Ascension Medical Group-Fox Valley Wisconsin Inc

“The process for determining compensation of the organization's ceo, executive director, or top management official, as well as that of any other officers or senior executives (if any), is directed by a related organization. The related organization's board committee responsible for compensation oversees the process, utilizing independent delegees within the organization as appropriate, depending on the role. In some cases, the process may utilize comparability data and analysis from a national third-party compensation firm; or, if more appropriate for the role, it may instead utilize other applicable sources of market comparability data as needed to verify reasonableness. The process also includes contemporaneous substantiation of the analysis and decision regarding the compensation arrangement. Compensation is reviewed at least annually and the process is administered to assure independence, avoid conflicts of interest, ensure reasonableness and market comparability of total compensation, and to otherwise abide by pertinent laws and regulations.”

“Ascension medical group-fox valley wisconsin, inc. Has a single corporate member, affinity health system.”

“Ascension medical group-fox valley wisconsin, inc. Has a single corporate member, affinity health system, who has the ability to elect members to the governing body of network health system, inc.”

“All decisions that have a material impact to the ascension medical group-fox valley wisconsin, inc. Financial information or corporation as a whole are subject to approval by its sole corporate member, affinity health system.”

“During the return preparation process, the tax department works with other functional areas which may include, as needed, finance, accounting, treasury, legal, human resources, and corporate compliance for advice, information and assistance in order to prepare a complete and accurate return. A complete final copy of the return is provided to designated management team members with experience in tax in lieu of the full board.”

“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 on the governing board or committee will decide if conflicts of 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 conflicts of interest policy, has read and understands 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.”

“The organization will provide any documents open to public inspection upon request.”

“The organization utilizes an affiliate as the common pay agent. Employees reported in part vii may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting.”

“INTEREST INCOME FROM PATIENT ACCOUNTS - Total Revenue: 546, Related or Exempt Function Revenue: 546, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“EDUCATION REVENUE - Total Revenue: -180, Related or Exempt Function Revenue: -180, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;”

“Physician Fees - Total Expense: 31967773, Program Service Expense: 31967773, Management and General Expenses: , Fundraising Expenses: ; Consulting Fees - Total Expense: 83525, Program Service Expense: 83525, Management and General Expenses: , Fundraising Expenses: ; Professional Fees - Total Expense: 29952, Program Service Expense: 29952, Management and General Expenses: , Fundraising Expenses: ; Contract Labor - Total Expense: -8213, Program Service Expense: -8213, Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ;”

“Transfers with affiliate - 67301681;”

“The activity of the filing organization is reported in the consolidated financial statements of ascension health alliance. No individual audit of the filing organization is completed. Therefore, the audited financial statements are of ascension health alliance and affiliates, which include the activity of the filing organization.”

“The filing organization is included in the consolidated financial statements of ascension health alliance. The finance and audit committee of ascension health alliance's board assumes responsibility for the consolidated organization as a whole.”

“Ascension medical group-fox valley wisconsin, inc. Is exempt as a hospital under internal revenue code section 170(b)(1)(a)(iii); however, it is not a hospital as defined by form 990, schedule h instructions because it is not required to be licensed as a hospital.”

“The physical address for this entity is 1570 midway place, menasha, wi 54952. The address on page 1 is for mailing purposes only.”