2026-03-20T10:33:24-05:00 2025-06-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2024-07-01 390806324 DOOR COUNTY MEMORIAL HOSPITAL DOOR 9207435566 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 ANDREW LALUZERNE CFO 9207435566 2026-03-18 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-03-18 2024 2025-03-06 01:10:19Z BRIAN STEPHENS 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 160268779 0 X WWW.DCMEDICAL.ORG X 1944 WI DELIVERING COMPASSIONATE, QUALITY CARE THAT INSPIRES A HEALTHY COMMUNITY. 19 15 877 120 0 0 631969 1198080 115477729 123777901 3915002 4254351 112348 81669 120137048 129312001 12500 259211 0 0 74155063 77513666 0 0 0 40980022 41875421 115147585 119648298 4989463 9663703 160046648 170108551 15722750 13439527 144323898 156669024 OUR MISSION AS A HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS CHRIST BY IMPROVING THE HEALTH AND WELL-BEING OF OUR COMMUNITY, ESPECIALLY THOSE IN NEED. 0 0 105317622 259211 123494721 DOOR COUNTY MEMORIAL HOSPITAL ("THE HOSPITAL") IS A FULLY ACCREDITED, ACUTE-CARE HOSPITAL AND OUTPATIENT MEDICAL CENTER, WITH 25 LICENSED BEDS. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES AND SPECIALTIES, INCLUDING A SKILLED NURSING FACILITY FOR LONG-TERM CARE AND REHABILITATION SERVICES, A REHAB SERVICES DEPARTMENT AND NORTH SHORE MEDICAL CLINIC. DURING FISCAL 2025, THE HOSPITAL COUNTED 3,409 INPATIENT DAYS, INCLUDING SWING BED. THE HOSPITAL'S OUTPATIENT FACILITIES, WHICH INCLUDE ITS REHABILITATION AGENCY, 32 BED EXTENDED CARE FACILITY, EMERGENCY ROOM, NORTH SHORE MEDICAL CLINIC SERVED 215,226 VISITS, AND THE NORTH SHORE MEDICAL CLINIC, INCLUDING ITS URGENT CARE FACILITY SERVED 84,530 VISITS. SEE SCHEDULE H FOR FURTHER DETAILS REGARDING THE COMMUNITY BENEFITS THE HOSPITAL PROVIDES. 105317622 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 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 94 0 877 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ANDREW LALUZERNE 9207435566 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 DR JAMES HEISE PHYSICIAN/MED STAFF PRES (THRU 12/24) 40.00 1.00 X 479748 0 64009 DR MICHAEL ST JEAN PHYSICIAN/MED STAFF PRESIDENT 40.00 1.00 X 438741 0 47094 DR DORENE DEMPSTER BOARD MEMBER/PHYSICIAN 40.00 1.00 X 393188 0 63871 BRIAN STEPHENS CHIEF EXECUTIVE OFFICER 40.00 1.30 X X 372881 0 62249 DR TOMASZ MICHALSKI MED STAFF PRESIDENT ELECT 40.00 X 346749 0 66103 DR AMY FOGARTY MED STAFF PRES. ELECT (THRU 07/24) 40.00 X 194355 0 33932 PATRICIA VICKMAN BOARD CHAIR 1.00 1.00 X X 0 0 0 DREW RICHMOND VICE CHAIR 1.00 1.00 X X 0 0 0 JAMIE ALBERTS TREASURER 1.00 1.00 X X 0 0 0 CORWIN DAHL SECRETARY 1.00 1.00 X X 0 0 0 PATTY ALLEN CLASS H MEMBER (THRU 04/25) 1.00 X 0 0 0 BRADLEY ANDREAE BOARD MEMBER 1.00 1.00 X 0 0 0 EDGAR TED COLLISON CLASS H MEMBER 1.00 X 0 0 0 BERNADETTE CONROY BOARD MEMBER 1.00 1.00 X 0 0 0 ROBERT ERICKSON CLASS H MEMBER 1.00 X 0 0 0 POLLY HELM MEMBER AT LARGE 1.00 1.00 X 0 0 0 ERIN HELGESON BOARD MEMBER 1.00 1.00 X 0 0 0 JON JAROSH BOARD MEMBER 1.00 1.00 X 0 0 0 JOEL KITCHENS BOARD MEMBER 1.00 1.00 X 0 0 0 JEFF RABAS BOARD MEMBER 1.00 1.00 X 0 0 0 MARTI SPITTELL ZIEGELBAUER BOARD MEMBER 1.00 1.00 X 0 0 0 TAMMY STERNARD MEMBER AT LARGE 