2024-05-15T09:21:24-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 383236977 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC ASPI 9062656121 1400 W ICE LAKE RD IRON RIVER MI 49935 JERRY M YANG SVP - CHIEF FINANCIAL OFFICER 7158472250 2024-05-14 1 JERRY YANG 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MATTHEW HEYWOOD 1400 W ICE LAKE RD IRON RIVER MI 49935 39158047 0 X WWW.ASPIRUS.ORG X 1995 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 14 7 212 24 0 0 1353165 1215742 38488071 37724801 8679 63451 138598 151230 39988513 39155224 177 5192 0 0 16389458 16241666 0 0 0 23419208 24778729 39808843 41025587 179670 -1870363 34664104 29017921 27410242 20624065 7253862 8393856 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 27538033 5192 37724801 ASPIRUS IRON RIVER HOSPITAL (AIR) PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL AND PHYSICIAN CLINIC SERVICES. IN 2022, AIR HAD 428 INPATIENT ADMISSIONS AND 1,869 INPATIENT DAYS ALONG WITH 7,019 EMERGENCY DEPARTMENT VISITS WITH AN EMERGENCY PROVIDER STAFFED 24/7. AIR HAS 2 PROVIDER CLINICS, ONE ON THE HOSPITAL CAMPUS AND ONE LOCATED 15 MILES AWAY IN CRYSTAL FALLS, MI., BOTH PROVIDED 21,822 PATIENT VISITS IN 2022. THE HOSPITAL ALSO PROVIDES ICU SERVICES ALONG WITH A SWING BED PROGRAM. THE HOSPITAL ALSO HAS FULLY FUNCTIONING LAB AND RADIOLOGY DEPARTMENTS THAT ARE SUPPLEMENTED BY A MOBILE MRI UNIT THAT VISITS THE HOSPITAL CAMPUS BIWEEKLY. BOTH IP AND OP SURGERIES ARE PERFORMED WITH TOTAL OR CASES OF 685 IN 2022. BECAUSE OF REGIONAL AFFILIATION, AIR IS ALSO ABLE TO PROVIDE ORTHOPEDIC, OB CLINIC VISITS, CARDIOLOGY, BEHAVIORAL HEALTH, AND ONCOLOGY SERVICES. 27538033 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 212 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JERRY M YANG 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 JESSE TISCHER BOARD MEMBER/SVP & PRES. REG. MKTS 1.00 50.00 X 0 781575 128595 JOHN PIETILA BOARD MEMBER/RADIOLOGIST 1.00 40.00 X 0 876739 57266 DANIEL J LUKES DO BOARD MEMBER/PHYSICIAN 1.00 50.00 X 0 802805 46236 JENNIFER REDMAN-SCHELL VICE CHAIR/SVP & PRESIDENT-AMG 1.00 50.00 X X 0 641148 101726 JONATHAN N BRUEGGEMAN BOARD MEMBER/CMO-UP REGION 1.00 50.00 X 0 450639 55802 PATRICK TINCHER JR BOARD MEMBER/VP FINANCE REGIONAL OPS. 1.00 50.00 X 0 336475 56521 KRISTEN D MESKE NP-C BOARD MEMBER/NURSE PRACTITIONER 1.00 50.00 X 136910 0 5756 JOHN D MATONICH CHAIR 1.00 3.00 X X 0 0 0 STEVEN TINTI TREASURER 1.00 3.00 X X 0 0 0 KATIE CLARK SECRETARY 1.00 3.00 X X 0 0 0 ROBIN MENEZUGGO BOARD MEMBER 1.00 3.00 X 0 0 0 RICHARD J KOUBEK PHD BOARD MEMBER 1.00 3.00 X 0 0 0 JAMES R RICHARDSON BOARD MEMBER 1.00 3.00 X 0 0 0 KIRK R SCHOTT BOARD MEMBER/PHYSICIAN 1.00 3.00 X 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1799938 311110 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 1911464 144118 CHRISTINE HARFF (NV) PRESIDENT - REGIONAL UP 1.00 50.00 X 0 459422 103257 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 2.00 50.00 X 0 672916 123676 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 2.00 50.00 X 0 539401 110893 TODD RICHARDSON SVP & CHIEF INFO. OFF. (THRU 06/23) 2.00 50.00 X 0 534868 104438 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 519926 106843 CONSTANCE BRADLEY SVP-SYSTEM CHIEF NURSING EXECUTIVE 2.00 50.00 X 0 502032 95550 DEBRA BALL SVP & CHIEF HR OFFICER 2.00 50.00 X 0 458839 103553 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 2.00 50.00 X 0 348443 48718 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 2.00 50.00 X 0 321116 49427 SCOTT REMMICH VP-CHIEF COMPLIANCE OFFICER 2.00 50.00 X 0 304493 45336 ANDREW COSTIC VP-FINANCE UP REGION 2.00 50.00 X 0 272701 24274 MARGUERITE HALE VP-REG. PATIENT CARE & CNO 2.00 50.00 X 0 259724 13384 MEDHAT FANOUS PHYSICIAN 40.00 X 0 687874 40148 ALBERT PENNEY PHYSICIAN 40.00 X 0 464558 23691 TAKI RIDA PHYSICIAN 40.00 X 0 360772 49298 SHIRIN SULTANA PHYSICIAN 40.00 X 0 316688 56910 DONALD PATTON PHYSICIAN 40.00 X 0 244072 34295 136910 14868628 2040821 8 0 1 0 INNOVA EMERGENCY SERVICES 700 N COLORADO BLVD SUITE 109 DENVER CO 80206 EMERGENCY DEPT PROVIDERS 2340179 RENOVO SOLUTIONS LLC 4 EXECUTIVE