 6 - FAMILY MEDICAL CENTER BELLEVUE 3263 EATON RD GREEN BAY WI 543116830 PROVIDER CLINIC SITE 7 - BELLIN HEALTH SURGERY AND SPECIALTY CENTE 933 WAUBE LN ASHWAUBENON WI 54304 HOSPITAL BASED SITE 8 - FAMILY MEDICAL CENTER HOWARD 2714 RIVERVIEW GREEN BAY WI 54313 PROVIDER CLINIC SITE 9 - BELLIN HEALTH ESCANABA 610 S LINCOLN ROAD ESCANABA MI 49829 PROVIDER CLINIC SITE 10 - BELLIN HEALTH GENERATIONS 704 S WEBSTER AVE SUITE 300 GREEN BAY WI 54301 PROVIDER CLINIC SITE 11 - FAMILY MEDICAL CENTER GREEN BAY 704 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 12 - FAMILY MEDICAL CENTER DE PERE WEST 1800 LAWRENCE DR DE PERE WI 54115 PROVIDER CLINIC SITE 13 - BELLIN HEALTH EAR NOSE AND THROAT 923 ELIZA ST GREEN BAY WI 54301 PROVIDER CLINIC SITE 14 - FAMILY MEDICAL CENTER KEWAUNEE 575 4TH STREET KEWAUNEE WI 54216 PROVIDER CLINIC SITE 15 - THE CANCER TEAM OF BELLIN HEALTH 1580 COMMANCHE AVE GREEN BAY WI 54313 HOSPITAL BASED SITE 16 - FAMILY MEDICAL CENTER BRILLION 964 W RYAN ST SUITE B BRILLION WI 54110 PROVIDER CLINIC SITE 17 - FAMILY MEDICAL CENTER MANITOWOC 3415 CUSTER ST SUITE D MANITOWOC WI 54221 PROVIDER CLINIC SITE 18 - FAMILY MEDICAL CENTER ALGOMA 831 PARKER AVE ALGOMA WI 54201 PROVIDER CLINIC SITE 19 - BELLIN HEALTH ENDOCRINOLOGY 704 S WEBSTER SUITE 501 GREEN BAY WI 54301 PROVIDER CLINIC SITE 20 - BELLIN HEALTH ASTHMA & ALLERGY 519 S MONROE AVENUE GREEN BAY WI 54301 PROVIDER CLINIC SITE 21 - FAMILY MEDICAL CENTER PULASKI 723 S WISCONSIN ST PULASKI WI 541620109 PROVIDER CLINIC SITE 22 - BELLIN HEALTH SURGICAL ASSOCIATES 720 S VAN BUREN ST SUITE 201 GREEN BAY WI 54301 PROVIDER CLINIC SITE 23 - GASTROENTEROLOGY ASSOCIATES OF GREEN BAY 725 S WEBSTER AVE GREEN BAY WI 54301 PROVIDER CLINIC SITE 24 - CARDIOLOGY ASSOCIATES OF BELLIN HEALTH 744 S WEBSTER AVE GREEN BAY WI 54301 HOSPITAL BASED SITE 25 - FAMILY MEDICAL CENTER DENMARK 595 COUNTY ROAD R DENMARK WI 54208 PROVIDER CLINIC SITE 26 - FAMILY MEDICAL CENTER SEYMOUR 405 COMMERCIAL ST SEYMOUR WI 54165 PROVIDER CLINIC SITE 27 - FAMILY MEDICAL CENTER LUXEMBURG 140 B SCHOOL CREEK TRAIL LUXEMBURG WI 54217 PROVIDER CLINIC SITE 28 - FAMILY MEDICAL CENTER STURGEON BAY 311 N 3RD AVE STURGEON BAY WI 43235 PROVIDER CLINIC SITE 29 - FAMILY MEDICAL CENTER WRIGHTSTOWN 555 QUALITY CT WRIGHTSTOWN WI 54180 PROVIDER CLINIC SITE 30 - BELLIN HEALTH NEPHROLOGY 2020 RIVERSIDE DR SUITE 200 GREEN BAY WI 54301 PROVIDER CLINIC SITE 31 - FAMILY MEDICAL CENTER TWO RIVERS 1516 WASHINGTON STREET TWO RIVERS WI 54241 PROVIDER CLINIC SITE 32 - FAMILY MEDICAL CENTER MARQUETTE 1414 WEST FAIR AVENUE SUITE 390 MARQUETTE MI 49855 PROVIDER CLINIC SITE 33 - BELLIN HEALTH FASTCARE - GREEN BAY WEST 2015 SHAWANO AVE GREEN BAY WI 54303 CONVENIENT CARE CENTER 34 - BELLIN HEALTH FASTCARE - GREEN BAY EAST 1976 LIME KILN RD GREEN BAY WI 54311 CONVENIENT CARE CENTER 35 - BELLIN HEALTH CARDIOVASCULAR & THORACIC SU 720 S VAN BUREN ST SUITE 303 GREEN BAY WI 54301 PROVIDER CLINIC SITE PART I, LINE 6A: BELLIN MEMORIAL HOSPITAL IS INCLUDED IN THE BELLIN HEALTH SYSTEMS, INC. COMMUNITY BENEFIT REPORT. PART I, LINE 7: AMOUNTS ARE CALCULATED BASED ON COST TO CHARGE RATIOS AND AMOUNTS PER THE FINANCIAL STATEMENTS. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $19,639,735 INCLUDED ON FORM 990, PART IX, LINE 25 WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS WHEN CALCULATING THE PERCENT TOTAL EXPENSES ON 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. 