2024-05-15T10:39:04-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 390806250 DIVINE SAVIOR HEALTHCARE INC DIVI 6087424131 PO BOX 387 2817 NEW PINERY ROAD PORTAGE WI 53901 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 ASPIRUS DIVINE SAVIOR HOSPITAL & CLINICS INC MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 81019038 0 X WWW.ASPIRUS.ORG X 1917 WI WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. X 5 1 625 10 0 0 2483258 906324 89909017 78891194 1615992 854881 132482 84410 94140749 80736809 10000 35253 0 0 46948082 37746747 0 0 0 51821633 54794474 98779715 92576474 -4638966 -11839665 138487582 86627338 48226517 36629079 90261065 49998259 X WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 0 1 58184909 35253 63103963 ASPIRUS DIVINE SAVIOR HOSPITAL & CLINICS, INC. IS A 73-BED HOSPITAL CAMPUS, LOCATED IN PORTAGE, WI, PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2023, ASPIRUS DIVINE SAVIOR HOSPITAL & CLINICS, INC. TREATED APPROXIMATELY 1,074 ADULTS AND CHILDREN FOR A TOTAL OF APPROXIMATELY 3,911 PATIENT DAYS OF SERVICE. ASPIRUS DIVINE SAVIOR HOSPITAL & CLINICS, INC. ALSO OFFERS A WIDE ARRAY OF OUTPATIENT SERVICES TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. EMERGENCY ROOM, URGENT CARE, SURGERY, AMBULANCE, RENAL DIALYSIS, AND REHABILITATION SERVICES ARE AMONG MANY OF THE OUTPATIENT SERVICES PROVIDED. THE HOSPITAL AND ASSOCIATED CLINICS ALSO PROVIDED SERVICES FOR APPROXIMATELY 91,107 OUTPATIENT VISITS, WHICH INCLUDED APPROXIMATELY 2,743 OUTPATIENT SURGERIES AND APPROXIMATELY 15,396 EMERGENCY ROOM VISITS DURING FISCAL YEAR 2023. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 19541215 0 12442200 TOTAL CLINIC VISITS FOR FISCAL YEAR 2023 WERE 52,845. THESE CLINICS PROVIDE FAMILY PRACTICE, INTERNAL MEDICINE, PHYSIATRY, OB, ORTHOPEDICS, AND SURGICAL SERVICES, AMONG MANY OTHER CLINICAL SERVICES OFFERED TO PATIENTS IN THE COMMUNITY, AND WORK TOGETHER WITH THE HOSPITAL SERVICES OF ADS IN AN EFFORT TO COORDINATE HOSPITAL AND CLINICAL CARE TO PROVIDE CONVENIENT, COST-EFFECTIVE CARE TO MEMBERS OF THE COMMUNITY. THE RURAL OXFORD CLINIC IS IN A HEALTH SHORTAGE AREA TO BETTER MEET THE RESIDENTS OF THIS COMMUNITY CLOSER TO THEIR HOMES.THE CLINICS SERVICE A LARGE PORTION OF ELDERLY, DISABLED, AND LOW-INCOME PATIENTS WHO ARE COVERED UNDER THE MEDICARE AND WISCONSIN MEDICAL ASSISTANCE PROGRAMS. THE CLINICS ARE OFTEN REIMBURSED FROM THESE PROGRAMS AT RATES WELL BELOW THE COST OF CARING FOR THESE PATIENTS, HOWEVER, IT IS ADS'S MISSION IN THE COMMUNITY TO PROVIDE CARE TO THESE PATIENTS.PATIENTS OF THE ADS CLINICS ARE ALSO ELIGIBLE FOR THE ORGANIZATION'S CHARITY AND COMMUNITY CARE PROGRAMS WHICH PROVIDE FREE OR REDUCED CARE TO INDIVIDUALS AND FAMILIES BASED ON INCOME AND ASSET GUIDELINES. THE FIGURES PRESENTED IN STATEMENT 4A OF THE HOSPITAL PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE CHARITY CARE AMOUNTS PROVIDED TO CLINIC PATIENTS AS WELL. ADDITIONAL INFORMATION ON THE CHARITY CARE POLICIES CAN ALSO BE FOUND IN SCHEDULE H (HOSPITALS) OF THE FORM 990. 