2024-02-09T13:44:30-06:00 2023-03-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156352111 1280 CHANDLER DRIVE SPOONER WI 54801 MICHAEL D SCHAFER CHIEF EXECUTIVE OFFICER 7156352111 2024-02-09 1 MICHAEL SCHAFER 999009999 0 MACKENZIE MCNAUGHTON P02025805 6123764500 2024-01-31 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MICHAEL D SCHAFER 1280 CHANDLER DRIVE SPOONER WI 54801 34419462 0 X WWW.SPOONERHEALTH.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 7 7 173 35 0 0 930328 645510 26959179 30686261 1199051 1033881 119700 179898 29208258 32545550 8000 5000 0 0 12066273 12673838 0 0 0 15779110 18538419 27853383 31217257 1354875 1328293 66862131 63107255 24139182 21474759 42722949 41632496 TO PROVIDE HIGH QUALITY HEALTHCARE. 0 0 25953510 5000 30294596 SPOONER HEALTH SYSTEM IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, REHABILITATION, DIAGNOSTIC, HOSPICE AND WOUND CARE. FOR THE FISCAL YEAR ENDING 3/31/2023, THERE WERE 2,105 INPATIENT DAYS, 375 INPATIENT DISCHARGES, 23,847 OUTPATIENT VISITS, 7,151 EMERGENCY ROOM VISITS, AND 441 SURGERIES ALONG WITH 649 SCOPE PROCEDURES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS SUCH AS MEDICARE AND MEDICAID AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM, WHICH INCLUDES FEE DISCOUNTS AS WELL AS 100% FREE CARE, IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES. 635779 0 391665 THE HOME HEALTH AGENCY PROVIDES ESSENTIAL NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/2023, THERE WERE 2,386 HOME HEALTH VISITS SERVING 282 PATIENTS, 102 ADMITTED CASES, AND 103 DISCHARGED CASES. 26589289 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 23 0 1 173 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X REBECCA BUSCH CFO 7159391732 1280 CHANDLER DR SPOONER WI 54801 JAMIE MORALES BOARD PRESIDENT 1.00 X X 0 0 0 TIM REEDY BOARD VICE PRESIDENT 1.00 X X 0 0 0 NICOLE TIMS BOARD TREASURER 1.00 X X 0 0 0 MARK VAN ETTEN MD BOARD SECRETARY 1.00 X X 0 0 0 MARK REUTER MD MEDICAL DIRECTOR 1.00 X 0 0 0 BRIAN GASKILL DO BOARD MEMBER/CHIEF OF STAFF 1.00 X 0 0 0 MATT THOMPSON BOARD MEMBER 1.00 X 0 0 0 SUE CHURCHILL BOARD MEMBER 1.00 X 0 0 0 REBECCA BUSCH CHIEF FINANCIAL OFFICER 40.00 X 170088 0 28205 MICHAEL SCHAFER CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 PHILIP MOFLE MD SURGERY MEDICAL DIRECTOR 40.00 X 345426 0 40052 TAMARA DANIELS MD E.D. MEDICAL DIRECTOR 23.00 X 229610 0 0 JOHN BERLIN APNP HOSPITALIST DIRECTOR 40.00 X 220880 0 47640 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 40.00 X 201427 0 45694 TIMOTHY BASSETT PHARMACY DIRECTOR 40.00 X 180977 0 13809 1348408 0 175400 16 0 1 0 WAPITI MEDICAL GROUP-WOOD RIVER LLC 107 FLYNN DR STE 600 MILBANK SD 57252 ER PHYSICIAN COVERAGE 1756800 ARAMARK 27310 NETWORK PLACE CHICAGO IL 60673 CULINARY/LAUNDRY/EVS 1342332 MEDICAL SOLUTIONS LLC 1010 N 102ND ST STE 300 OMAHA NE 68114 CONTRACT STAFFING 1069318 AUREUS NURSING LLC 1010 N 102ND ST STE 300 OMAHA NE 68114 CONTRACT STAFFING 881079 AYA HEALTHCARE 5930 CORNERSTONE CRT W STE 300 SAN DIEGO CA 92121 CONTRACT STAFFING 867260 15 8196 637314 645510 PATIENT