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 UTILIZES 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 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. 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: 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. PART VI, LINE 3: 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. PART VI, LINE 4: 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. PART VI, LINE 5: THE GOVERNING BODY OF BELLIN MEMORIAL HOSPITAL PRIMARILY CONSISTS OF INDIVIDUALS WHO RESIDE WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OF SUCH INDIVIDUALS. FURTHERMORE, 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. PART VI, LINE 6: 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. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 NEW COMMUNITY CLINIC 610 N BROADWAY GREEN BAY WI 54303 391200636 501(C)(3) 150000 0 DONATION ACHIEVE BROWN COUNTY 340 N BROADWAY STE 400 GREEN BAY WI 54303 474100686 501(C)(3) 37263 0 CAMPAIGN PLEDGE ENCOMPASS - EARLY EDUCATION AND CARE 2589 S WEBSTER AVE GREEN BAY WI 54301 390824004 501(C)(3) 30000 0 DONATION YWCA GREATER GREEN BAY 230 S MADISON ST GREEN BAY WI 54301 390806277 501(C)(3) 20000 0 DONATION UNIVERSITY OF WI GREEN BAY 2420 NICOLET DR GREEN BAY WI 54311 391805963 GOVT-STATE AGENCY 20000 0 MARK REINKE, MD MEMORIAL SCHOLARSHIP ALTRUSA HOUSE 1116 E MASON ST GREEN BAY WI 54301 391593989 501(C)(3) 14000 0 COMMUNITY SPONSORSHIP GREATER GREEN BAY COMMUN FOUNDATION 310 W WALNUT GREEN BAY WI 54303 391699966 501(C)(3) 13700 0 GREEN BAY NEIGHBORHOOD LEADERSHIP COUNCIL, ACHIEVE BROWN COUNTY NEVILLE PUBLIC MUSEUM PO BOX 325 GREEN BAY WI 54305 930756332 501(C)(3) 10000 0 DONATION GOLDEN HOUSE INC PO BOX 727 GREEN BAY WI 54305 391342659 501(C)(3) 10000 0 DONATION 9 0 PART I, LINE 2: 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 1 1 X X X X X 0 1 0 0 0 0 0 0 0 CHRISTINE WOLESKE BOARD MEMBER/EXECUTIVE VICE PRES. 957900 0 634883 0 182656 0 226898 0 11333 0 2013670 0 175207 0 DAVID STAMPFL MD PHYSICIAN 994343 0 937483 0 1188 0 22070 0 25305 0 1980389 0 0 0 SCOTT RATHGABER MD BOARD MEMBER/BGHS CEO 0 1274504 0 200000 0 169717 0 45225 0 23503 0 1712949 0 0 KEVIN SHEPET PHYSICIAN 616774 0 673459 0 161 0 18408 0 25147 0 1333949 0 0 0 YOON CHUN PHYSICIAN 548411 0 632409 0 414 0 11372 0 10783 0 1203389 0 0 0 JAMES SPEARS MD PHYSICIAN 669447 0 453737 0 2286 0 19711 0 24507 0 1169688 0 0 0 KANWAR ARORA MD PHYSICIAN 543288 0 587964 0 774 0 19187 0 2679 0 1153892 0 0 0 PRAVEEN CHOPRA CHIEF DIGITAL & INFORMATION OFFICER 0 559971 0 50000 0 45011 0 45225 0 25749 0 725956 0 0 PETER VANDENHOUTEN BOARD MEMBER/SR VP-GENERAL COUNSEL 384456 0 189505 0 38110 0 63919 0 11564 0 687554 0 37336 0 WILLIAM FARRELL CHIEF INNOVATION & STRATEGY OFFICER 0 481600 0 141200 0 5550 0 45225 0 319 0 673894 0 0 LEANNE ANDERSEN CHIEF PEOPLE OFFICER 0 460498 0 99114 0 4689 0 41063 0 22536 0 627900 0 0 SHARLA BAENEN BOARD MEMBER/COO 387636 0 78025 0 34774 0 59243 0 27156 0 586834 0 34504 0 GERALD OETZEL FORMER CHIEF FINANCIAL OFFICER 0 480094 0 70000 0 4974 0 12220 0 5888 0 573176 0 0 MICHAEL LANDRUM MD BOARD MEMBER/COO 364691 0 106030 0 415 0 22475 0 2208 0 495819 0 0 0 LAURA HIEB BOARD MEMBER/CNO 