5771191 0 3345031 ADS OWNS AND OPERATES AN 83-BED EXTENDED CARE FACILITY AND 40-BED ASSISTED LIVING FACILITY. THE EXTENDED CARE FACILITY OFFERS SKILLED AND INTERMEDIATE CARE NURSING FOR RESIDENTS WHO REQUIRE SHORT-TERM REHABILITATION PROGRAMS OR LONG-TERM CARE. THE FACILITY ALSO OFFERS MEDICATION MANAGEMENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, IV THERAPY, AND NUTRITION SERVICES, AS WELL AS ACCESS TO OTHER HEALTHCARE AND HOSPITAL SERVICES OFFERED BY ADS'S HOSPITAL PROGRAMS. IN 2023, 5,841 RESIDENT DAYS OF CARE AND 7,775 ASSISTED LIVING DAYS WERE PROVIDED BY THE EXTENDED CARE FACILITY. A MAJORITY OF THE RESIDENTS RECEIVE CARE UNDER THE WISCONSIN MEDICAL ASSISTANCE OR FAMILY CARE PROGRAMS. ADS RECOGNIZES THAT THE COST OF CARING FOR THESE INDIVIDUALS OFTEN EXTENDS BEYOND THE AMOUNT THAT IS PAID TO THE FACILITY BY THE MEDICAL ASSISTANCE PROGRAM. RESIDENTS OF THE EXTENDED CARE FACILITY AT ADS WHO HAVE EXHAUSTED ALL OTHER PROGRAMS SUCH AS MEDICAL ASSISTANCE OR THE WISCONSIN FAMILY CARE PROGRAM ARE ALSO ABLE TO APPLY FOR DISCOUNTED OR FREE CARE FOR HOSPITAL OR CLINICAL SERVICES UNDER THE ORGANIZATION'S CHARITY AND COMMUNITY CARE PROGRAMS AS DESCRIBED EARLIER NOTING THE HOSPITAL AND CLINIC PROGRAM SERVICE ACCOMPLISHMENTS. SINCE MOST EXTENDED CARE CHARGES ARE COVERED UNDER WISCONSIN MEDICAL ASSISTANCE PROGRAMS WHEN INCOME LEVELS ARE BELOW ESTABLISHED GOVERNMENT STANDARDS, THESE PROGRAMS ARE MOST OFTEN UTILIZED AS A SOURCE OF PAYMENTS FOR MANY RESIDENTS. IF THESE MEDICAL ASSISTANCE PROGRAMS ARE NOT AVAILABLE DUE TO A UNIQUE CIRCUMSTANCE, THE RESIDENT'S STAY MAY BE EVALUATED FOR CHARITY OR COMMUNITY CARE ON A CASE BY CASE BASIS BY ADMINISTRATION OF THE ORGANIZATION. THE EXTENDED CARE PROGRAM ENDED FEBRUARY 2023. 83497315 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 0 0 625 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 1 1 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 ERIC ANDERSON CHAIR/SVP-SERVICE & PATIENT EXP. 1.00 50.00 X 0 519926 106843 JESSE TISCHER VICE CHAIR/SVP & PRES. REG. MKTS. 1.00 50.00 X X 0 781575 128595 JOSHUA M POGORELEC DO BOARD MEMBER/PHYSICIAN 40.00 X 0 687218 50208 SUSAN H KRECKMAN MD BOARD MEMBER/PHYSICIAN 40.00 X 0 347629 50684 TRAVIS HAMELE CHAIRPERSON (THRU 09/22) 3.00 X X 0 0 0 LYNN M VOGT SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 ROBERT CRAWFORD BOARD MEMBER (THRU 09/22) 1.00 X 0 0 0 LOUIS HEITKE BOARD MEMBER (THRU 09/22) 2.50 X X 0 0 0 ROBIN KVALO BOARD MEMBER (THRU 09/22) 1.00 X 0 0 0 CHAD STEVENSON BOARD MEMBER (THRU 09/22) 1.00 X 0 0 0 ROB WALZ BOARD MEMBER (THRU 10/22) 1.00 X 0 0 0 MICHAEL HOLZHUETER ASSIST. SEC./SVP-GENERAL COUNSEL 2.00 50.00 X 0 672916 123676 CRYSTAL KIRSCHLING INTERIM PRESIDENT/VP-REGIONAL INTEGRATION OFFICER 1.00 40.00 X 0 120187 19469 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 1911464 144118 BRIAN KIEF (NV) BOARD MEMBER/PRESIDENT-ADS 1.00 40.00 X 0 311163 38822 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1799938 311110 