CIRCLE SUITE 185 IRVINE CA 92614 EQUIPMENT PREVENTATIVE MAINTENANCE 484037 ORTHOPEDIC SOLUTIONS N10565 GRANDVIEW LN IRONWOOD MI 49938 LOCUM DOCTOR 394796 TELEHEALTH SOLUTIONS PLLC PO BOX 1813 SPARTANBURG SC 29304 ELECTRONIC MEDICAL SERVICES 350070 JOHN MAESAKA MD 15730 CTY RD 28 GOSHEN IN 46528 LOCUM DOCTOR 336475 9 1213381 2361 1215742 PATIENT SERVICE REVENUE 621110 36447718 36447718 PHARMACY REVENUE 456110 616041 616041 CONTRACT SERVICE REVENUE 621110 70885 70885 590157 590157 37724801 66274 66274 81564 0 81564 81564 81564 2823 -2823 -2823 -2823 CAFETERIA SALES 621990 69666 69666 69666 39155224 37724801 0 214681 X 5192 5192 116446 116446 12936355 10765741 2170614 445354 273349 172005 1901305 1533331 367974 842206 682895 159311 117104 117104 4076 4076 1538 1538 6213372 5952704 260668 5945 251 5694 45285 20661 24624 28047 15233 12814 522121 59862 462259 81277 56740 24537 686895 119 686776 1993702 647100 1346602 265482 61773 203709 CORPORATE ALLOCATIONS 6189170 1130975 5058195 MEDICAL SUPPLIES 5494859 5474022 20837 HOSPITAL TAX 960929 960929 BAD DEBT EXPENSE 897746 897746 1271181 858085 413096 41025587 27538033 13487554 0 1293166 3040393 148920 150847 5398271 5500879 819977 824680 473906 427252 48769399 30109212 19793508 18660187 6736356 413683 34664104 29017921 2096701 1735012 649154 0 16442997 15915000 8221390 2974053 27410242 20624065 X 7253862 8393856 7253862 8393856 34664104 29017921 X -1870363 3576 3006781 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 4076 4076 0 PART II-B, LINE 1: MEMBERSHIP DUES ARE PAID TO THE MICHIGAN HOSPITAL ASSOCIATION (MHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). A PORTION OF THOSE DUES ARE COMMITTED TO LOBBYING PURPOSES. MHA INVOICE STATES 9.97% OF $10,435 ($1,040) GOES FOR LOBBYING ON INVOICE COVERING THE PERIOD OF 7/1/22-6/30/23. SIMILARLY, AHA DUES COMMITTED TO LOBBYING WAS 27.29% OF $11,126 ($3,036). 210026 210026 35241887 19727164 15514723 13043425 10272350 2771075 274061 109698 164363 18660187 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2658043 MEDICARE REFUNDABLE ADVANCES -24042 FINANCE LEASE LIABILITY 59068 DEFERRED COMPENSATION 13780 OPERATING LEASE LIABILITY 5497 LONG TERM PENSION 251077 DEFERRED POSTRETIREMENT BENEFITS 10630 2974053 X PART X, LINE 2: ASPIRUS HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND CONCLUDED THAT NO MATERIAL LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS AT JUNE 30, 2023. 1 1 X 1 X 1 X 1 1 0 1 1 209067 209067 0.00520 8343139 6238495 2104644 0.05240 8552206 6238495 2313711 0.05760 1864 1864 0.00000 5100 5100 0.00010 3513767 3079618 434149 0.01080 1600 1600 0.00000 3522331 3079618 442713 0.01090 12074537 9318113 2756424 0.06850 1 347355 0 8487903 8539434 -51531 X 1 1 1 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 WWW.ASPIRUS.ORG 1060000150 X X X X ASPIRUS IRON RIVER HOSPITAL & CLINICS I 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS X 1 21 1 WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: THE FOLLOWING DESCRIPTION IS FOR THE CHNA COMPLETED IN FY22 (SPRING 2022). THROUGHOUT THE PLANNING AND PRODUCTION OF THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT, A STEERING COMMITTEE OF COMMUNITY LEADERS AND SUBJECT MATTER EXPERTS MET REGULARLY TO DIRECT THE REPORTING PROCESS, WHICH INCLUDED THE CREATION AND DISTRIBUTION OF A SURVEY TO A RANDOM SELECTION OF RESIDENTS. FOR ASPIRUS IRON RIVER, THIS INCLUDES INPUT FROM THE WESTERN UPPER PENINSULA HEALTH DEPARTMENT AS WELL AS OTHER ASPIRUS UP HOSPITALS. REPRESENTATIVES FROM EACH ORGANIZATION COMMUNICATED IN REGULAR MEETINGS. THE KEY DATA ELEMENT IN THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT IS THE COMMUNITY SURVEY, WHICH IDENTIFIED IMPORTANT ISSUES REGARDING QUALITY OF LIFE THAT HAD NOT BEEN MEASURED BEFORE THE SURVEY WAS CONDUCTED. THE SURVEY WAS MAILED TO THOUSANDS OF HOUSEHOLDS ACROSS THE ENTIRE UPPER PENINSULA, WITH NEARLY 5,000 RESPONSES BACK FROM RESIDENTS. THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT ALSO INCLUDES A SIGNIFICANT AMOUNT OF DATA INDICATORS ACROSS MULTIPLE CATEGORIES RELATING TO HEALTH AND HEALTH FACTORS. THIS DATA WAS COMPILED FROM A WIDE ARRAY OF PUBLISHED SOURCES AND FROM HEALTH CARE PROVIDERS. PUBLISHED SOURCES INCLUDED THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, AND STATISTICS COMPILED BY THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH AND OTHER GOVERNMENT AND PRIVATE AGENCIES. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: FOR THE CHNA COMPLETED IN FY22 (SPRING 2022), THE HOSPITAL COLLABORATED WITH ASPIRUS KEWEENAW HOSPITAL, ASPIRUS IRONWOOD HOSPITAL AND ASPIRUS ONTONAGON HOSPITAL. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6B: FOR THE CHNA COMPLETED IN FY22 (SPRING 2022), ASPIRUS IRON RIVER HOSPITAL COLLABORATED WITH THE WESTERN UPPER PENINSULA HEALTH DEPARTMENT. ASPIRUS IRON RIVER HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS IRON RIVER HOSPITAL. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: IN FY23, ASPIRUS HEALTH CONTINUED TO COME TOGETHER AS A SYSTEM. THE ADDITION OF SEVEN HOSPITALS IN FY22 RESULTED IN CHANGES IN PROCESSES, TEAM STRUCTURE AND RELATED IMPACTS. ASPIRUS HEALTH IS WORKING TO STRATEGICALLY BUILD STRONG, EFFECTIVE COMMUNITY HEALTH EFFORTS THAT MEET LOCAL NEEDS WHILE ACCOMMODATING ECONOMIC AND OTHER PRESSURES FACING HEALTH SYSTEMS. ASPIRUS IRON RIVER HOSPITAL IS ONE OF FOUR ASPIRUS HOSPITALS IN THE UPPER PENINSULA OF MICHIGAN. THE AREA IS VERY RURAL. ASPIRUS IRON RIVER IMPLEMENTED STRATEGIES LOCALLY AND REGIONALLY, WITH THE HELP OF STAFF MEMBERS, BUT ALSO PARTNERING WITH OTHERS IN THE COMMUNITY. THE HOSPITAL'S SIGNIFICANT NEEDS ARE: MENTAL HEALTH; SUBSTANCE USE; CHRONIC DISEASES. MENTAL HEALTH: ASPIRUS IRON RIVER HOSPITAL STAFF PARTICIPATED IN A PARENTING EXPO/FAIR, PROVIDING HEALTH AND WELL-BEING INFORMATION AND MATERIALS TO OVER 40 PEOPLE. SUBSTANCE USE: THE ASPIRUS IRON RIVER HOSPITAL AND CLINICS PROVIDES ACCESS TO ADDICTION-RELATED TREATMENT, INCLUDING SUBOXONE. THE HOSPITAL FACILITATES REFERRALS TO LOCAL NON-PROFIT BEHAVIORAL HEALTH SERVICES ORGANIZATIONS FOR PATIENTS WITH SIGNIFICANT MENTAL HEALTH AND SUBSTANCE USE ISSUES. CHRONIC DISEASE: ASPIRUS IRON RIVER HOSPITAL STAFF FACILITATED A MONTHLY DIABETES SUPPORT GROUP. THE GROUP STARTED IN FEBRUARY 2023. FIVE PEOPLE PARTICIPATED. OVERALL/OTHER: THE HOSPITAL PROVIDED FUNDING TO THE MICHIGAN TRANSPORTATION CONNECTION TO INCREASE THE ACCESSIBILITY OF MEDICAL TREATMENT AND OTHER SERVICES FOR MICHIGAN RESIDENTS. THE HOSPITAL CONTRIBUTED FUNDS TO THE SUPERIOR HEALTH FOUNDATION. THE SUPERIOR HEALTH FOUNDATION'S MISSION IS 'TO ASSIST WITH UNMET HEALTHCARE NEEDS, WITH HEALTH EDUCATION, AND WITH PROGRAMS AND RESEARCH ON PREVENTING ILLNESS AND PROMOTING HEALTH IN THE UPPER PENINSULA.'- - - - - - - - - - - - - - - FROM THE COMMUNITY SURVEY, THE TOP-SELECTED ISSUES WERE: - HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES- DRUG ABUSE- LACK OF HEALTH INSURANCE- UNEMPLOYMENT, WAGES AND ECONOMIC CONDITIONSFROM THIS LIST, THE HOSPITAL IS ADDRESSING DRUG ABUSE (SUBSTANCE USE). THE OTHER THREE ISSUES WERE NOT SELECTED FOR THE FOLLOWING REASONS. - THE LACK OF AFFORDABLE HEALTH INSURANCE IS OF HIGH CONCERN FOR MANY PEOPLE IN THE UPPER PENINSULA. ASPIRUS PROVIDES FINANCIAL ASSISTANCE FOR PATIENTS WHO STRUGGLE TO AFFORD CARE. ASPIRUS HOSPITALS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE THE AVAILABILITY AND THE AFFORDABILITY OF HEALTH INSURANCE, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. - UNEMPLOYMENT, WAGES AND ECONOMIC CONDITIONS ARE IMPORTANT ISSUES FOR ASPIRUS. ASPIRUS WORKS TO PAY FAIR WAGES AND PROVIDE REASONABLE BENEFITS PACKAGES. ASPIRUS HOSPITALS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE ECONOMIC CONDITIONS, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 2 1 - ASPIRUS IRON RIVER CLINIC 814 S ICE LAKE ROAD IRON RIVER MI 49935 PHYSICIAN PRACTICES, REHAB AND OUTPATIENT CLINIC 2 - CRYSTAL FALLS CLINIC 1328 US HWY 2 CRYSTAL FALLS MI 49920 FAMILY PRACTICE PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF THE FOLLOWING (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY): PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200% EQUITY ALLOWANCE IS $75,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G., DAIRY FARM) IS EVALUATED