2024-05-15T10:18:35-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 390807065 ASPIRUS STANLEY HOSPITAL & CLINICS INC ASPI 7156445571 1120 PINE STREET STANLEY WI 54768 JERRY M YANG SVP - CHIEF FINANCIAL OFFICER 7156445571 2024-05-14 1 JERRY YANG 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 20325105 0 X WWW.ASPIRUS.ORG X 1921 WI WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 11 4 113 10 1993 0 351837 309269 17748934 19938895 0 -8938 94656 76936 18195427 20316162 0 12000 0 0 8064615 8667340 0 0 0 11654790 12085393 19719405 20764733 -1523978 -448571 24281273 23900227 19118491 19743277 5162782 4156950 WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 0 0 13628678 12000 19936902 ASPIRUS STANLEY HOSPITAL, INC. IS A 12-BED HOSPITAL CAMPUS PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2023, ASPIRUS STANLEY HOSPITAL, INC. SERVICED THE COMMUNITY THROUGH A TOTAL OF APPROXIMATELY 584 INPATIENT DAYS, AND APPROXIMATELY 811 SWING BED DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR APPROXIMATELY 22,222 OUTPATIENT VISITS, WHICH INCLUDED APPROXIMATELY 2,670 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 13628678 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 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 113 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JERRY M YANG 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 DIANE ANDERSON BOARD MEMBER/NURSE PRACTITIONER 1.00 40.00 X 0 209483 38395 JAMES MATHESON VICE CHAIR/SVP-CHIEF STRATEGY OFF. 1.00 50.00 X 0 539401 110893 JESSE TISCHER SVP & PRESIDENT-REG. MARKETS 2.00 50.00 X X 0 781575 128595 MATTHEW BREWER VP-OPERATIONS 2.00 50.00 X 0 290861 44790 RACHEL DIXON BOARD MEMBER/PHYSICIAN ASSISTANT 1.00 40.00 X 0 108456 41300 SUSAN SCHNEIDER BOARD MEMBER/PHYSICIAN 1.00 40.00 X 0 541839 39761 MICHAEL HOLZHUETER ASST SECRETARY/SVP-GEN. COUNSEL 2.00 50.00 X X 0 672916 123676 LEONARD W HAMMAN CHAIR 1.00 1.00 X X 0 0 0 WILLIAM G ARCISZEWSKI BOARD MEMBER 1.00 1.00 X 0 0 0 RANDY L JUEDES BOARD MEMBER 1.00 1.00 X 0 0 0 JOHNATHON R LANGE BOARD MEMBER 1.00 1.00 X 0 0 0 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 2.00 50.00 X 0 1911464 144118 MATTHEW HEYWOOD PRESIDENT & CEO-ASPIRUS 2.00 50.00 X 0 1799938 311110 DALE HUSTEDT (NV) PRESIDENT-ASPIRUS NW DIVISION 2.00 50.00 X 0 375459 93306 ROBERT SMITH VP-STEVENS POINT CAMPUS 2.00 50.00 X 0 346937 58590 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 2.00 50.00 X 0 321116 49427 CONSTANCE BRADLEY SVP-SYSTEM CHIEF NURSING EXEC 2.00 50.00 X 0 502032 95550 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 2.00 50.00 X 0 348443 48718 DEBRA BALL SVP & CHIEF HR OFFICER 2.00 50.00 X 0 458839 103553 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 519926 106843 GREG SHAW VP-FINANCE NORTH REGION 2.00 50.00 X 0 220782 30975 JANELLE KOMMERS-MARKGRAF VP-HR NORTH REGION 2.00 50.00 X 0 236917 44327 JESSICA FAUDE VP-PATIENT CARE & CNO 2.00 50.00 X 0 165895 31476 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 534868 104438 TYLER HACK VP-FINANCE NORTH REGION 2.00 50.00 X 0 246807 27314 JOHNATHON JUSTICE