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 2.00 50.00 X 0 539401 110893 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 2.00 50.00 X 0 321116 49427 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 KIMBERLY JOHNSON VP-PATIENT CARE & CNO 2.00 50.00 X 0 245213 41637 SCOTT REMMICH VP-CHIEF COMPLIANCE OFFICER 2.00 50.00 X 0 304493 45336 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 534868 104438 JANIS BAUMAN VP-PATIENT CARE & CNO 50.00 2.00 X 291825 0 32622 JOESPH MUELLER PHYSICIAN 40.00 X 0 634797 51965 DOUGLAS ARNOLD PHYSICIAN 40.00 X 0 601492 59220 WALTER KAO PHYSICIAN 40.00 X 0 519632 9834 BRAD ROGOWSKI PHYSICIAN 40.00 X 0 523937 53220 MICHAEL KUKLINSKI PHYSICIAN 40.00 X 0 487299 54906 MICHAEL WALTERS FORMER KE/VP-SEN. SYS. PHYS. EXEC. 2.00 50.00 X 0 699878 54614 291825 13525013 1840740 44 1 1 0 TOTAL MSP LLC 221 WEST COLLEGE AVE APPLETON WI 54944 STAFFING SERVICE 4512598 NOVUS WISCONSIN SERVICE CORP PO BOX 12766 PENSACOLA FL 32591 STAFFING SERVICE 2558093 DAILY CARE LLC 323 N MORRISON ST STE100 APPLETON WI 54911 CREDENTIALING SERVICES 1540809 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 STAFFING SERVICE 1071227 RENOVO SOLUTIONS LLC 4 EXECUTIVE CIRCLE STE 185 IRVINE CA 92614 MAINTENANCE SERVICE 741110 24 850605 55719 906324 PATIENT SERVICE REVENUE 621990 61808378 61808378 CLINIC REVENUE 623000 12442200 12442200 EXTENDED CARE FACILITY REVENUE 621110 3345031 3345031 1295585 1295585 78891194 1137110 1137110 13000 0 13000 13000 13000 275907 6322 -275907 -6322 -282229 -282229 CAFETERIA REVENUE 722514 71410 71410 71410 80736809 78891194 0 939291 X 35253 35253 563937 563937 30682491 26786720 3895771 757564 708099 49465 3846197 2916911 929286 1896558 1617919 278639 10875 10875 5660 5660 15166745 13621685 1545060 99551 99551 134504 62077 72427 80359 22506 57853 1875600 838 1874762 167083 137023 30060 97608 97608 624281 624281 5880788 2045541 3835247 212210 36044 176166 CORPORATE ALLOCATIONS 13753781 24855897 -11102116 MEDICAL SUPPLIES 9362447 9084834 277613 BAD DEBT EXPENSE 2712565 2712565 REPAIRS AND MAINTENANCE 2484942 1291328 1193614 2125475 177032 1948443 92576474 83497315 9079159 0 961292 1361679 5435352 13605299 10578985 1398492 1283612 614181 355858 145746555 79299989 69231180 66446566 42105546 525258 5136240 6075380 138487582 86627338 4867850 3209130 664096 54615 34914514 32434039 7780057 931295 48226517 36629079 X 90230825 49913627 30240 84632 90261065 49998259 138487582 86627338 X -11839665 -458182 -27964959 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 10875 10875 0 PART II-B, LINE 1: ADS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE WHA HAS NOTIFIED ADS THAT APPROXIMATELY $2,647 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. ADS IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, ADS PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT APPROXIMATELY $1,492 OF THE FEES PAID BY DIVINE SAVIOR HEALTHCARE IN FISCAL YEAR 2023 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. ADS PAID AHA DUES OF $24,682 OF WHICH 27.29% IS FOR LOBBYING OR $6,736. 