SERVICE REVENUE 621400 30262546 30262546 OTHER PATIENT REVENUE FROM JV 621400 423715 423715 30686261 925471 925471 36209 0 36209 36209 36209 1936571 33700 1845702 16159 90869 17541 108410 108410 14934 8196 12051 2883 2883 MEAL INCOME 900099 80937 80937 MISCELLANEOUS 900099 59869 59869 140806 32545550 30686261 0 1213779 X 5000 5000 200460 200460 9880046 8618269 1261777 391558 343406 48152 1495510 1292888 202622 706264 605171 101093 918781 918781 67656 67656 91512 91512 5261 5261 5136685 5002258 134427 303785 303785 151930 94778 57152 938431 265291 673140 1315811 1291416 24395 76284 63748 12536 41405 38273 3132 508837 508837 1990595 1990595 124812 124812 DRUGS 4112327 4112327 MEDICAL SUPPLIES 1537594 1507103 30491 BAD DEBT EXPENSE 712976 712976 MISCELLANEOUS 304769 304769 198968 136953 62015 31217257 26589289 4627968 0 4258615 1549860 822560 541120 3371133 3406966 621408 676442 307690 348915 37090903 16005268 21466259 21085635 35511660 33849817 502806 633975 0 1014525 66862131 63107255 3062825 3296547 3129859 0 17321498 16452269 625000 1725943 24139182 21474759 X 42722949 41632496 42722949 41632496 66862131 63107255 1328293 -2418746 0 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 5261 5261 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, RURAL WISCONSIN HEALTH COOPERATIVE AND WISCONSIN HOSPITAL ASSOCIATION WERE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF SPOONER HEALTH SYSTEM AND OTHER MEMBERS. 1215671 1215671 20335400 7758253 12577147 882897 552107 330790 14076427 7694908 6381519 580508 580508 21085635 THIRD PARTY PAYOR PAYABLE 693650 LEASE LIABILITY 1032293 1725943 X 29413828 -2418746 -712976 -3131722 32545550 0 32545550 30504281 0 30504281 712976 712976 31217257 PART X, LINE 2: THE SYSTEM IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE SYSTEM FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE SYSTEM FOLLOWS THE ACCOUNTING STANDARD FOR INCOME TAXES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -712,976. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 712,976. GOLF OUTING 23130 8196 14934 5130 4104 2700 117 23130 8196 14934 5130 4104 2700 117 12051 2883 1 1 1 X 1 X 1 1 1 0 1 1 99 144723 144723 0.00460 5140146 1946125 3194021 0.10230 99 5284869 1946125 3338744 0.10690 12 16079 60537 11699 48838 0.00160 3 33 36241 36241 0.00120 1 282 777163 391666 385497 0.01230 4 26651 26651 0.00090 20 16394 900592 403365 497227 0.01600 20 16493 6185461 2349490 3835971 0.12290 610 610 0.00000 1556 1556 0.00000 2166 2166 0.00000 1 712976 14160710 14160710 X 1 1 1 1 SPOONER HEALTH SYSTEM INC 1280 CHANDLER DRIVE SPOONER WI 54801 WWW.SPOONERHEALTH.COM 1024 X X X X HOME HEALTH AGENCY SPOONER HEALTH SYSTEM 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V, PAGE 8 X 1 22 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X 1 X 0 X X X 1 X 0 0 SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 5: A SURVEY WAS CONDUCTED TO ACQUIRE INPUT FROM COMMUNITY MEMBERS WHO REPRESENT THE BROAD INTEREST OF THE COMMUNITY REGARDING THE HEALTH NEEDS OF WASHBURN COUNTY. A LINK TO THE SURVEY WAS DISTRIBUTED AND PROMOTED