RN-DIRECTOR NURSING 40.00 X 0 322092 43692 KATHERINE JACKSON-SCHNEIDER RN NURSE-EMERGENCY 40.00 X 0 283465 43242 PETER GINTNER SUPERVISOR-NURSING-EMERGENCY 40.00 X 0 244465 35102 DANIEL GILLES SUPERVISOR-THERAPY-PEDS 40.00 X 0 239931 9067 STEVEN SANTOS PHARMACIST-INPATIENT 40.00 X 0 187529 10034 0 12411436 1918292 10 0 1 0 ACUTE CARE INC 1609 N ANKENY BLVD STE 200 ANKENY IA 50023 CLINICAL SERVICES 2144775 TOTAL MSP LLC (STAFFENCY) 221 W COLLEGE AVENUE FLOOR 2 APPLETON WI 54911 CLINICAL SERVICES 875179 RENOVO SOLUTIONS LLC 4 EXECUTIVE CIRCLE STE 185 IRVINE CA 92614 CLINICAL SERVICES 357397 SHARED MEDICAL TECHNOLOGY INC 202 WEST NEWTON STREET RICE LAKE WI 54868 CLINICAL SERVICES 208227 COMPASS GROUP USA INC - TOUCHPOINT SUPPO PO BOX 102289 ATLANTA GA 30368 CLINICAL SERVICES 187700 7 309269 309269 PATIENT SERVICE REVENUE 621990 19073530 19073530 LAB REVENUE 621500 713669 711676 1993 PHARMACY REVENUE 900099 146917 146917 4779 4779 19938895 5 5 42556 0 42556 42556 42556 8943 -8943 -8943 -8943 CAFETERIA REVENUE 722514 34213 34213 VENDING REVENUE 900099 167 167 34380 20316162 19936902 1993 67998 X 12000 12000 7011909 5790125 1221784 191700 166520 25180 992575 743214 249361 471156 390538 80618 1035 1035 3877783 3804783 73000 350 350 25160 18629 6531 18874 3166 15708 586000 192056 393944 34938 18059 16879 529984 529984 1439736 306819 1132917 31085 26362 4723 CORPORATE ALLOCATIONS 2940449 83511 2856938 MEDICAL SUPPLIES 1388735 1337155 51580 REPAIRS AND MAINTENANCE 567015 342769 224246 EQUIPMENT RENTALS 218850 214144 4706 425399 178828 246571 20764733 13628678 7136055 0 1395 1545 114084 113185 2485352 2959617 351033 332327 9156 10090 22571056 2139721 20593969 20431335 726284 52128 24281273 23900227 1074201 1266297 309269 0 17522527 17428953 212494 1048027 19118491 19743277 X 5162782 4156950 5162782 4156950 24281273 23900227 X -448571 -557261 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 1035 1035 0 PART II-B, LINE 1: ASPIRUS STANLEY HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND WHA HAVE NOTIFIED THE HOSPITAL THAT APPROXIMATELY $1,035 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 2690000 2690000 17835716 1481106 16354610 2045340 658615 1386725 20431335 RELATED PARTY PAYABLES 350 OPERATING LEASE LIABILITY 52128 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 995549 1048027 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 1 0 1 1 118869 118869 0.00570 3761746 1937220 1824526 0.08790 1179618 1040808 138810 0.00670 5060233 2978028 2082205 0.10030 61568 61568 0.00300 3443 3443 0.00020 12000 12000 0.00060 77011 77011 0.00380 5137244 2978028 2159216 0.10410 1 35 234 234 0.00000 1 35 234 234 0.00000 1 34291 0 5329313 5343558 -14245 X 1 1 1 1 ASPIRUS STANLEY HOSPITAL 1120 PINE STREET STANLEY WI 54768 WWW.ASPIRUS.ORG/FIND-A-LOCATION/ASPIRU 1013 X X X X ASPIRUS STANLEY HOSPITAL & CLINICS 0 1 1 X X X X X X X X X 21 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 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 STANLEY HOSPITAL & CLINICS PART V, SECTION B, LINE 2: THE HOSPITAL WAS ACQUIRED BY ASPIRUS, INC. IN AUGUST 2021 (FY22). ASPIRUS