INDIVIDUALLY ON A CASE-BY-CASE BASIS. CASH ASSETS IN EXCESS OF $4,000 AT THE TIME OF APPLICATION (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY). SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS WHERE RETIREMENT WITHDRAWALS HAVE NOT BEGUN AND IRREVOCABLE BURIAL TRUST FUNDS. TOTAL NET ASSETS CANNOT EXCEED 800% OF FEDERAL POVERTY GUIDELINES. THIS INCLUDES ALL ASSETS INCLUDING CASH ASSETS ABOVE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990, SCHEDULE H IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR FORM 990. PART I, LINE 7G: THE ABOVE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE EMERGENCY DEPARTMENT. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. THE EMERGENCY DEPARTMENT REPORTED COSTS OF $3,513,767 WITH OFFSETTING REVENUE OF $3,079,618. PART I, LN 7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $897,746 WAS EXCLUDED FROM THE DENOMINATOR. PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLES ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES. THE COSTING METHODOLOGY USED WAS THE PATIENT CARE COST TO CHARGE RATIO WHICH WAS DERIVED FROM THE CALCULATION ON IRS WORKSHEET 2. PART III, LINE 3: THE ORGANIZATION 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 PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLES ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES.BAD DEBT POLICY AND PROCEDURE:POLICY: I. ASPIRUS' FINANCIAL POLICY REQUIRES SETTLEMENT OF A PATIENT SELF-PAY BILL OR ACCOUNT WILL BE REFERRED FOR OUTSIDE COLLECTION. II. FAILURE TO MEET THESE REQUIREMENTS IN ASPIRUS POLICY WILL RESULT IN THE ACCOUNT BEING CONSIDERED FOR BAD DEBT ONCE ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. THE ACCOUNT WILL BE REMOVED FROM ACCOUNTS RECEIVABLE AND TURNED OVER TO AN OUTSIDE AGENCY OR LAW FIRM FOR COLLECTION. PRIOR TO THIS HAPPENING, THE FOLLOWING CRITERIA MUST BE MET: A. PATIENT FINANCIAL SERVICES STAFF WILL MAKE REASONABLE COLLECTION EFFORTS BY WAY OF: 1. MONTHLY STATEMENTS 2. COLLECTION LETTERS INCLUDING PLAIN LANGUAGE SUMMARY (PLS) 3. COLLECTION PHONE CALLS 4. VERIFICATION THAT CHARITY CARE WAS OFFERED WITHIN THE PAST 12-MONTHS AS RECORDED IN THE ELECTRONIC HEALTH RECORD (EMR) WITH STAFF HAVING THE DISCRETION TO OFFER AGAIN WITHIN THE 12-MONTHS. III. ALL COLLECTION ACTIVITY AND PATIENT CONTACTS WILL BE DOCUMENTED ON THE INDIVIDUAL ACCOUNTS. IV. ALL COLLECTION ACCOUNTS ARE TO BE TREATED THE SAME REGARDLESS OF PAYOR TYPE: SELF-PAY, GENERAL INSURANCE, MEDICARE, OR MEDICAL ASSISTANCE. V. PATIENT FINANCIAL SERVICES STAFF WILL USE SOUND BUSINESS JUDGMENT WHEN WORKING WITH THE ACCOUNT. AT THE DISCRETION OF THE FINANCIAL COUNSELOR, CREDIT REPORTS WILL BE REQUESTED FROM THE CREDIT BUREAU AND PROPERTY VERIFICATION OBTAINED THROUGH THE COUNTY TREASURER'S OFFICE. PROCEDURE: VI. THE FINAL STEP IS TO SUBMIT THE ACCOUNT TO A COLLECTION AGENCY OR LAW FIRM. EACH ACCOUNT IS REVIEWED TO DETERMINE IF THE ACCOUNT HAS MET THE BAD DEBT CRITERIA. ONCE IT HAS BEEN DETERMINED THAT ALL REQUIREMENTS HAVE BEEN MET, THE ACCOUNT IS TRANSFERRED FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY THE FINANCIAL COUNSELOR. SPECIFIC PROCEDURES PERTAINING TO THE DETAILED PROCEDURAL STEPS FOR TRANSFERRING TO THE AGENCY CAN BE FOUND IN THE INTERNAL POLICY. A. ADDITIONAL INFORMATION REGARDING MEDICARE BAD DEBTS: 1. THE DEBT MUST BE RELATED TO COVERED SERVICES AND DERIVED FROM DEDUCTIBLE AND COINSURANCE AMOUNTS. 2. THE HOSPITAL MUST PROVIDE REASONABLE COLLECTION EFFORTS. 3. THE DEBT IS NOT COLLECTABLE (AT LEAST 120 DAYS OUTSTANDING FROM THE DATE OF THE LAST PATIENT PAYMENT.) 4. SOUND BUSINESS JUDGMENT ESTABLISHES THAT THERE WAS NO LIKELIHOOD OF RECOVERY AT ANY TIME IN THE FUTURE. B. BAD DEBT RECOVERIES 1. PAYMENTS ON MONTHLY REMITTANCE ADVICES FROM OUTSIDE COLLECTION AGENCIES WILL BE POSTED TO EACH INDIVIDUAL ACCOUNT. 2. PAYMENTS MADE DIRECTLY TO ASPIRUS BUT INTENDED FOR COLLECTION ACCOUNTS WILL BE POSTED TO THE APPROPRIATE ACCOUNT AND REPORTED DAILY/WEEKLY TO COLLECTION AGENCIES FOR RECONCILIATION OF THEIR RECORDS. 