VIA THE FOLLOWING METHODS INCLUDING PRINT ADS, WEB ADS, EMAIL DISTRIBUTION LISTS AND WAS AVAILABLE ON THE SPOONER HEALTH SYSTEM (SH) WEBSITE. PAPER COPIES OF THE SURVEY WERE DISTRIBUTED IN VARIOUS PUBLIC LOCATIONS INCLUDING COMMUNITY FLU SHOT CLINICS HELD AT SEVERAL LOCATIONS IN WASHBURN COUNTY, THE HEALTH DEPARTMENT, LIBRARIES, MEALS ON WHEELS, CLINICS AND AT SH. IN ADDITION, QUESTIONS WERE POSED TO TWO WASHBURN COUNTY (WC) HEALTH DEPARTMENT EMPLOYEES, A HEALTH OFFICER AND A PUBLIC HEALTH SPECIALIST, FOR THEIR SPECIFIC EXPERTISE ABOUT THE ISSUES IN WC AND WHAT SH CAN DO TO ADDRESS THE ISSUES. AFTER THE SURVEY DATA WAS COLLECTED, A PRIORITIZATION MEETING WAS HELD TO REVIEW THE DATA COLLECTED AND PRIORITIZE THE HEALTH NEEDS. A GROUP OF INDIVIDUALS THAT REPRESENTED THE INTERESTS OF THE COUNTY AND /OR HAD SPECIFIC EXPERTISE REGARDING THE HEALTH NEEDS OF THE VULNERABLE AND UNDERSERVED POPULATIONS WERE ASKED TO PARTICIPATE. THE GROUP INCLUDED PERSONS REPRESENTING NORTH LAKES COMMUNITY CLINIC, SPOONER MEMORIAL LIBRARY, WC PUBLIC HEALTH INCLUDING ALCOHOL AND OTHER DRUG ABUSE, MENTAL HEALTH TASK FORCE OF WC & COMMUNITY ALLIANCE FOR PREVENTION, UW-EXTENSION, AGING DISABILITY RESOURCE CENTER, WC HEALTH AND HUMAN SERVICES, LAKELAND FAMILY RESOURCE CENTER, WC BOARD OF SUPERVISORS AND SPOONER HEALTH. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 6B: SPOONER HEALTH SYSTEM CONTRACTED HEALTHTECHS3 TO ASSIST IN CONDUCTING THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 11: THREE PRIORITIZED HEALTH NEEDS WERE IDENTIFIED IN THE 2022 CHNA WHICH SPOONER HEALTH (SH) WILL FOCUS THEIR EFFORTS ON IN ORDER TO SEEK THE MOST EFFICIENT USE OF RESOURCES WHILE GAINING THE MOST IMPACTFUL OUTCOMES. 1. MENTAL HEALTH - IMPLEMENT PROGRAMS THAT ENHANCE MENTAL HEALTH AWARENESS AND INCREASE UTILIZATION OF COMMUNITY RESOURCES THAT SUPPORT MENTAL WELL-BEING. SH SUPPORTS A DEMENTIA FRIENDLY COMMUNITY THROUGH LEADING AND MANAGING THE APHASIA SUPPORT GROUP. THE APHASIA SUPPORT GROUP PROVIDES INDIVIDUALS TANGIBLE TOOLS TO ASSIST IN COPING WITH APHASIA AS WELL AS A FORUM TO SHARE SIMILAR EXPERIENCES WITH OTHERS. SH ALSO PROVIDES REPRESENTATION ON THE MENTAL HEALTH TASK FORCE OF WASHBURN COUNTY, CREATED IN 2018 TO SUPPORT MENTAL HEALTH PREVENTION AND AWARENESS PROGRAMMING. AN UPDATED LIST OF RESOURCES FOR PATIENTS IS AVAILABLE ON THE SH WEBSITE AND THROUGH OUR CAREGIVERS. THESE SERVICES ARE INCORPORATED INTO DISCHARGE PLANNING AND CASE MANAGEMENT AS APPLICABLE AND WILL BE COMMUNICATED TO THE PUBLIC THROUGH THE SH WEBSITE, SOCIAL MEDIA AND COMMUNITY NEWSLETTER. 2. SUBSTANCE ABUSE - PROVIDE EDUCATION, SUPPORT AND HEALTHY ALTERNATIVES TO PREVENT SUBSTANCE USE AND MISUSE. PROGRESS TOWARD THIS GOAL INCLUDES CONTINUED REPORTING OF OPIOID DISPENSING TO WISCONSIN VIA THE PRESCRIPTION DRUG MONITORING PROGRAM. SH HAS INCREASED THE AMOUNT OF INFORMATION ABOUT OPOIDS THAT IS INCLUDED IN EVERY AFTER VISIT SUMMARY. SH PROVIDES REPRESENTATION ON SEVERAL COLLABORATIVE COMMUNITY GROUPS SUCH AS THE WASHBURN COUNTY COMMUNITY ALLIANCE FOR PREVENTION COMMITTEE AND THE DRUG ENDANGERED