STANLEY HOSPITAL & CLINICS PART V, SECTION B, LINE 5: ASPIRUS STANLEY HOSPITAL COLLABORATED WITH THE CLARK COUNTY HEALTH DEPARTMENT AND THE MARSHFIELD MEDICAL CENTER-NEILLSVILLE HOSPITAL TO CONDUCT THE ASSESSMENT. NO OUTSIDE CONTRACTORS OR VENDORS WERE PAID FOR SERVICES.THE COLLABORATORS CONDUCTED A COMMUNITY SURVEY IN SUMMER 2021. THE SURVEY CAPTURED SOME DEMOGRAPHIC DATA AS WELL AS RESPONDENTS' OPINIONS ON THE TOP HEALTH ISSUES FACING THE COMMUNITY. THE SURVEY WAS AVAILABLE ELECTRONICALLY (THROUGH A HYPERLINK) AND ON PAPER. PAPER SURVEYS WERE ENTERED INTO THE ONLINE SURVEY COLLECTOR. APPROXIMATELY 320 PEOPLE RESPONDED (THOUGH THE NUMBER VARIED BY QUESTION). DELIBERATE EFFORTS WERE MADE TO REACH MEMBERS OF THE PLAIN COMMUNITY (AMISH, MENNONITE), INDIVIDUALS WHO ARE IN THE JAIL AND ANY/ALL CLARK COUNTY RESIDENTS AT THE COUNTY FAIR. ASPIRUS STANLEY HOSPITAL & CLINICS PART V, SECTION B, LINE 6A: ASPIRUS STANLEY HOSPITAL COLLABORATED WITH THE MARSHFIELD MEDICAL CENTER-NEILLSVILLE HOSPITAL. ASPIRUS STANLEY HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS STANLEY HOSPITAL. ASPIRUS STANLEY HOSPITAL & CLINICS PART V, SECTION B, LINE 6B: ASPIRUS STANLEY HOSPITAL COLLABORATED WITH THE CLARK COUNTY HEALTH DEPARTMENT. ASPIRUS STANLEY HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS STANLEY HOSPITAL. ASPIRUS STANLEY HOSPITAL & CLINICS PART V, SECTION B, LINE 11: FACILITY NAME: ASPIRUS STANLEY HOSPITAL 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. THE HOSPITAL IS IN RURAL NORTHERN WISCONSIN. BECAUSE OF THAT SETTING, COMMUNITY HEALTH EFFORTS ARE FREQUENTLY COMPLETED WITH OTHER REGIONAL PARTNERS. IN FY23, ASPIRUS STANLEY HOSPITAL'S SIGNIFICANT NEEDS WERE: CHRONIC DISEASE; MENTAL HEALTH; PHYSICAL ENVIRONMENT AND SAFETY. THE HOSPITAL ADDRESSED THOSE NEEDS IN THE FOLLOWING WAYS. CHRONIC DISEASEFOOD GLEANING. ASPIRUS STANLEY HOSPITAL CONTINUED THE FOOD GLEANING PROGRAM IT STARTED IN FY21. THE FOOD GLEANING PROGRAM TAKES UNTOUCHED FOOD FROM THE HOSPITAL CAFETERIA, PACKAGES IT AND THEN DISTRIBUTES IT TO AN AREA FOOD PANTRY. THE HOSPITAL CONTRIBUTES BOTH THE CONTAINERS FOR THE FOOD AS WELL AS THE TIME THAT STAFF SPENDS PACKAGING THE FOOD. HOSPITAL STAFF SPENDS APPROXIMATELY 1 HOUR PER WEEK PACKAGING MEALS, TOTALING 52 HOURS OF STAFF TIME AND 1,681LBS OF FOOD DONATED IN FY23. MEALS ON WHEELS. HOSPITAL FOOD AND NUTRITION STAFF SPENT 10 HOURS/WEEK (520 ANNUALLY) PACKAGING FOOD FOR MEALS ON WHEELS DELIVERIES TO HOMEBOUND INDIVIDUALS IN CHIPPEWA COUNTY.COALITION. ASPIRUS STANLEY HOSPITAL IS PART OF THE EAT RIGHT BE FIT COALITION IN CLARK COUNTY. THE GOAL OF THIS COALITION IS TO INCREASE HEALTHY NUTRITION AND PHYSICAL ACTIVITY IN THE COMMUNITY.STORY WALK. ASPIRUS STANLEY COLLABORATED WITH THE EAT RIGHT, BE FIT COALITION TO DEVELOP A STORY WALK GRANT APPLICATION PROCESS MADE AVAILABLE TO COMMUNITY PARTNERS. IN APRIL 2023, THE APPLICATIONS WERE RECEIVED AND THE $4,000 GRANT WAS AWARDED TO THE GRANTON AREA SCHOOL DISTRICT FOR THEIR IMPLEMENTATION ON THIS PROJECT. GRANTON SCHOOL DISTRICT HOSTED THE GRAND OPENING OF THEIR "TRAILS AND TAILS" STORY WALK ON AUGUST 