1.00 1.00 X 0 0 0 SCOT WEDERQUIST MEMBER AT LARGE (THRU 12/24) 1.00 1.00 X 0 0 0 ANDREW LALUZERNE CHIEF FINANCIAL OFFICER 40.00 X 224595 0 56089 DANIEL TOMASZEWSKI PHYSICIAN 40.00 X 1258894 0 62503 MARC BINARD PHYSICIAN 40.00 X 747673 0 58094 MARTIN FINCK PHYSICIAN 40.00 X 558009 0 63503 BRIAN MATYSIAK PHYSICIAN 40.00 X 551759 0 61253 JOSEPH REBHAN PHYSICIAN 40.00 X 527344 0 57732 6093936 0 696432 120 0 1 0 INFINITY HEALTHCARE INC 111 E WISCONSIN AVE SUITE 2000 MILWAUKEE WI 54302 ER PHYSICIANS 4521798 MEDICAL STAFFING SOLUTIONS PO BOX 101 RICE LAKE WI 54868 CONTRACT LABOR 1292009 CHG COMPANIES DBA COMPHEALTH PO BOX 972651 DALLAS TX 753972651 LOCUMS PHYSICIAN LABOR 998335 ST VINCENT HOSPITAL PO BOX 13508 GREEN BAY WI 543073508 LAB AND OTHER MEDICAL SERVICES 803723 PSYCHIATRIC MEDICAL CARE PO BOX 734606 DALLAS TX 753734606 PSYCHIATTRIC MEDICAL CONSULTING SERVICES 531308 29 1110395 87685 1198080 NET PATIENT SERVICE REVENUE 900099 119628182 119628182 MOB RENTAL INCOME 900099 299957 299957 CAFETERIA REVENUES 900099 283180 283180 THERAPY OTHER REVENUES 900099 208973 208973 OCCUPATIONAL HEALTH AND WELLNESS 900099 12424 12424 3345185 3345185 123777901 2093252 2093252 145042 63373 81669 81669 81669 33015504 39000 30833446 59959 2182058 -20959 2161099 2161099 129312001 123494721 0 4619200 X 259211 259211 2621777 2345274 276503 57227094 51191707 6035387 2822610 2524927 297683 11118303 9945724 1172579 3723882 3331147 392735 268109 105691 162418 68882 13100 55782 18824 18824 252173 252173 12634601 11603389 1031212 709069 5349 703720 1904083 1564981 339102 3027660 897158 2130502 1894472 1745446 149026 543006 411585 131421 137537 129828 7709 4701123 4435491 265632 596355 177307 419048 MEDICAL SUPPLIES 6648320 6648320 PHARMACEUTICALS 4858142 4858142 BAD DEBT EXPENSE 2218613 2218613 DUES & SUBSCRIPTIONS 224832 99603 125229 1169620 805629 363991 119648298 105317622 14330676 0 3378 24010 10386875 11417282 15458072 15682401 764478 708935 1926129 1956155 2080404 2227958 84665696 29666804 52586900 54998892 70342584 75757853 6497828 7335065 160046648 170108551 7935750 7691776 4444737 3981416 758897 110122 2583366 1656213 15722750 13439527 X 141429908 153834919 2893990 2834105 144323898 156669024 160046648 170108551 X 9663703 2741308 -59885 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18824 18824 0 PART II-B, LINE 1: LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT ARE SPECIFICALLY ALLOCABLE TO LOBBYING. DOOR COUNTY MEMORIAL HOSPITAL DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OF STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 4673888 4673888 50281817 17318573 32963244 6354 6354 0 27128743 12341877 14786866 2574894 2574894 54998892 LEASE OBLIGATION 1601562 ASSET RETIREMENT OBLIGATION 54651 1656213 129645896 2741308 2741308 126904588 252173 2155240 2407413 129312001 117240885 0 117240885 252173 2155240 2407413 119648298 PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -63,373. BAD DEBT EXPENSE 2,218,613. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -63,373. BAD DEBT EXPENSE 2,218,613. 