CHILDREN M-TEAM, WHICH IS A MULTI-DISCIPLINARY TEAM TO PROVIDE SERVICES FOR CHILDREN FOUND AT DRUG LAB SITES. THE SH PAIN MANAGEMENT CLINIC OPENED IN 2018 AND TREATED 132 PATIENTS IN FISCAL YEAR 2023. THE CLINIC HELPS PEOPLE TAKE AN ACTIVE ROLE IN MANAGING CHRONIC PAIN WITH A COMBINATION OF THERAPIES RATHER THAN TURNING TO OTHER SUBSTANCES TO FIND RELIEF FROM PAIN. AN UPDATED LIST OF RESOURCES FOR PATIENTS IS AVAILABLE ON THE SH WEBSITE AND THROUGH OUR CAREGIVERS. 3. ACCESS TO CARE - INCREASE ACCESS AVAILABILITY AND AWARENESS TO AVAILABLE PRIMARY CARE AND SPECIALITY CARE PROVIDERS AND SERVICES. SH OFFERS MANY SPECIALTY SERVICES AT ITS DESIGNATED OUTPATIENT CLINIC. PHYSICIANS HOLD CLINICS SEVERAL DAYS A WEEK INCLUDING SERVICES SUCH AS OPHTHALMOLOGY, PODIATRY, GASTROENTEROLOGY, PAIN MEDICINE, UROLOGY AND EAR, NOSE AND THROAT. SH RECOGNIZES THE NEED FOR LOCAL PATIENTS TO BE ABLE TO RECEIVE SPECIALTY CARE CLOSE TO HOME AND THE DIFFERENCE THIS CAN MAKE ON HEALTH OUTCOMES. THESE SERVICES ARE ADVERTISED THROUGH NEWSPAPERS, THE SH WEBSITE, NEWSLETTERS AND SOCIAL MEDIA POSTS AS WELL AS AN ELECTRONIC SIGN BOARD INSIDE THE HOSPITAL ENTRANCE SCROLLING UPCOMING CLINICS. SH ALSO EMPLOYS A GENERAL SURGEON WHO PERFORMS ROUTINE SURGERIES SUCH AS HERNIA REPAIRS, APPENDECTOMIES AND GALLBLADDER REMOVALS ALLOWING PATIENTS TO REMAIN CLOSE TO HOME FOR SURGICAL NEEDS. SH HAS TELEMEDICINE EQUIPMENT IN ITS EMERGENCY DEPARTMENT TO PROVIDE STROKE VICTIMS 24/7 ACCESS TO A NEUROLOGIST WHO CAN PROMPTLY ASSESS A PATIENT'S SYMPTOMS RESULTING IN QUICKER DIAGNOSIS AND TREATMENT. 66 PATIENTS WERE ABLE TO BENEFIT FROM THIS TECHNOLOGY IN FY23. SH MAKES INFORMATION ON FINANCIAL ASSISTANCE WIDELY AVAILABLE THROUGH OUR WEBSITE AND EMPLOYS A PATIENT FINANCIAL COUNSELOR TO WORK DIRECTLY WITH PATIENTS TO EDUCATE THEM ON AVAILABLE OPTIONS. SH CONTINUES FINANCIAL AND IN-KIND SUPPORT FOR THE RICE LAKE AREA FREE CLINIC AND LOCAL REGIONAL HOSPICE SERVICES. SH HOLDS NUMEROUS FLU SHOT CLINICS AT VARIOUS LOCATIONS IN THE COMMUNITY WHERE CLOSE TO 400 COMMUNITY MEMBERS WERE ABLE TO RECEIVE THEIR FLU VACCINATION IN 2022. SH ORGANIZES AN ANNUAL HEALTH FAIR WHERE FREE LAB CHOLESTEROL SCREENINGS ARE PROVIDED ONSITE. IN FISCAL YEAR 2023, OVER 50 COMMUNITY MEMBERS TOOK ADVANTAGE OF THE FREE LAB SCREENINGS. SH WILL CONTINUE TO ADVOCATE TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO REDEFINE THEIR MIXED-USE SPACE INTERPRETATION SO URGENT CARE CAN BE IMPLEMENTED AT THE SH FACILITY IN THE FUTURE ALLOWING GREATER ACCESS TO HEALTH CARE SERVICES. FOUR COMMUNITY HEALTH NEEDS WERE IDENTIFIED IN THE 2022 CHNA PROCESS THAT SH WILL NOT SPECIFICALLY FOCUS THEIR EFFORTS ON BUT ARE RECOGNIZED AS IMPORTANT AREAS AS WELL. 1. CHRONIC DISEASE THESE ARE ALREADY SERVICES INCORPORATED INTO THE CARE AT SH AND PREVENTION EFFORTS ARE LED DOMINANTLY BY LOCAL PUBLIC HEALTH. 2. LACK OF COMMUNITY EDUCATION THE HOSPITAL DOES PROVIDE EDUCATION WITH THE RESOURCES WE CURRENTLY HAVE. WE WILL RELY ON COUNTY SERVICES AND PUBLIC HEALTH TO INCREASE EDUCATION. 