24, 2023.MENTAL HEALTH COALITIONS. THE HOSPITAL IS A MEMBER OF THE CLARK COUNTY PREVENTION PARTNERSHIP WHICH AIMS TO PROVIDE MENTAL HEALTH AWARENESS AND EDUCATION. AS PART OF THE CHIPPEWA COUNTY HEALTH IMPROVEMENT PARTNERSHIP, ASPIRUS PARTICIPATES ON THE MENTAL HEALTH SUBCOMMITTEE. PHYSICAL ENVIRONMENT AND SAFETYCOALITIONS. ASPIRUS STAFF PARTICIPATE IN THE WOOD AND CLARK COUNTY SAFE KIDS COALITION. AS PART OF THE CHIPPEWA COUNTY HEALTH IMPROVEMENT PARTNERSHIP, ASPIRUS PARTICIPATED IN THE SAFE KIDS DAY AT THE YMCA IN APRIL 2023, OFFERING CHILDREN AND FAMILIES SOME FUN WAYS TO IMPROVE NUTRITION AND PHYSICAL ACTIVITY.CAR SEATS. ASPIRUS STANLEY WORKED WITH ASPIRUS WAUSAU TO FUND THE DISTRIBUTION OF CAR SEATS AND CAR SEAT CHECKS AT COMMUNITY EVENTS ($2,000). IN ADDITION, ASPIRUS STANLEY ALSO PROVIDED FUNDING OF $2,500 FOR PACK 'N' PLAYS TO ALSO BE DISTRIBUTED AT THESE EVENTS.YOUTH. ASPIRUS STANLEY HOSPITAL PROVIDED $500 TO CADOTT SCHOOL DISTRICT AND STANLEY BOYD SCHOOL DISTRICT FOR THEIR HIGH SCHOOL SENIOR LOCK-INS. OTHER ASPIRUS STAFF PARTICIPATE IN THE RURAL RESILIENCY NETWORK. THE RURAL RESILIENCY NETWORK (R2N) WAS CREATED TO IMPROVE UNDERSTANDING OF HEALTH INFORMATION AND ACCESS TO HEALTHCARE THROUGHOUT RURAL CENTRAL WISCONSIN. R2N COLLABORATES WITH PUBLIC HEALTH ORGANIZATIONS, RESOURCE AGENCIES, AND COMMUNITY ORGANIZATIONS. AS A PART OF THESE EFFORTS, ASPIRUS PROVIDED FUNDING IN THE AMOUNT OF $5,000TO SUPPORT A COMMUNITY HEALTH WORKER. THE ROLE OF THE COMMUNITY HEALTH WORKER IS TO REACH INDIVIDUALS IN RURAL COMMUNITIES AND PROVIDE HEALTH EDUCATION AND SUPPORT. THE HOSPITAL PROVIDED FUNDING ($4,000) TO SUPPORT ENGLISH AS A SECOND LANGUAGE (ESL) AND GENERAL EDUCATIONAL DEVELOPMENT (GED) CLASSES IN A COMMUNITY THAT HAS A SIGNIFICANT HISPANIC POPULATION.LOCKBOXES (TO HELP KEEP PRESCRIPTION DRUGS SECURE) THAT WERE PURCHASED IN FY22 WERE STILL MADE AVAILABLE IN FY23.ASPIRUS STANLEY HOSPITAL PARTICIPATES ON THE YOUTH PROGRAMMING SUBCOMMITTEE OF THE CENTRAL WISCONSIN PARTNERSHIP FOR RECOVERY (CWPR). THE CWPR WAS GIVEN A GRANT TO SUPPORT THE MATERIALS AND TRAINING FOR SUBSTANCE ABUSE PREVENTION AND EARLY INTERVENTION CURRICULUM IN SCHOOLS AND YOUTH-SERVING ORGANIZATIONS. THE CWPR OFFERS TECHNICAL ASSISTANCE, TRAINING AND DIRECT SERVICES TO SCHOOL DISTRICTS ON A VARIETY OF TOPICS, INCLUDING CURRICULUM, RECOVERY COACHES, MINDFULNESS GROUPS.IN ADDITION TO THE CHIPPEWA COUNTY HEALTH IMPROVEMENT PARTNERSHIP PARTICIPATION MENTIONED ABOVE, ASPIRUS STANLEY ALSO PARTICIPATES ON THE CHRONIC DISEASE AND HEALTH EQUITY SUBCOMMITTEES. - - - - - - - - - - - - - - - - THE HOSPITAL'S FINAL PRIORITIES ARE: CHRONIC DISEASE MENTAL HEALTH PHYSICAL ENVIRONMENT AND SAFETYTHE THREE ISSUES THAT WERE NOT SELECTED AND THE CORRESPONDING RATIONALE ARE: SUBSTANCE USE ALTHOUGH THIS WAS A PRIORITY IN THE PREVIOUS 3-YEAR CYCLE, THERE WAS VERY LITTLE MOMENTUM OR ENERGY AROUND IT FROM OTHER ORGANIZATIONS, RESULTING IN LITTLE PROGRESS. THE HOSPITAL FELT ITS RESOURCES WERE BETTER DIRECTED TO EFFORTS THAT COULD RESULT IN COLLECTIVE IMPACT. COMMUNICABLE DISEASES THE HOSPITAL WILL WORK ON THIS ISSUE