1 1 X 1 X 1 X 1 1 1 0 1 1 1748020 1748020 0.01490 9794891 9606360 188531 0.00160 11542911 9606360 1936551 0.01650 168092 168092 0.00140 390880 390880 0.00330 30045282 16456501 13588781 0.11570 430772 430772 0.00370 31035026 16456501 14578525 0.12410 42577937 26062861 16515076 0.14060 1 29088 29088 0.00020 1 996 996 0.00000 1 14216 14216 0.00010 1 102 39174 39174 0.00030 3 77 84618 84618 0.00070 7 179 168092 168092 0.00130 1 2218613 0 22216936 22302738 -85802 X 1 1 1 1 DOOR COUNTY MEMORIAL HOSPITAL 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 WWW.DCMEDICAL.ORG 1054 X X X X DOOR COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X HTTPS://WWW.DCMEDICAL.ORG/ABOUT X 1 22 1 HTTPS://WWW.DCMEDICAL.ORG/ABOUT 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X SEE SUPPLEMENTAL SECTION X SEE SUPPLEMENTAL SECTION X SEE SUPPLEMENTAL SECTION X X X X X X 1 X 0 X X X X 1 X 0 0 DOOR COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE CHNA PROCESS LISTED BELOW HAPPENS EVERY THREE YEARS. DOOR COUNTY MEDICAL CENTER'S CHNA PROCESS SOUGHT INPUT FROM COMMUNITY MEMBERS, INCLUDING MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND FROM ORGANIZATIONS THAT SERVE THOSE POPULATIONS. THE 2021 CHNA WAS COMPLETED IN DECEMBER 2022, WHICH INCLUDED INPUT FROM ALL COMMUNITY STAKEHOLDERS. DOOR COUNTY MEDICAL CENTER INTENTIONALLY INCLUDED ORGANIZATIONS THAT REPRESENT MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE STAKEHOLDERS USED COMMUNITY COLLABORATION TO DISCUSS COMMUNITY HEALTH DATA, PROGRESS ON THE PREVIOUS PRIORITY AREAS, AND ANY EMERGING NEEDS. THE LIST OF ORGANIZATIONS PARTICIPATING IN THE MOST RECENT CHNA STAKEHOLDER DISCUSSIONS IS BELOW. DOOR COUNTY DEPARTMENT OF PUBLIC HEALTH STAFF* DOOR COUNTY MEDICAL CENTER UNITED WAY OF DOOR COUNTY* DOOR COUNTY PUBLIC LIBRARY DOOR COUNTY MEDICAL CENTER DENTAL CLINIC* UW-EXTENSION, DOOR COUNTY UW-GREEN BAY DOOR COUNTY PUBLIC SCHOOLS* BOYS AND GIRLS CLUB OF DOOR COUNTY* DOOR COUNTY YMCA SENIOR RESOURCE CENTER* MINISTRY HOME CARE STURGEON BAY FIRE DEPARTMENT NORTHEAST WISCONSIN TECHNICAL COLLEGE (NWTC) DOOR COUNTY BOARD OF HEALTH BELLIN COLLEGE GOOD SAMARITAN- SCANDIA VILLAGE LAKESHORE CAP FOOD PANTRY* DOOR COUNTY SHERIFF'S DEPARTMENT**DENOTES ORGANIZATIONS OR PROGRAMS DOOR COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PRIORITY NEED #1. MENTAL HEALTH MENTAL HEALTH WAS IDENTIFIED AS THE TOP AREA OF CONCERN ACROSS THE COMMUNITY INPUT SURVEY, KEY INTERVIEWS, AND THE SECONDARY DATA. ONLY 22% OF RESPONDENTS FEEL THERE IS PROPER ACCESS TO MENTAL HEALTH RESOURCES IN THIS COMMUNITY. JANUARY 2019 DCMC, ALONG WITH UNITED WAY OF DOOR COUNTY, STARTED THE DOOR COUNTY COLLABORATIVE SCHOOL MENTAL HEALTH PROJECT (STRIDE). THIS PROGRAM ALLOWS MENTAL HEALTH PROVIDERS FROM DCMC TO HAVE COUNSELING SESSIONS WITH STUDENTS AND FAMILIES AT LOCAL SCHOOL DISTRICTS. THE PROGRAM ALSO INCLUDES TIME FOR DCMC MENTAL HEALTH PROVIDERS TO EDUCATE AND TRAIN SCHOOL STAFF REGARDING SCHOOL-BASED MENATL HEALTH. THIS PROGRAM CONTINUES TO GROW AND IN 2024 MORE SCHOOLS WERE ADDED TO THE SERVICE AREA.DCMC HAS ADDED MORE MENTAL HEALTH PROVIDERS AND THE TELEHEALTH PROGRAM TO TRY TO REACH THOSE IN NEED AND ALLOW MORE ACCESS. IN 2025 DCMC PROVIDES AT LEAST ONE FULL-TIME BEHAVIORAL HEALTH PROVIDER AT EACH OUTREACH CLINIC LOCATION.DCMC STAFF VOLUNTEER TIME TO THE ADRC MEALS ON