3. POVERTY AND BASIC NEEDS - THE HOSPITAL DOES NOT PROVIDE DIRECT SERVICES THAT CAN HELP IN THESE AREAS, HOWEVER, IT DOES PASS ALONG RESOURCES TO ITS PATIENTS AS NEEDED REGARDING HELP IN THE COMMUNITY. 4. COVID-19 - THIS HAS BECOME PART OF OPERATIONS AT THE HOSPITAL AND WILL CONTINUE TO BE A SIGNIFICANT HEALTH NEED THAT IS ALWAYS ADDRESSED. THE HOSPITAL CHOSE TO FOCUS ON THE THREE OTHER PRIORITIES MENTIONED IN THEIR IMPLEMENTATION PLAN. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE WEBSITE AT HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE/. THE APPLICATION IS ON THE WEBSITE HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/09/395-100-FAP-ATTACHMENT-E-APPLICATION-2021.PDF. THE PLAIN LANGUAGE SUMMARY IS ON THE WEBSITE HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFORMATION/PLAIN-LANGUAGE-SUMMARY/. THE INFORMATION ON THE WEBSITES EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE AT REGISTRATION. A FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE. PART V, LINE 7A, CHNA REPORT HOSPITAL FACILITY'S WEBSITE: HTTPS://SPOONERHEALTH.COM/WP-CONTENT/UPLOADS/2022/03/CHNA_SPOONER_2022_FINAL.PDF (CHANGE CAPITAL LETTERS TO LOWERCASE TO ACCESS) PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE: HTTPS://SPOONERHEALTH.COM/CHNA/ PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED PRIMARILY ON HOUSEHOLD INCOME COMPARED TO FEDERAL POVERTY GUIDELINES. HOWEVER, QUALIFIED HOUSEHOLD ASSETS ARE ALSO CONSIDERED WHEN DETERMINING AN INDIVIDUAL'S ABILITY TO PAY FOR HEALTHCARE SERVICES. FINALLY, INSURANCE STATUS CAN IMPACT A PERSON'S ELIGIBILITY IF THEY HAVE ACCESS TO HEALTH INSURANCE, THIRD-PARTY REIMBURSEMENT OR GOVERNMENTAL ASSISTANCE BUT FAIL TO TAKE ADVANTAGE OF IT OR FAIL TO MAINTAIN ELIGIBILITY. PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7A-C WERE COMPUTED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H, IRS INSTRUCTIONS. THE AMOUNTS REPORTED IN LINES 7E-I WERE REPORTED BASED ON DIRECT COSTS INCURRED BY SH. PART I, LINE 7G: INCLUDED IN PART I, LINE 7G IS THE HOME HEALTH AGENCY. THIS SERVICE IS LISTED AS A SUBSIDIZED HEALTH SERVICE BECAUSE IT IS OPERATED BY SHS TO PROVIDE A SERVICE THAT IS NEEDED IN THE COMMUNITY BUT THAT CANNOT BE SUSTAINED ON ITS OWN. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE HOME HEALTH AGENCY WAS $777,163 WITH DIRECT OFFSETTING REVENUE OF $391,666 RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $385,497. PART I, LN 7 COL(F): THE HOSPITAL IS REPORTING $712,976 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24C. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $30,504,281. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: SPOONER HEALTH (SH) CONTINUES TO BE A COMMUNITY DROP OFF LOCATION FOR INFECTIOUS WASTE, WHICH IS ROUTINELY COLLECTED AND PROPERLY DISPOSED OF FOR ENVIRONMENTAL SAFETY IN THE REGION. SH PROVIDES FREE MEETING ROOM SPACE TO MANY NON-PROFIT COMMUNITY GROUPS, INCLUDING HOSTING THE HEALTH & AGING DAY FOR THE LEADERSHIP WASHBURN COUNTY PROGRAM. ADDITIONAL ACTIVITIES RELATED TO COMMUNITY BUILDING ARE REPORTED IN THE COMMUNITY HEALTH IMPROVEMENT CATEGORY INCLUDING REPRESENTATION ON MANY COMMUNITY HEALTH RELATED BOARDS INCLUDING WASHBURN COUNTY COMMUNITY COORDINATED RESPONSE TEAM, WASHBURN & BURNETT COUNTY INTERDISCIPLINARY TEAMS, BURNETT COUNTY CRISIS OVERSIGHT COMMITTEE, AND THE CHILD DEATH REVIEW TEAM. SH ALSO HAS A REPRESENTATIVE ON ADVISORY BOARDS FOR NORTHWOODS TECHNICAL COLLEGE AND THE COLLEGE OF ST. SCHOLASTICA SCHOOL OF NURSING TO HELP PROMOTE WORKFORCE DEVELOPMENT. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 3: A PORTION OF THE BAD DEBT EXPENSE REPORTED IN LINE 2 WOULD BE CONSIDERED CHARITY CARE IF THE PROPER PAPERWORK WAS COMPLETED BY THE PATIENTS, HOWEVER THIS AMOUNT CANNOT BE QUANTIFIED. PART III, LINE 4: FOR INFORMATION ABOUT BAD DEBT EXPENSE, SEE THE "PATIENT ACCOUNTS RECEIVABLES AND CREDIT POLICY" SECTION OF NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2023 FILED MEDICARE COST REPORT. PART III, LINE 9B: AFTER FINANCIAL ASSISTANCE IS PROVIDED, SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. SPOONER HEALTH SYSTEM MAKES ALL REASONABLE ATTEMPTS TO CONFIRM THAT PATIENTS ARE NOT ELIGIBLE FOR OTHER ASSISTANCE PROGRAMS PRIOR TO COLLECTION AGENCY ASSIGNMENT. PRIOR TO TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND STATEMENTS AND COLLECTION LETTERS TO THE PATIENT AT THE ADDRESS PROVIDED BY THE PATIENT. STATEMENTS AND COMMUNICATIONS WILL INFORM THE PATIENT OF THEIR FINANCIAL RESPONSIBILITY AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN. PART VI, LINE 2: THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED IN PART V, SECTION B WAS THE ONLY ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS CONDUCTED DURING THE FISCAL YEAR. PART VI, LINE 3: PATIENTS WITHOUT INSURANCE ARE GIVEN THE FINANCIAL ASSISTANCE (FA) APPLICATION. OUR FINANCIAL COUNSELOR CALLS THEM AFTER DISCHARGE AND EXPLAINS WHAT ASSISTANCE (FROM THE GOVERNMENT OR SHS) MAY BE AVAILABLE TO THEM. SHE ASKS THEM TO FILL IT OUT AND MAKES AN APPOINTMENT WITH THEM IN THE OFFICE IF THEY NEED ASSISTANCE WITH THE FA APPLICATION OR GOING TO WWW.ACCESS.WISCONSIN.GOV TO APPLY FOR GOVERNMENTAL ASSISTANCE. WHEN THEY COME IN, SHE WILL ASSIST THEM WITH THE APPLICATION PROCESS AS MUCH AS SHE CAN. IF THEY NEED FURTHER ASSISTANCE, ARE OF RETIREMENT AGE, OR IF THERE IS A DISABILITY INVOLVED, SHE REFERS THEM TO THE WASHBURN COUNTY AGING AND DISABILITY RESOURCE CENTER WHERE THEY WILL HELP THE PATIENTS IN GETTING ADDITIONAL ASSISTANCE. OUR FINANCIAL COUNSELOR ALSO REFERS PATIENTS TO THE COUNTY'S PUBLIC HEALTH DEPARTMENT IF THEY NEED FAMILY OR WOMEN'S HEALTH ASSISTANCE. WE ALSO PUBLICIZE THE AVAILABILITY OF FA IN OUR ANNUAL REPORT TO THE COMMUNITY THAT IS SENT OUT TO EVERY ADDRESS IN OUR PRIMARY SERVICE AREA. PART VI, LINE 4: SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURN COUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 30TH LARGEST COUNTY BY LAND AREA IN WISCONSIN WITH AN ESTIMATED POPULATION OF 16,911 (PER JULY 2022 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $54,550 WITH 11.8% OF PERSONS BELOW POVERTY LEVEL (PER 2016-2020 DATA). WASHBURN COUNTY HAD A 3.3% UNEMPLOYMENT RATE IN SEPTEMBER 2023 PER