OUTSIDE OF THE FORMAL IMPLEMENTATION STRATEGY. SOCIAL DETERMINANTS OF HEALTH THE HOSPITAL WILL WORK TO ADDRESS SOCIAL DETERMINANTS, PARTICULARLY THOSE DETERMINANTS THAT CONTRIBUTE TO HEALTH INEQUITIES, AS PART OF THEIR EFFORTS TO ADDRESS CHRONIC DISEASE, MENTAL HEALTH AND PHYSICAL ENVIRONMENT AND SAFETY. ASPIRUS STANLEY HOSPITAL & CLINICS PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 3 1 - ASPIRUS STANLEY CLINIC 1120 PINE STREET STANLEY WI 54768 PHYSICIANS CLINIC 2 - ASPIRUS THORP CLINIC 704 SOUTH CLARK STREET THORP WI 54771 PHYSICIANS CLINIC 3 - ASPIRUS OWEN CLINIC 6 JOHNSON STREET OWEN WI 54460 PHYSICIANS CLINIC 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, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $61,151 PART II, COMMUNITY BUILDING ACTIVITIES: ASPIRUS STANLEY HOSPITAL PROVIDES A SHARPS DISPOSAL PROGRAM FOR THE COMMUNITY. BY SAFELY REMOVING SHARPS FROM THE ENVIRONMENT, WE MAKE THE COMMUNITY SAFER IN TERMS OF INJURY AND INFECTION. 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 BOARD OF DIRECTORS, WHICH MEETS QUARTERLY. HOSPITAL BOARD MEMBERS ARE FROM MULTIPLE SECTORS, INCLUDING BANKING, LOCAL BUSINESSES, AND COMMUNITY SERVICE ORGANIZATIONS. - SUPPORTS ITS STAFF IN PARTICIPATING ON COMMUNITY BOARDS, COALITIONS AND COMMITTEES THAT PROVIDE INSIGHT ON LOCAL CIRCUMSTANCES.- REVIEWS FUNDING REQUESTS 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: THE PRIMARY SERVICE AREA OF THE HOSPITAL IS CLARK COUNTY, ALTHOUGH IT DOES SERVE NEIGHBORING COUNTIES INCLUDING CHIPPEWA. CLARK COUNTY IS A RURAL COUNTY IN CENTRAL WISCONSIN. IT COVERS 1,209 SQUARE MILES, WITH 28.7 PEOPLE PER SQUARE MILE AND AN OVERALL POPULATION OF 34,751 PEOPLE. HERE ARE SOME DETAILS ABOUT ITS POPULATION: PERSONS 14 YEARS AND UNDER: 24.5%PERSONS 65 YEARS AND OVER: 17.7%WHITE PERSONS: 97.7%AFRICAN AMERICAN PERSONS: 0.9%AMERICAN INDIAN PERSONS: 0.8%ASIAN PERSONS: 0.6%HISPANIC OR LATINO: 5.2%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 17.3%HIGH SCHOOL GRADUATE OR HIGHER: 82.3%PERSONS BELOW POVERTY LEVEL: 13.1%MEDIAN HOUSEHOLD INCOME: $54,012PERCENT UNINSURED: 17%PERCENT USING PUBLIC INSURANCE (MEDICAID, MEDICARE, VETERAN'S BENEFITS, ETC.) 33.4%NUMBER OF HOSPITALS IN THE COUNTY: 2 (INCLUDING ASPIRUS STANLEY HOSPITAL)CLARK COUNTY IS A DESIGNATED HEALTH PROFESSIONS SHORTAGE AREA (HPSA) FOR MENTAL HEALTH, DENTAL CARE, AND PRIMARY CARE.ANOTHER GROUP WITHIN OUR COMMUNITY IS "THE PLAIN PEOPLE," CONSISTING OF INDIVIDUALS FROM THE AMISH, MENNONITE, GERMAN BAPTIST, AND OLD GERMAN BAPTIST RELIGIONS. THE PLAIN PEOPLE ALSO REQUIRE SPECIAL CONSIDERATION BY ASPIRUS STANLEY AND THE HEALTH DEPARTMENTS BECAUSE OF THEIR NON-MAINSTREAM LIFESTYLE. DEPENDING ON THE GROUP, BELIEFS MAY INFLUENCE THEIR USE OF PREVENTIVE HEALTH CARE, TREATMENT FOR ILLNESSES AND INJURIES, USE OF INSURANCE, USE OF ELECTRICITY, TRANSPORTATION, AND VARIOUS OTHER FACETS OF DAILY LIFE. 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 BOARD OF DIRECTORS THAT REFLECTS THE COMMUNITY. - 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 TRANSPORTATION ASSISTANCE FOR PATIENTS AS APPROPRIATE. - PROVIDES PRECEPTORS FOR HEALTH PROFESSIONS STUDENTS-IN-TRAINING, WHICH ADVANCES THE HEALTH CARE WORKFORCE. 