WHEELS PROGRAM. THE DELIVERY OF FOOD ALSO PROVIDES HUMAN CONTACT FOR THE RECIPIENTS WHO MOST COMMONLY ARE ELDERLY IN RURAL AREAS AND LIVING ALONE.PRIORITY NEED #2. SUBSTANCE USEALCOHOL AND DRUG ABUSE WERE THE TOP RATED AREAS OF CONCERN THAT SURVEY RESPONDENTS IDENTIFIED IN DOOR COUNTY, 69% OF RESPONDENTS RECOGNIZED ALCOHOL ABUSE AS A TOP HEALTH ISSUE IN OUR COMMUNITY.DCMC HAS IMPLEMENTED A SUDS (SUBSTANCE USE DISORDERS) PROGRAM IN FISCAL YEAR 2024. THIS PROGRAM CONTINUES TO GROW IN 2025.PRIORITY NEED #3. HEALTHY LIFESTYLES DCMC HAD A DENTAL CLINIC AND JANUARY 2025 SIGNED A CONTRACT THAT TRANSITIONED TO OFFICIALLY BECOME N.E.W. COMMUNITY CLINIC DOOR COUNTY DENTAL. AS A FEDERALLY QUALIFIED HEALTH CENTER, N.E.W COMMUNITY CLINIC HAS GREATER ACCESS TO FEDERAL AND STATE FUNDING SOURCES. THIS WILL CREATE OPPORTUNITIES TO EXPAND SERVICES, PARTICULARY BENEFITING UNDERINSURED AND UNINSURED RESIDETNS. DCMC CONTINUES TO SUPPORT DENTAL CARE WITH HELPING WITH SOME OPERATING EXPENSES FOR THE N.E.W. COMMUNITY CLINICDCMC OFFERS SPACE FOR A COMMUNITY GARDEN WHICH IS A WAY TO HELP LOCAL, LOW-INCOME FAMILIES ENJOY NOT ONLY THE HEALTH BENEFITS ASSOCIATED WITH GROWING THEIR OWN FOOD, BUT THE FINANCIAL BENEFITS AS WELL. AT THE COMMUNITY GARDEN, THE $40 RENTAL FEE FOR A 20' X 20' PLOT IS WAIVED FOR FAMILIES THAT RECEIVE WIC OR SNAP BENEFITS THROUGH FOODSHARE, WI. ALL OF THE START-UP COSTS ASSOCIATED WITH A NEW FOOD GARDEN ARE NON-EXISTENT DUE TO ALL TOOLS AND TILLING PROVIDED AND DONE BY DCMC AND THE CITY OF STURGEON BAY. EACH YEAR, ABOUT 43 GARDENERS ARE HARVESTING 42 PLOTS, ROUNDING OUT ANOTHER SUCCESSFUL GROWING SEASON.DCMC SPONSORS A FOOD VOUCHER PROGRAM AT THE STURGEON BAY FARMER'S MARKET. THE DOUBLE YOUR FOODSHARE DOLLARS PROGRAM AIMS TO INCENTIVIZE HEALTHY EATING BY DOUBLING AVAILABLE FUNDS. THE VOUCHER IS BOUGHT FOR $10 ON A QUEST CARD AND IS WORTH $20 IN FOODSHARE TOKENS TO BE USED AT THE FARMERS MARKET.OVER THE PAST SEVERAL YEARS, DCMH HAS ALSO ASSISTED CROSSROADS OF BIG CREEK WITH THE CREATING OF WALKING PATHS AND CROSS-COUNTRY SKI AND SNOW-SHOE TRAILS. THESE EFFORTS ALSO ENCOURAGE PHYSICAL EXERCISE AND THE APPRECIATION OF BEING OUTDOORS DURING ALL FOUR SEASONS.COMMUNITY HEALTH FAIRS ARE HELD SEVERAL TIMES DURING THE YEAR, WITH DIFFERENT HEALTH AND WELLNESS PARTNERS SUCH AS THE YMCA OF DOOR COUNTY, AND KEWAUNEE COUNTY AGING HEALTH SERVICES. THESE HEALTH FAIRS INCLUDE FREE HEALTH CARE SERVICES FOR THE PUBLIC SUCH AS CHOLESTEROL AND BLOOD PRESSURE SCREENINGS, AS WELL AS SEMINARS FACILITATED BY OUR CLINICAL STAFF AND PHYSICIANS. PART V, LINES 16A: HTTPS://WWW.DCMEDICAL.ORG/BILLING-AND-PAYMENTS PART V, LINES 16B: HTTPS://WWW.DCMEDICAL.ORG/BILLING-AND-PAYMENTS PART V, LINES 16C: HTTPS://WWW.DCMEDICAL.ORG/BILLING-AND-PAYMENTS 5 1 - DCMC - STURGEON BAY CLINIC 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 RURAL HEALTH CLINIC 2 - DCMC - SISTER BAY CLINIC 2345 CANTERBURY LANE SISTER BAY WI 54234 RURAL HEALTH CLINIC 3 - DCMC - ALGOMA CLINIC 815 JEFFERSON STREET ALGOMA WI 54201 RURAL HEALTH CLINIC 4 - DIRECTCARE 911 GREEN BAY RD SUITE 3 STURGEON BAY WI 54235 RURAL HEALTH CLINIC 5 - DCMC - WASHINGTON ISLAND CLINIC 910 MAIN ROAD WASHINGTON ISLAND WI 54246 RURAL HEALTH