3. INVOICES FOR COMMISSIONS DUE TO COLLECTION AGENCIES WILL BE PROCESSED MONTHLY. INVOICE AND REMITTANCE ADVICE WILL BE REVIEWED BY THE FINANCIAL COUNSELOR TEAM LEAD AND APPROVED BY THE MANAGER/DIRECTOR, THEN SUBMITTED TO FISCAL SERVICES FOR CHECK PROCESSING AND PAYMENT TO AGENCIES FOR COMMISSIONS DUE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULES AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND SURGICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND THEREFORE THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2023 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: PATIENT FINANCIAL SERVICES (PFS) PROACTIVELY IDENTIFIES UNINSURED PATIENTS AND UNDER-INSURED PATIENTS AND SCREENS THEM FOR FINANCIAL ASSISTANCE AND COUNSELING WITHOUT REGARD TO RACE, ETHNICITY, GENDER, RELIGION, OR NATIONAL ORIGIN. THESE SERVICES ARE PROVIDED AT NO CHARGE. PFS COUNSELORS WORK WITH UNINSURED AND UNDER-INSURED PATIENTS TO HELP THEM UNDERSTAND THE SYSTEM'S FINANCIAL ASSISTANCE/DISCOUNTING POLICIES AND HOW THEY CAN QUALIFY FOR ASSISTANCE AND/OR DISCOUNTS INCLUDING A REFERRAL TO PUBLIC AND PRIVATE PROGRAMS TO DETERMINE ELIGIBILITY. PART VI, LINE 2: IN ADDITION TO ASSESSING NEEDS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL:- SYSTEMATICALLY REVIEWS PATIENT EXPERIENCE DATA TO UNDERSTAND OPPORTUNITIES TO ADDRESS PATIENT CONCERNS. - MAINTAINS AN INVOLVED LOCAL / REGIONAL BOARD OF DIRECTORS, WHICH MEETS NEARLY MONTHLY. HOSPITAL BOARD MEMBERS ARE FROM MULTIPLE SECTORS, INCLUDING ACADEMIC, LAW AND MEDICAL FIELDS.- SUPPORTS ITS STAFF IN PARTICIPATING ON COMMUNITY BOARDS AND COMMITTEES THAT PROVIDE INSIGHT ON LOCAL CIRCUMSTANCES.- REVIEWS FUNDING REQUESTS TO THE HOSPITAL (AND THE LOCAL HEALTH FOUNDATION) AS AN INDICATOR OF LOCAL NEEDS.- INITIATED A SOCIAL NEEDS SCREENING PROCESS THAT, OVER TIME, WILL PROVIDE INSIGHT INTO PATIENT NEEDS IN ADDITION TO THEIR IMMEDIATE CARE. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATION AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. IF ASPIRUS FINANCIAL COUNSELORS NOTICE THE PATIENT HAS NOT BEEN OFFERED AN APPLICATION WITHIN THE PAST YEAR, THEY WILL ALSO ASK IF THE PATIENT WOULD LIKE ONE MAILED OR IF THE PATIENT SHOWS FINANCIAL DISTRESS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS, WHEN APPLICABLE. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. ELEVATE PFS (CONTRACTED ENTITY) IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: ASPIRUS IRON RIVER HOSPITAL IS ONE OF FOUR ASPIRUS SYSTEM HOSPITALS IN A 5-COUNTY RURAL REGION OF THE UPPER PENINSULA OF MICHIGAN. THE 5-COUNTY REGION INCLUDES HOUGHTON, KEWEENAW, ONTONAGON, IRON AND GOGEBIC COUNTIES. ASPIRUS IRON RIVER HOSPITAL IS LOCATED IN IRON COUNTY. IRON COUNTY COVERS 1166 SQUARE MILES, WITH 10.1 PEOPLE PER SQUARE MILE AND AN OVERALL POPULATION OF 11,635 PEOPLE. HERE ARE SOME DETAILS ABOUT ITS POPULATION: PERSONS UNDER AGE 18: 16.8%PERSONS 65 YEARS AND OVER: 31.2%WHITE PERSONS: 95.8%AFRICAN AMERICAN PERSONS: 0.4%AMERICAN INDIAN PERSONS: 1.6%ASIAN PERSONS: 0.5%TWO OR MORE RACES: 1.7%HISPANIC OR LATINO: 2.4%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 1.7%ADULTS AGES 25 AND OVER WITH A HIGH SCHOOL DIPLOMA OR EQUIVALENT: 92.1% PERSONS IN POVERTY: 14.2%MEDIAN HOUSEHOLD INCOME: $44,183 PERCENT UNINSURED: 8%PERCENT USING PUBLIC INSURANCE (MEDICAID, MEDICARE, VETERANS BENEFITS, ETC.): 53.2% NUMBER OF HOSPITALS IN THE COUNTY: 1 (ONLY ASPIRUS) THE COUNTY IS A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY CARE, MENTAL HEALTH AND DENTAL HEALTH. THE COUNTY IS ALSO DESIGNATED AS MEDICALLY UNDERSERVED. PART VI, LINE 5: THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH ITS COMMUNITY HEALTH AND COMMUNITY BENEFIT WORK. ADDITIONALLY, THE HOSPITAL: - MAINTAINS A REGIONAL BOARD OF DIRECTORS THAT REFLECTS THE COMMUNITY AND THE REGION. - BRINGS ITS EXPERTISE INTO THE COMMUNITY THROUGH PROGRAMS, SCREENINGS, AND COMMUNITY BOARD AND ADVISORY COMMITTEE MEMBERSHIP.- PROVIDES HIGH QUALITY SERVICES AND IMPLEMENTS ONGOING QUALITY IMPROVEMENT INITIATIVES. - BUDGETS FOR CUTTING EDGE TECHNOLOGIES AND EQUIPMENT THAT SUPPORT PATIENT HEALTH.