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 PUBLIC. - IN ADDITION, SEVERAL COMMUNITY EFFORTS ARE SUPPORTED BY ASPIRUS STANLEY INCLUDING PARTICIPATING IN H2N, R2N, COMMUNITY EVENTS AND MANY OTHERS. 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 WI 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 C SCZYGELSKI SENIOR VP OF FINANCE & CFO 0 649844 0 1057601 0 204019 0 20794 0 123324 0 2055582 0 195109 JESSE TISCHER SVP & PRESIDENT-REG. MARKETS 0 580082 0 150199 0 51294 0 18561 0 110034 0 910170 0 50242 MICHAEL HOLZHUETER ASST SECRETARY/SVP-GEN. COUNSEL 0 479018 0 135622 0 58276 0 18672 0 105004 0 796592 0 55822 JAMES MATHESON VICE CHAIR/SVP-CHIEF STRATEGY OFF. 0 386985 0 110566 0 41850 0 17683 0 93210 0 650294 0 32339 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 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 EXEC 0 385875 0 113420 0 2737 0 16421 0 79129 0 597582 0 0 SUSAN SCHNEIDER BOARD MEMBER/PHYSICIAN 0 445792 0 92863 0 3184 0 16507 0 23254 0 581600 0 0 DEBRA BALL SVP & CHIEF HR OFFICER 0 349805 0 106987 0 2047 0 13179 0 90374 0 562392 0 0 DALE HUSTEDT (NV) PRESIDENT-ASPIRUS NW DIVISION 0 279433 0 60753 0 35273 0 18056 0 75250 0 468765 0 28030 ROBERT SMITH VP-STEVENS POINT CAMPUS 0 308433 0 35611 0 2893 0 17848 0 40742 0 405527 0 0 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 0 291308 0 56573 0 562 0 12036 0 36682 0 397161 0 0 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 0 267466 0 51102 0 2548 0 18436 0 30991 0 370543 0 0 JOHNATHON JUSTICE RN-DIRECTOR NURSING 0 316580 0 0 0 5512 0 8991 0 34701 0 365784 0 0 MATTHEW BREWER VP-OPERATIONS 0 247654 0 42650 0 557 0 10229 0 34561 0 335651 0 0 KATHERINE JACKSON-SCHNEIDER RN NURSE-EMERGENCY 0 265615 0 0 0 17850 0 7385 0 35857 0 326707 0 0 JANELLE KOMMERS-MARKGRAF VP-HR NORTH REGION 0 203520 0 29058 0 4339 0 14791 0 29536 0 281244 0 0 PETER GINTNER SUPERVISOR-NURSING-EMERGENCY 0 237377 0 0 0 7088 0 7288 0 27814 0 279567 0 0 TYLER HACK VP-FINANCE NORTH REGION 0 214263 0 28807 0 3737 0 13090 0 14224 0 274121 0 0 GREG SHAW VP-FINANCE NORTH REGION 0 191783 0 27247 0 1752 0 12702 0 18273 0 251757 0 0 DANIEL GILLES SUPERVISOR-THERAPY-PEDS 0 233788 0 0 0 6143 0 7014 0 2053 0 248998 0 0 DIANE ANDERSON BOARD MEMBER/NURSE PRACTITIONER 0 202520 0 1250 0 5713 0 10159 0 28236 0 247878 0 0 STEVEN SANTOS PHARMACIST-INPATIENT 0 181899 0 0 0 5630 0 5520 0 4514 0 197563 0 0 JESSICA FAUDE VP-PATIENT CARE & CNO 0 151288 0 14345 0 262 0 3834 0 27642 0 197371 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS STANLEY HOSPITAL & CLINICS, 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. SCZYGESLSKI $195,109 D. HUSTEDT $28,030 J. MATHESON $32,339 J. TISCHER $50,242 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 & EDUCATIONAL FACILITIES AUTH 391337855 97712JDN0 2021-11-10 17711082 REVENUE BONDS SERIES 2021 0 0 0 A 17711082 126172 17584910 0 0 1 1 A 0 0 1 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K, PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2021 