CLINIC PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS FOR SCHEDULE H, LINE 7, IS A COMBINATION OF AVERAGE COSTS AND ACTUAL COSTS PERTAINING TO SUPPLIES, WAGES, AND BENEFITS. THE ACTUAL COST OF SUPPLIES USED FOR EACH EVENT IS APPLIED. IF NO ACTUAL COST IS AVAILABLE, WE THEN USE AN ESTIMATE. WAGES ARE CALCULATED BY MULTIPLYING THE AVERAGE WAGE RATE TIMES ACTUAL HOURS WORKED. THE BENEFIT RATE USED INCLUDES A RATIO OF ALL BENEFITS RELATED TO THE WAGE CALCULATION. NO COST TO CHARGE RATIO IS USED. PART I, LINE 7G: SUBSIDIZED SERVICES AT DOOR COUNTY MEMORIAL HOSPITAL INCLUDE DENTAL CLINIC COST CENTER, GERIATRIC SERVICES AND ATHLETIC TRAINING WITH AREA SCHOOLS AS WELL AS THE ACTIVITY OF THEIR RURAL HEALTH CLINICS. PART I, LN 7 COL(F): PATIENT PAYMENTS OR DISCOUNTS ARE APPLIED PRIOR TO DETERMINING BAD DEBT EXPENSE AND ARE NOT INCLUDED IN THE BAD DEBT WRITE-OFF REPORTED ON THE AUDITED FINANCIAL STATEMENTS. DEDUCTIBLES AND COINSURANCE AMOUNTS THAT ARE DEEMED UNCOLLECTIBLE ARE WRITTEN OFF EITHER TO BAD DEBT EXPENSE OR, IF APPLICABLE, TO CHARITY CARE IF THE PATIENT SO QUALIFIES FOR FINANCIAL ASSISTANCE. THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE BUT THEY ACCOUNT FOR BAD DEBTS BASED ON GROSS CHARGES TO PATIENTS AFTER REFLECTING ANY PAYMENTS OR DISCOUNTS, OR AMOUNTS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE. PART II, COMMUNITY BUILDING ACTIVITIES: DOOR COUNTY MEDICAL CENTER PARTICIPATES IN COMMUNITY COALITIONS AND OTHER COLLABORATIVE EFFORTS WITH THE COMMUNITY WHOSE PURPOSE IS TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE INCLUDE HABITAT FOR HUMANITY, WISCONSIN COMMUNITY HEALTH PROGRAM, SOUTHERN DOOR AUDITORIUM COMMITTEE, DOOR COUNTY ELDER AND ADULT-AT-RISK INTERDISCIPLINARY TEAM, DOOR COUNTY COMMUNITY PARTNERSHIP FOR CHILDREN AND FAMILIES, MENTAL HEALTH FOCUS GROUP ANDDOOR COUNTY UNITED WAY. BY WORKING TOGETHER WITH OTHER ORGANIZATIONS IN THE COMMUNITY, WE EXPECT TO HAVE A GREATER IMPACT ON HEALTH. ACCORDING TO THE COUNTY HEALTH RANKINGS SITE, WITH A SHARED VISION AND COMMITMENT TO IMPROVED HEALTH, WORKING TOGETHER CAN YIELD BETTER RESULTS THAN WORKING ALONE. LEADERSHIP FROM DOOR COUNTY MEDICAL CENTER ALSO ATTEND LEADERSHIP DOOR COUNTY. FUTURE COMMUNITY LEADERS WHO ARE KNOWLEDGEABLE ABOUT BOTH THE ASSETS AND CHALLENGES OUR COMMUNITY HAS WILL HELP US TO POSITIVELY ADDRESS THE HEALTH ISSUES OF THE FUTURE. THE MEDICAL CENTER ALSO IS A COMMUNITY SHARPS DISPOSAL SITE. BY SAFELY REMOVING SHARPS FROM THE ENVIRONMENT, WE MAKE THE COMMUNITY SAFER IN TERMS OF INJURY AND INFECTION. IN ADDITION, DOOR COUNTY MEDICAL CENTER PROVIDES JOB SHADOWING FOR AREA YOUTH. ACCORDING TO THE COUNTY HEALTH RANKINGS, EMPLOYMENT PROVIDES INCOME AND, OFTEN, BENEFITS THAT CAN SUPPORT HEALTHY LIFESTYLE CHOICES. UNEMPLOYMENT AND UNDER EMPLOYMENT LIMIT THESE CHOICES, AND NEGATIVELY AFFECT BOTH QUALITY OF LIFE AND HEALTH OVERALL. PART III, LINE 2: ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER ALL INTERNAL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. ATTEMPTS TO RESOLVE THESE OUTSTANDING BALANCES CAN INCLUDE, BUT ARE NOT LIMITED TO STATEMENTS BEING SENT, PHONE CALLS AND LETTERS BEING SENT. ACCOUNT FOLLOW UP PROTOCOL IS BASED ON PERSONAL PAY BALANCE SIZE OWED. PART III, LINE 3: DOOR COUNTY MEMORIAL HOSPITAL HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. PART III, LINE 4: THE BAD DEBT EXPENSE INCLUDED ON FORM 990 (PART IX, LINE 25, COLUMN A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,218,613. PART III, LINE 8: HOSPITALS MUST ACCEPT MEDICARE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SERVICES TO THOSE PATIENTS. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATIONS MEDICARE COST REPORT IS STEP DOWN. PART III, LINE 9B: DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS MADE AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICES SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS. PART VI, LINE 2: OTHER THAN THE CHNA PROCESS, WHICH OCCURS EVERY THREE YEARS IN COLLABORATION WITH THE DOOR COUNTY PUBLIC HEALTH DEPARTMENT, THE ORGANIZATION USES MARKET RESEARCH TO GAUGE HEALTH CARE NEEDS. THE ORGANIZATION CONDUCTS FACEBOOK SURVEYS THAT ASSESS NEEDS IN OUR MARKET/COMMUNITY AND RECEIVED INPUT ON HEALTH CARE NEEDS THAT WILL BE USED IN THE NEXT CHNA. PART VI, LINE 3: THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE CHARITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE. PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASSISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS. PART VI, LINE 4: DOOR COUNTY MEMORIAL HOSPITAL ("DCMH") PROVIDED SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT, WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. THE CITY OF STURGEON BAY IS LOCATED IN DOOR COUNTY. THE POPULATION OF DOOR COUNTY, AS OF THE 2023 CENSUS DATA, IS 30,279. THE POPULATION CONSISTED OF 93% WHITE, 4% HISPANIC, 1% AFRICAN AMERICAN, 1% NATIVE, AND 1% ASIAN. OF THE 30,279 POPULATION, 51% WERE FEMALE AND 49% MALE. THE AGE POPULATION IS WIDELY SPREAD. 18% WERE UNDER 18 AND 41% WERE 60+. THE LARGEST INDUSTRIES IN DOOR COUNTY ARE MANUFACTURING 18%, RETAIL 12%, HEALTHCARE 12%, AND HOSPITALITY 11%. ROUGHLY 8.7% OF THE POPULATION WERE BELOW THE POVERTY LINE. PART VI, LINE 5: THE LOCAL BOARD FOR DOOR COUNTY MEMORIAL HOSPITAL IS MADE UP OF COMMUNITY MEMBERS THAT LIVE IN OUR PRIMARY SERVICE AREA. DOOR COUNTY MEMORIAL HOSPITAL PARTNERS WITH THE LOCAL YMCA ON VARIOUS EVENTS PROMOTING HEALTH AND WELL-BEING IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. DOOR COUNTY MEMORIAL HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, AND OTHER GOVERNMENT SPONSORED PROGRAMS. PART VI, LINE 6: STARTING 11/1/16 DOOR COUNTY MEMORIAL HOSPITAL ENTERED INTO AN AFFILIATION AGREEMENT WITH HOSPITAL SISTERS HEALTH SYSTEM, HOSPITAL SISTERS SERVICES, INC. AND ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS. THERE ARE SOME DECISIONS THAT REQUIRE AFFIRMATIVE APPROVAL OF THE CLASS H DIRECTORS, VOTING A SINGLE VOTE AS A CLASS, AND THE AFFIRMATIVE APPROVAL OF THE CLASS D DIRECTORS, VOTING A SINGLE VOTE AS A CLASS. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 DOOR COUNTY ECONOMIC DEVELOPMENT 185 E WALNUT STREET STURGEON BAY WI 54235 391621905 501(C)(3) 7500 0 DOOR COUNTY ECONOMIC DEVELOPMENT NWTC EDUCATIONAL FOUNDATION 2740 W MASON STREET PO BOX 19042 GREEN BAY WI 54307 237069405 501(C)(3) 25000 0 NURSING & HEALTH CARE PROGRAMS NEW COMMUNITY CLINIC LTD 610 N BROADWAY GREEN BAY WI 54303 391200636 501(C)(3) 192534 0 COMMUNITY DENTAL SERVICES 3 0 PART I, LINE 2: POLICY STAT ID: 6244784 POLICY STATEMENT: IT IS THE POLICY OF DOOR COUNTY MEDICAL CENTER THAT ANY GRANT OR OTHER ASSISTANCE OF $5,000 OR MORE FROM DOOR COUNTY MEDICAL CENTER WILL REQUIRE ADMINISTRATIVE APPROVAL. THE CONTRIBUTIONS ADDRESSED IN THIS POLICY ARE CONSIDERED GRANT DONATIONS AND ARE NOT SPONSORSHIPS OR MARKETING EVENTS. PROCEDURE: A REQUEST FOR DONATIONS OF $5,000 OR MORE WILL NEED TO BE WRITTEN IN LETTER FORMAT ADDRESSED TO THE DOOR COUNTY MEDICAL CENTER ADMINISTRATIVE TEAM. THE CHECK REQUEST TO BE PROCESSED BY ACCOUNTS PAYABLE SHOULD BE SIGNED BY THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL. THE ADMINISTRATIVE TEAM WILL DISCUSS AND APPROVE OR REJECT THE REQUEST DURING ITS WEEKLY TEAM MEETING. DEPARTMENT DIRECTORS DO NOT HAVE THE AUTHORITY TO APPROVE ANY DONATION REQUEST. WHEN A REQUEST IS APPROVED BY THE ADMINISTRATIVE TEAM, A "GRANT AGREEMENT" FORM (COPY ATTACHED) WILL BE ISSUED AND WILL BE SIGNED BY THE ORGANIZATION RECEIVING THE CONTRIBUTION. THE ADMINISTRATIVE TEAM, WHEN MAKING DECISIONS ON REQUESTS FOR DONATIONS, MUST DETERMINE THAT THERE IS A DIRECT BENEFIT TO THE WELFARE OF DCMC OR TO THE PATIENTS AND COMMUNITY IT SERVES. AT THE COMPLETION OF THE GRANT PERIOD NOTED ON THE "GRANT AGREEMENT" FORM, THE ORGANIZATION THAT RECEIVED THE CONTRIBUTION WILL NEED TO COMPLETE A "GRANT FINAL REPORT" FORM. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 DANIEL TOMASZEWSKI PHYSICIAN 1250862 0 0 0 8032 0 20700 0 41803 0 1321397 0 0 0 MARC BINARD PHYSICIAN 738791 0 0 0 8882 0 20700 0 37394 0 805767 0 0 0 MARTIN FINCK PHYSICIAN 515640 0 0 0 42369 0 20700 0 42803 0 621512 0 0 0 BRIAN MATYSIAK PHYSICIAN 511054 0 0 0 40705 0 20700 0 40553 0 613012 0 0 0 JOSEPH REBHAN PHYSICIAN 355240 0 166814 0 5290 0 20700 0 37032 0 585076 0 0 0 DR JAMES HEISE PHYSICIAN/MED STAFF PRES (THRU 12/24 449631 0 0 0 30117 0 22036 0 41973 0 543757 0 0 0 DR MICHAEL ST JEAN PHYSICIAN/MED STAFF PRESIDENT 431346 0 0 0 7395 0 20750 0 26344 0 485835 0 0 0 DR DORENE DEMPSTER BOARD MEMBER/PHYSICIAN 386300 0 0 0 6888 0 20879 0 42992 0 457059 0 0 0 BRIAN STEPHENS CHIEF EXECUTIVE OFFICER 360485 0 0 0 12396 0 20700 0 41549 0 435130 0 0 0 DR TOMASZ MICHALSKI MED STAFF PRESIDENT ELECT 340067 0 0 0 6682 0 20700 0 45403 0 412852 0 0 0 ANDREW LALUZERNE CHIEF FINANCIAL OFFICER 201979 0 0 0 22616 0 14254 0 41835 0 280684 0 0 0 DR AMY FOGARTY MED STAFF PRES. ELECT (THRU 07/24) 191014 0 0 0 3341 0 8044 0 25888 0 228287 0 0 0 PART I, LINE 1A PHYSICIANS ARE ALLOWED UP TO $1,000 FOR SPOUSE TRAVEL TO CONFERENCES. SUPPORTING DOCUMENTATION OF THE EXPENSES IS MAINTAINED AND TRACKED BY THE PHYSICIANS. SPOUSE TRAVEL AMOUNTS ARE INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 7 SCHEDULE J, PART II, COLUMN (B)(II) REPORTS DISCRETIONARY INCENTIVE AMOUNTS THAT WERE APPROVED BY THE BOARD BASED UPON PERFORMANCE. A WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 2014-08-15 10000000 REFUND DEBT ISSUED 10/21/09 0 0 0 A 6018583 10000000 10000000 2011 1 0 1 1 A 0 0 1 1 0 0 0 1 A 0 1 0 0 1 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 THERE