THE WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT. PART VI, LINE 5: THE MAJORITY OF OUR ORGANIZATION'S GOVERNING BOARD MEMBERS LIVE IN THE PRIMARY SERVICE AREA FOR SPOONER HEALTH. SPOONER HEALTH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROVIDERS IN OUR COMMUNITY. SURPLUS FUNDS GENERATED BY SPOONER HEALTH ARE INVESTED BACK INTO THE FACILITY AND ITS EQUIPMENT TO CONTINUE OFFERING HIGH QUALITY HEALTHCARE INCLUDING EXPANDING SERVICES WHEN POSSIBLE FOR OUR COMMUNITY AND SERVICE AREA. PART VI, LINE 6: SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X 0 0 0 0 0 0 0 0 0 PHILIP MOFLE MD SURGERY MEDICAL DIRECTOR 341426 0 4000 0 0 0 2935 0 37117 0 385478 0 0 0 JOHN BERLIN APNP HOSPITALIST DIRECTOR 216880 0 4000 0 0 0 11543 0 36097 0 268520 0 0 0 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 197427 0 4000 0 0 0 10183 0 35511 0 247121 0 0 0 TAMARA DANIELS MD E.D. MEDICAL DIRECTOR 227610 0 2000 0 0 0 0 0 0 0 229610 0 0 0 REBECCA BUSCH CHIEF FINANCIAL OFFICER 166088 0 4000 0 0 0 8818 0 19387 0 198293 0 0 0 TIMOTHY BASSETT PHARMACY DIRECTOR 176977 0 4000 0 0 0 9169 0 4640 0 194786 0 0 0 A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2022-02-24 16730000 CONSTRUCTING REPLACEMENT HOSPITAL 0 0 0 A 900000 17630000 259587 17370413 2022 1 0 1 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/24/2022 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE POWER AND AUTHORITY OF THE BOARD OF DIRECTORS TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 SPOONER HEALTH SYSTEM, INC. CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. INCLUDED IN THE FEES PAID TO HEALTHTECH MANAGEMENT SERVICES IS THE COMPENSATION FOR THE CEO. DURING 2022, THE CEO RECEIVED $334,211 OF TAXABLE PAY, $68,004 OR NONTAXABLE DEFERRED COMPENSATION AND $31,305 OF OTHER NONTAXABLE BENEFITS FROM HEALTHTECH MANAGEMENT SERVICES FOR HIS SERVICES TO SPOONER HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 WAS REVIEWED WITH BOARD MEMBERS WHO APPROVED IT. THE 990 WAS THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ANY OFFICER, BOARD MEMBER, OR KEY EMPLOYEE OF THE ORGANIZATION ON AN ANNUAL BASIS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE PERSON WITH THE CONFLICT SHALL LEAVE MEETINGS DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 MICHAEL SCHAFER, CEO, IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION, INCLUDING COMPENSATION SURVEYS, TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL, WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. ALL OFFICERS AND KEY EMPLOYEES' COMPENSATION IS REVIEWED ON AN ANNUAL BASIS AND COMPARED TO MARKET DATA GATHERED BY THE HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,838,265. MANAGEMENT AND GENERAL EXPENSES 1,995. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,840,260. SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 716,375. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 716,375. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 447,618. MANAGEMENT AND GENERAL EXPENSES 132,432. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 580,050.