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL & CLINICS, INC. (EIN 39-1138241); ASPIRUS BUILDINGS, INC. (EIN 39-1406537); ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC. (EIN 39-0808443); ASPIRUS STANLEY HOSPITAL & CLINICS, INC. (EIN 39-0807065); ASPIRUS MERRILL HOSPITAL & CLINICS, INC. (EIN 39-0808503); ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS, INC. (EIN 39-1390638); ASPIRUS EAGLE RIVER HOSPITAL & CLINICS, INC. (EIN 39-0985690); AND THE HOWARD YOUNG MEDICAL CENTER, INC. (EIN 39-0873606). INFORMATION REGARDING THE SERIES 2021 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 2021 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2021 BONDS.] PART III, LINES 3A AND 3B: ASPIRUS, INC., THE PARENT ORGANIZATION OF APIRUS STANLEY HOSPITAL INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW LEASE AGREEMENTS, 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. SCHEDULE K, PART III, LINE 9 SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES THAT WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. 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 THE BOARD OF DIRECTORS IS COMPRISED OF TEN DIRECTORS. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS MEMBER CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS, CONSISTING OF THREE NOMINATED BY THE NOMINATING COMMITTEE AND THREE NOMINATED BY ASPIRUS, INC. WITH CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD, AND ELECTED BY ASPIRUS, INC., TWO ASPIRUS MEMBER CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTOR FROM EACH HOSPITAL, CONSISTING OF PHYSICIANS IN THE ACTIVE CATEGORY OF THE MEDICAL STAFF AT THE HOSPITAL, 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 SOLE MEMBER OF THE ORGANIZATION, ASPIRUS, INC.: 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 AND 990-T INFORMATION, INCLUDING THE UBIT CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 AND 990-T ARE 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 BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL MANAGERS ARE REQUIRED TO SIGN BIANNUAL CONFLICT OF INTEREST STATEMENTS. THE ORGANIZATION'S CEO AND BOARD CHAIR REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTION WHERE A CONFLICT HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, 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 DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, NOR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,804,783. MANAGEMENT AND GENERAL EXPENSES 73,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,877,783. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS - AWH 97,257. INTERCOMPANY TRANSFERS - AI -909,042. INTERCOMPANY TRANSFERS - AMG 17,890. INTERCOMPANY TRANSFERS - AIW 175. INTERCOMPANY TRANSFERS - AIR -159. INTERCOMPANY TRANSFERS - ARH -362. INTERCOMPANY TRANSFERS - ADS 21. INTERCOMPANY TRANSFERS - AMH -14,106. INTERCOMPANY TRANSFERS - AKH 8. INTERCOMPANY TRANSFERS - ASP 14,732. INTERCOMPANY TRANSFERS - AMR 313,443. INTERCOMPANY TRANSFERS - ARN -126,505. INTERCOMPANY TRANSFERS - AER 49,387. 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