ARE TWO CLASSES OF MEMBERS. CLASS H MEMBERS ARE REPRESENTATIVES FROM HSHS. TWO CLASS H MEMBERS ARE REQUIRED PER THE PARTNERSHIP AGREEMENT WITH HSHS. CLASS D MEMBERS ARE REPRESENTATIVES FROM DOOR COUNTY MEDICAL CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A CLASS H DIRECTORS OF THE GOVERNING BODY OF DOOR COUNTY MEMORIAL HOSPITAL SHALL BE APPOINTED BY ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS PROVIDED THAT THE CLASS D DIRECTORS SHALL RECEIVE ADVANCE NOTICE OF AND THE RIGHT TO ATTEND AND PARTICIPATE IN DISCUSSION AT SVGB MEETINGS DURING WHICH SVGB DISCUSSES POTENTIAL CANDIDATES TO THE CLASS H DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B STARTING 11/1/16 DOOR COUNTY MEMORIAL HOSPITAL ENTERED INTO AN AFFILIATION AGREEMENT WITH HOSPITAL SISTERS HEALTH SYSTEM, HOSPITAL SISTERS SERVICES, INC. AND ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS. THERE ARE SOME DECISIONS THAT REQUIRE AFFIRMATIVE APPROVAL OF THE CLASS H DIRECTORS, VOTING A SINGLE VOTE AS A CLASS, AND THE AFFIRMATIVE APPROVAL OF THE CLASS D DIRECTORS, VOTING A SINGLE VOTE AS A CLASS. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT AND CERTAIN OFFICERS WORK DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS' QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS OF THE GOVERNING BOARD OR COMMITTEE WILL DECIDE IF CONFLICTS ON INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTAND THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, WHICH IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO, WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE BOARD MINUTES. INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS PERFORMED BY DOOR COUNTY MEMORIAL HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE, ASSISTED BY AN INDEPENDENT CONSULTING FIRM, REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE DOOR COUNTY MEMORIAL HOSPITAL WEB PAGE IS AVAILABLE TO THE PUBLIC FOR INSPECTION WITH A GOOD DEAL OF INFORMATION REGARDING WHO DOOR COUNTY MEMORIAL HOSPITAL IS ALONG WITH OUR MISSION. THE ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT INCLUDED ON ANY WEB PAGE. HOWEVER, IF ANY INQUIRY IS MADE FOR ANY DOCUMENTS THEY ARE SHARED AS APPROPRIATE. FORM 990, PART IX, LINE 11G MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,306,039. MANAGEMENT AND GENERAL EXPENSES 786,488. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,092,527. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 6,297,350. MANAGEMENT AND GENERAL EXPENSES 244,724. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,542,074. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS IN DOOR COUNTY HOSPITAL FOUNDATION -59,885. FORM 990, PART XII, LINE 2C: THERE WERE NO CHANGES MADE FROM PRIOR YEAR. DOOR COUNTY MEDICAL CORPORATION 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 814221171 SUPPORTING ORGANIZATION WI 501(C)(3) LINE 12B, II 0 DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC 228 SOUTH 18TH AVENUE STURGEON BAY WI 54235 391649104 CHARITABLE FOUNDATION WI 501(C)(3) LINE 7 DOOR COUNTRY MEDICAL CORPORATION 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC C 1110395 ACTUAL DOOR COUNTY MEMORIAL HOSPITAL FOUNDATION INC O 450111 ACTUAL