311452 0 66025 0 31925 0 53011 0 12440 0 474853 0 31151 0 LISA HARTON CHIEF QUALITY OFFICER 333861 0 63651 0 414 0 18933 0 10249 0 427108 0 0 0 CINDY LASECKI MD FORMER BOARD MEMBER/COO 357502 0 25000 0 774 0 17421 0 3731 0 404428 0 0 0 ANDREA WERNER CHIEF POPULATION OFFICER 306068 0 58357 0 774 0 16382 0 10711 0 392292 0 0 0 STEVE LITTLE BOARD MEMBER/CFO (THRU 2/24) 0 258317 0 75000 0 0 0 0 0 0 0 333317 0 0 PART I, LINE 1A 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. PART I, LINE 4B 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 2023: CHRISTINE WOLESKE $175,207 PETER VANDENHOUTEN $37,336 LAURA HIEB $31,151 SHARLA BAENEN $34,504 FORM 990, PART VII, SECTION A, LINE 5 SAIED ASSEF WAS COMPENSATED BY BELLIN HEALTH PARTNERS, AN UNRELATED ORGANIZATION, FOR INDIVIDUAL SERVICES RENDERED TO BELLIN MEMORIAL HOSPITAL, INC. IN THE AMOUNT OF $188,000 DURING CALENDAR YEAR 2023. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-08-29 35000000 FUNDING OF NICU EXPANSION PROJECT AND VARIOUS RENOVATION AND EQUIPMENT PURCH 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-08-29 8000000 FUNDING OF IT INFRASTRUCTURE 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2022-12-14 106130278 AMBULATORY SURGERY CENTER BUILDING COMPONENTS 0 0 0 D WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712JGU1 2022-12-14 31617523 AMBULATORY SURGERY CENTER MOVEABLES AND EQUIPMENT 0 0 0 A 400000 41624205 314452 41309753 2023 0 0 1 1 B 100000 8351848 74748 8277100 2023 0 0 1 1 C 106130278 982522 105147756 2023 0 0 1 1 D 31617523 4368747 314546 26934230 0 0 0 1 A 0 1 1 1 0 0.01000 0.01000 1 0 1 B 0 1 1 1 0 0.01000 0.01000 1 0 1 C 0 1 1 1 0 0.01000 0.01000 1 0 1 D 0 1 1 1 0 0.01000 0.01000 1 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2024-06-03 28980000 REFUND AND LEGALLY DEFEASE 0 0 0 A 27461326 235689 27225637 2009 0 1 1 1 A 0 1 1 1 0 0.01000 0.01000 1 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC., HAS THE POWER TO APPOINT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBER, BELLIN HEALTH SYSTEMS, INC., HAS THE POWER TO APPROVE MAJOR EXPENDITURES AND LONG-TERM BORROWINGS. 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 EACH YEAR A CONFLICT OF INTEREST REQUEST DOCUMENT IS PROVIDED TO EACH BOARD MEMBER. ALL DOCUMENTS ARE PROVIDED BACK TO ADMINISTRATION AND REVIEWED. ALL EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AS PART OF ANNUAL MANDATORY EDUCATION. IF THERE IS A CONFLICT OF INTEREST, THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE, WHICH IS A COMMITTEE OF THE BOARD OF DIRECTORS, IS NOTIFIED. THE CORPORATE COMPLIANCE OFFICER AND CORPORATE COMPLIANCE COMMITTEE ADDRESSES THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 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 CONSULTANT'S 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 FACILITATES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. SENIOR LEADERS: COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION 362,558. OTHER CHANGES IN NET ASSETS -304. TRANSFER OF FUNDS FROM FOUNDATION FOR OTHER THAN CAPITAL -670,118. FORM 990, PART XI, LINE 2B-2C BELLIN MEMORIAL HOSPITAL, INC. 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. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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