- OFFERS RESOURCES AND/OR REFERRALS FOR TRANSPORTATION ASSISTANCE FOR PATIENTS AS APPROPRIATE. - PROVIDES PRECEPTORS FOR HEALTH PROFESSIONS STUDENTS-IN-TRAINING, WHICH ADVANCES THE HEALTH CARE WORKFORCE. - HOSTS ON-SITE BLOOD DRIVES. AS PART OF A LARGER NETWORK OF ASPIRUS HEALTHCARE FACILITIES, THE HOSPITAL HAS ACCESS TO: - LOW-COST TEMPORARY LODGING AT ASPIRUS' FLAGSHIP TERTIARY CARE HOSPITAL PARTNER (IN WAUSAU, WI) SO THAT PATIENTS AND/OR THEIR FAMILY NEEDING EXTENDED SPECIALTY CARE HAVE ACCOMMODATIONS. - PROFESSIONAL DEVELOPMENT FOR STAFF, ASSURING THE CARE PROVIDED INCORPORATES THE MOST UP-TO-DATE BEST PRACTICES. - CROSS-TRAINING OPPORTUNITIES. FOR INSTANCE, A WAUSAU-BASED BEREAVEMENT COORDINATOR TRAINS STAFF ACROSS THE SYSTEM ON NORMAL GRIEF RESPONSE, RESILIENCE AND HOSPICE CARE AND SUPPORT. THE COORDINATOR TRAINS THROUGH THE NURSE RESIDENCY PROGRAM AS WELL AS IN UNIT/DEPARTMENT MEETINGS. UNIT/DEPARTMENT LEADERS CAN REQUEST BEREAVEMENT INFORMATION AND SUPPORT FOR THEIR TEAM. SIMILARLY, HOSPITALS HAVE ACCESS TO INJURY PREVENTION EXPERTISE AND RESOURCES THROUGH THE LEVEL 2 TRAUMA CENTER IN WAUSAU. - A MARKETING/COMMUNICATIONS TEAM THAT SUPPORTS THE ONLINE ASPIRUS MEDIA CENTER FEATURING MEDICAL EXPERTS. THE TEAM DEVELOPS AND PROMOTES HEALTH EDUCATION INFORMATION (E.G., ON DIABETES, TICK BITES, SNOWMOBILE SAFETY) FOR PATIENTS AND THE GENERAL PUBLIC. PART VI, LINE 6: ASPIRUS HEALTH IS A NON-PROFIT, COMMUNITY-DIRECTED HEALTHCARE SYSTEM BASED IN WAUSAU, WISCONSIN. ITS 11,000 EMPLOYEES ARE FOCUSED ON IMPROVING THE HEALTH AND WELL-BEING OF PEOPLE THROUGHOUT WISCONSIN AND UPPER MICHIGAN. ASPIRUS SERVES COMMUNITIES THROUGH FOUR HOSPITALS IN MICHIGAN AND 13 HOSPITALS IN WISCONSIN, 75 CLINICS, HOME HEALTH AND HOSPICE CARE, PHARMACIES, CRITICAL CARE AND AIR-MEDICAL TRANSPORT, MEDICAL GOODS, NURSING HOMES AND A BROAD NETWORK OF PHYSICIANS. THE COMBINED EFFORTS ARE ABLE TO PROVIDE SMALLER COMMUNITIES WITH THE ACCESS TO CARE THAT THEY MAY NOT OTHERWISE BE ABLE TO HAVE. FOR MORE INFORMATION, VISIT ASPIRUS.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES MI 0 1 0 0 0 0 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 1228335 0 567185 0 4418 0 18619 0 292491 0 2111048 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 649845 0 1057600 0 204019 0 20794 0 123324 0 2055582 0 195109 JOHN PIETILA BOARD MEMBER/RADIOLOGIST 0 845370 0 26000 0 5369 0 20519 0 36747 0 934005 0 0 JESSE TISCHER BOARD MEMBER/SVP & PRES. REG. MKTS 0 580082 0 150199 0 51294 0 18561 0 110034 0 910170 0 50242 DANIEL J LUKES DO BOARD MEMBER/PHYSICIAN 0 795483 0 0 0 7322 0 17894 0 28342 0 849041 0 0 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 0 479018 0 135622 0 58276 0 18672 0 105004 0 796592 0 55822 JENNIFER REDMAN-SCHELL VICE CHAIR/SVP & PRESIDENT-AMG 0 490009 0 148789 0 2350 0 17929 0 83797 0 742874 0 0 MEDHAT FANOUS PHYSICIAN 0 682136 0 0 0 5738 0 2736 0 37412 0 728022 0 0 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 0 386985 0 110566 0 41850 0 17683 0 93210 0 650294 0 32339 TODD RICHARDSON SVP & CHIEF INFO. OFF. (THRU 06/23) 0 378807 0 112026 0 44035 0 18079 0 86359 0 639306 0 39964 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 0 399954 0 117991 0 1981 0 17740 0 89103 0 626769 0 0 CONSTANCE BRADLEY SVP-SYSTEM CHIEF NURSING EXECUTIVE 0 385875 0 113420 0 2737 0 16421 0 79129 0 597582 0 0 CHRISTINE HARFF (NV) PRESIDENT - REGIONAL UP 0 338109 0 82831 0 38482 0 19524 0 83733 0 562679 0 34464 DEBRA BALL SVP & CHIEF HR OFFICER 0 349805 0 106987 0 2047 0 13179 0 90374 0 562392 0 0 JONATHAN N BRUEGGEMAN BOARD MEMBER/CMO-UP REGION 0 410123 0 39958 0 558 0 17584 0 38218 0 506441 0 0 ALBERT PENNEY PHYSICIAN 0 423316 0 35000 0 6242 0 8744 0 14947 0 488249 0 0 TAKI RIDA PHYSICIAN 0 325340 0 30000 0 5432 0 14843 0 34455 0 410070 0 0 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 0 291308 0 56573 0 562 0 12036 0 36682 0 397161 0 0 PATRICK TINCHER JR BOARD MEMBER/VP FINANCE REGIONAL OPS 0 278727 0 49894 0 7854 0 18549 0 37972 0 392996 0 0 SHIRIN SULTANA PHYSICIAN 0 271156 0 40000 0 5532 0 21267 0 35643 0 373598 0 0 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 0 267466 0 51102 0 2548 0 18436 0 30991 0 370543 0 0 SCOTT REMMICH VP-CHIEF COMPLIANCE OFFICER 0 251612 0 49272 0 3609 0 17778 0 27558 0 349829 0 0 ANDREW