5041760 5041760 96414223 48292961 48121262 42750937 31007028 11743909 1539635 1539635 66446566 DEFERRED COMPENSATION 364980 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 5710400 6075380 MEDICARE ACCELERATED PAYMENTS 566315 DEFERRED COMPENSATION 364980 931295 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 514551 514551 0.00570 15782363 7370015 8412348 0.09360 16296914 7370015 8926899 0.09930 79820 79820 0.00090 32746 32746 0.00040 35253 35253 0.00040 147819 147819 0.00170 16444733 7370015 9074718 0.10100 1 40 260 260 0.00000 1 25 108 108 0.00000 2 65 368 368 0.00000 1 1132959 0 11354493 18791230 -7436737 X 1 1 1 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTAGE WI 53901 WWW.ASPIRUS.ORG 80 X X X DIVINE SAVIOR HEALTHCARE INC 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART V, SECTION C, LINE 7D X 1 21 1 HTTPS://WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS 0 1 X 200.000000000000 300.000000000000 X 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 DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 5: FOR THE CHNA COMPLETED IN FY22 (SPRING 2022), COLUMBIA COUNTY COMMUNITY MEMBERS PROVIDED FEEDBACK ON COMMUNITY HEALTH NEEDS THROUGH A COMMUNITY SURVEY AND KEY INFORMANT INTERVIEWS. APPROXIMATELY 650 PEOPLE RESPONDED TO THE COMMUNITY SURVEY AND TWENTY-SEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED. AN INTENTIONAL EFFORT WAS MADE TO ENSURE THAT THE INDIVIDUALS AND ORGANIZATIONS REPRESENTED THE NEEDS AND PERSPECTIVES OF: 1) PUBLIC HEALTH PRACTICE; 2) INDIVIDUALS WHO ARE MEDICALLY UNDERSERVED, LOW INCOME, OR ARE CONSIDERED AMONG THE MINORITY POPULATIONS SERVED BY THE HOSPITAL; AND 3) THE BROADER COMMUNITY AT LARGE AND THOSE WHO REPRESENT THE BROAD INTERESTS AND NEEDS OF THE COMMUNITY SERVED. THE COMMUNITY SURVEY, DEVELOPED AND DISTRIBUTED BY ASPIRUS DIVINE SAVIOR AND COLUMBIA COUNTY HEALTH DEPARTMENT, WAS CONDUCTED IN FALL 2021. THE SURVEY WAS AVAILABLE IN SPANISH AND WAS DISTRIBUTED ELECTRONICALLY AND ON PAPER. NUMEROUS ORGANIZATIONS INCLUDING LIBRARIES, CHAMBERS OF COMMERCE, COLUMBIA COUNTY HEALTH DEPARTMENT, AGING AND DISABILITY RESOURCE CENTER, FOOD PANTRIES, COALITIONS AND MORE DISTRIBUTED THE SURVEY. KEY INFORMANTS PROVIDING INPUT ON THE TOP ISSUES INCLUDED REPRESENTATIVES FROM MULTIPLE SECTORS AND GROUPS: EDUCATION; AGING; SUBSTANCE USE AND RECOVERY; FAITH; RECREATION; HEALTH CARE; YOUTH SERVICES; MEDIA; ELECTED PUBLIC OFFICE; OTHER. DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 6B: FOR THE CHNA COMPLETED IN FY22 (SPRING 2022), ASPIRUS DIVINE SAVIOR COLLABORATED WITH THE COLUMBIA COUNTY HEALTH DEPARTMENT TO COMPLETE THIS WORK. COLUMBIA COUNTY HEALTH DEPARTMENT CONTRACTED WITH UNIVERSITY OF WISCONSIN-OSHKOSH FOR DATA ANALYSIS AND WISCONSIN COMMUNITY HEALTH ALLIANCE FOR PROCESS FACILITATION. ASPIRUS DIVINE SAVIOR HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS DIVINE SAVIOR