COSTIC VP-FINANCE UP REGION 0 232506 0 37668 0 2527 0 16343 0 7931 0 296975 0 0 DONALD PATTON PHYSICIAN 0 234494 0 0 0 9578 0 6872 0 27423 0 278367 0 0 MARGUERITE HALE VP-REG. PATIENT CARE & CNO 0 219694 0 34131 0 5899 0 11717 0 1667 0 273108 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRON RIVER HOSPITAL & CLINIC, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $195,109 C. HARFF $34,464 J. TISCHER $50,242 J. MATHESON $32,339 M. HOLZHUETER $55,822 T. RICHARDSON $39,964 KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31ST. EMPLOYER CONTRIBUTIONS: THE CONTRIBUTION MADE BY THE EMPLOYER IS A THREE-TIERED STRUCTURE DEPENDING UPON THE EXECUTIVE'S POSITION, WHICH ARE AS FOLLOWS: 13% FOR SENIOR VICE PRESIDENT OR PRESIDENT, 15% FOR SVP & CHIEF FINANCIAL OFFICER, AND 20% FOR THE PRESIDENT & CHIEF EXECUTIVE OFFICER. IF A PARTICIPANT TERMINATES DURING THE YEAR, THE PARTICIPANT'S EXECUTIVE ALLOWANCE IS PRORATED BASED ON THE NUMBER OF FULL CALENDAR MONTHS FROM THE BEGINNING OF THE PLAN YEAR TO THE BEGINNING OF THE CALENDAR YEAR MONTH CLOSEST TO THE CHANGE OR TERMINATION OF EMPLOYMENT. DISTRIBUTIONS: CONTINUATION OF EMPLOYMENT THROUGH THE DEFERRED VESTING DATE; THE DATE ON WHICH THE PARTICIPANT'S EMPLOYMENT IS TERMINATED AS A RESULT OF DEATH OR DISABILITY; 24 MONTHS FROM THE DATE ON WHICH THE PARTICIPANT INCURS AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE OR THE DATE THAT IS 24 MONTHS FOLLOWING THE PARTICIPANT'S SEPARATION FROM SERVICE, BUT ONLY IF THE PARTICIPANT'S INTEREST HAS NOT BEEN FORFEITED FOR COMPETITION DURING SUCH 24 MONTH PERIOD AND THE PARTICIPANT HAS NOT ENGAGED IN COMPETITION AFTER HIS OR HER SEPARATION FROM SERVICE AND PRIOR TO HIS OR HER DEATH, THE PARTICIPANT SHALL BE VESTED AT HIS OR HER DATE OF DEATH. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 463003AA1 2015-05-07 19765185 REFUND 2008 ISSUE 0 0 0 A 485000 19765185 119333 19645852 2010 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 1 A 1 PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2015 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. (EIN 38-3236977); AND ASPIRUS KEWEENAW HOSPITAL (EIN 38-1443361). INFORMATION REGARDING THE SERIES 2015 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2015 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2015 BONDS.] PART III, LINES 3A AND 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. PART III, LINE 9 SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES THAT WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. DONALD PATTON MD DONALD PATTON AND KRISTEN MESKE (BOARD MEMBER) HAVE A FAMILY RELATIONSHIP 278368 PAYROLL 0 FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THERE SHALL BE A MINIMUM OF 9 VOTING DIRECTORS ALLOCATED AS FOLLOWS. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN FOUR INDEPENDENT COMMUNITY CLASS DIRECTORS, THREE ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTOR NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE DIRECTORS OF THE ORGANIZATION: 1) CHANGE OR AMEND THE ARTICLES OF INCORPORATION OR BYLAWS; 2) CHANGE THE MISSION, PURPOSE, OR SCOPE OF THE CORPORATION; 3) RATIFICATION OR REMOVAL OF DIRECTORS OR OFFICERS; 4) CHANGE THE FORMULA OR METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION; 5) APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS, STRATEGIC AND LONG-RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 INFORMATION. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS THEN REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND ARE MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH DIRECTOR'S DESK OR OTHER MEANS OF ELECTRONIC RETRIEVAL. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, BOARD MEMBERS ARE REQUIRED TO DISCLOSE CONFLICTS TO THE BOARD. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS. AN INTERESTED PERSON IS A DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST. AFTER DISCLOSURE, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING MEMBERS SHALL DECIDE IF A CONFLICT EXISTS. THE MEMBER WILL ABSTAIN FROM VOTING ON THIS ISSUE IF A CONFLICT OF INTEREST IS DISCOVERED. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CHIEF ADMINISTRATIVE OFFICER, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS DEEMED THAT ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,042,659. MANAGEMENT AND GENERAL EXPENSES 260,668. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,303,327. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 514,006. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 514,006. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 260,925. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 260,925. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,135,114. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,135,114. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS - AWH 159,402. INTERCOMPANY TRANSFERS - ASH 159. INTERCOMPANY TRANSFERS - HYMC -232. INTERCOMPANY TRANSFERS - AI 2,553,049. INTERCOMPANY TRANSFERS - ACI 563,127. INTERCOMPANY TRANSFERS - AOH -92,644. INTERCOMPANY TRANSFERS - VNA -20,959. INTERCOMPANY TRANSFERS - AIW -55,883. INTERCOMPANY TRANSFERS - ARH 2,375. INTERCOMPANY TRANSFERS - ADS 201. INTERCOMPANY TRANSFERS - AKH -98,796. INTERCOMPANY TRANSFERS - ASP 2,427. INTERCOMPANY TRANSFERS - ARN -4,472. INTERCOMPANY TRANSFERS - AMH -973. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE WI 501 (C) 3 LINE 12B, II N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 333 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS MEDICAL GROUP INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS ONTONAGON HOSPITAL INC 601 SEVENTH STREET ONTONAGON MI 49953 260806477 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTH CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS VNA HOME HEALTH INC 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTGAGE WI 53901 390806250 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD HOSPITAL & CLINICS INC 135 S GIBSON STREET MEDFORD WI 54451 390964813 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD FOUNDATION INC 135 S GIBSON STREET MEDFORD WI 54451 391777081 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL & CLINICS INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 390808443 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL FOUNDATION INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 391657410 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS STANLEY HOSPITAL & CLINICS INC 1120 PINE STREET STANLEY WI 54768 390807065 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL & CLINICS INC 601 S CENTER AVENUE MERRILL WI 54452 390808503 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL FOUNDATION INC 601 S CENTER AVENUE MERRILL WI 54452 391627755 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS INC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391390638 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS EAGLE RIVER HOSPITAL & CLINICS INC 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 THE HOWARD YOUNG MEDICAL CENTER INC 240 MAPLE STREET WOODRUFF WI 54568 390873606 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 HOWARD YOUNG HEALTH CARE INC 240 MAPLE STREET WOODRUFF WI 54568 391499115 HEALTHCARE WI 501 (C) 3 LINE 12B, II ASPIRUS INC 1 ASPIRUS MEDICAL GROUP - NORTHERN WISCONSIN 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391965593 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI N/A 0 0 THE WESTWOOD CONFERENCE CENTER LLC 333 PINE RIDGE BLVD WAUSAU WI 54401 571184256 REAL ESTATE INVESTMENT WI N/A 0 0 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 ASPIRUS HEALTH VENTURES 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 1 ASPIRUS CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 842513742 ASSOCIATION WI N/A C 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 ASPIRUS INC C 6321808 COST ASPIRUS INC M 6217620 COST ASPIRUS INC O 15755161 COST ASPIRUS INC P 20976617 COST ASPIRUS INC S 7205504 COST ASPIRUS WAUSAU HOSPITAL INC O 153800 COST ASPIRUS WAUSAU HOSPITAL INC P 109962 COST ASPIRUS WAUSAU HOSPITAL INC Q 86275 COST ASPIRUS MEDICAL GROUP INC O 577651 COST ASPIRUS KEWEENAW HOSPITAL O 267534 COST ASPIRUS KEWEENAW HOSPITAL Q 146832 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC R 56825 COST