HOSPITAL. DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A:HTTPS://WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS DIVINE SAVIOR HEALTHCARE, 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. IN FY23, ASPIRUS DIVINE SAVIOR HOSPITAL'S SIGNIFICANT NEEDS WERE MENTAL HEALTH AND SUBSTANCE USE. THE HOSPITAL ADDRESSED THOSE AND OTHER NEEDS IN THE FOLLOWING WAYS. MENTAL HEALTHIN FY23 THE HOSPITAL PURCHASED A VERTICAL GARDEN FOR THE BOYS & GIRLS CLUB. THE BOYS & GIRLS CLUB IS NEW IN THE COMMUNITY AND IS DEVELOPING PROGRAMING TO ADDRESS YOUTH ACADEMICS, SOCIAL DEVELOPMENT AND PHYSICAL HEALTH. IN FY22 THE HOSPITAL PROVIDED FINANCIAL SUPPORT TO OPEN A BOYS & GIRLS CLUB. ASPIRUS DIVINE SAVIOR PROVIDED FUNDING FOR A MENTAL HEALTH FIRST AID COURSE. TWELVE PEOPLE ATTENDED THE TRAINING. THE HOSPITAL IS PART OF THE PREVENT SUICIDE COALITION AND THE PREVENTION AND RESPONSE COALITION. COALITION EFFORTS INCLUDED: - PROVIDING FUNDING TO SCHOOLS TO IMPLEMENT SOURCES OF STRENGTH.- BEGINNING TO PLAN A MENTAL HEALTH ANTI-STIGMA CAMPAIGN.- CREATING A MENTAL HEALTH RESOURCES BROCHURE. FIVE HUNDRED WERE PRINTED AND A PORTION HAVE BEEN DISTRIBUTED. ASPIRUS STAFF DISTRIBUTED BROCHURES INTERNALLY (E.G., TO CLINICS, THE EMERGENCY DEPARTMENT AND CARE COORDINATION) AND EXTERNALLY.- PLANNING AND IMPLEMENTING THE FALL 2023 WALK FOR HOPE. ASPIRUS STAFF WAS THE CHAIR OF THE PLANNING COMMITTEE AND THE HOSPITAL CONTRIBUTED FINANCIALLY.- DISTRIBUTING GUN LOCKS AND MEDICATION LOCK BOXES TO REDUCE ACCESS TO MEANS OF SUICIDE.SUBSTANCE USEASPIRUS DIVINE SAVIOR HAS A MEDICATION DROP BOX IN THE FRONT ENTRANCE. THIS ASSURES UNUSED PRESCRIPTION DRUGS ARE DISPOSED OF IN THE APPROPRIATE MANNER. PHARMACY STAFF SPEND ABOUT 1 HOUR PER WEEK DISPOSING OF THE MEDICATIONS. THEY COLLECTED 792 POUNDS FOR THE YEAR.AT THE START OF FY23, ASPIRUS DIVINE SAVIOR CONTRACTED WITH SATORI HOUSE TO PROVIDE RECOVERY COACHING TO PATIENTS IN THE EMERGENCY DEPARTMENT. DURING FY23, SATORI HOUSE DISBANDED. AS A RESULT, ASPIRUS STARTED WORKING WITH THREE BRIDGES RECOVERY TO BRING THE GRANT-FUNDED PROGRAM BACK. ASPIRUS HEALTH FOUNDATION AND THE HOSPITAL PROVIDED FUNDING TO INCLUDE RECOVERY COACHING SERVICES THAT WERE NOT COVERED UNDER THE ED2 RECOVERY GRANT.THE HOSPITAL PROVIDED FUNDING TO SUPPORT HARBOR RECOVERY CENTER. HARBOR RECOVERY CENTER PROVIDES SERVICES AND SUPPORT TO INDIVIDUALS AND THEIR FAMILIES WHO ARE STRUGGLING WITH SUBSTANCE USE AND/OR MENTAL HEALTH. THEY ALSO PROVIDE EDUCATIONAL OPPORTUNITIES AND EVENTS TO BUILD A RECOVERY CULTURE. IN 2022, 114 WERE SERVED THROUGH PRIMARY SERVICES AND 907 THROUGH SECONDARY SERVICES. IN 2023, 195 WERE SERVED THROUGH PRIMARY SERVICES AND 1800 THROUGH SECONDARY SERVICES. (AMOUNTS FOR CALENDAR 2023 ARE PRELIMINARY.) SECONDARY SERVICES WOULD INCLUDE ANYTHING THAT IS NOT A ONE-ON-ONE SESSION. EXAMPLES OF SECONDARY SERVICES ARE FAMILY MEALS, EVENTS AND SUPPORT GROUPS. ASPIRUS DIVINE SAVIOR STAFF SERVED ON THE PREVENTION AND RESPONSE COLUMBIA COUNTY COALITION. THIS COALITION COLLABORATES WITH COLUMBIA COUNTY COMMUNITIES TO IDENTIFY, GUIDE, SUPPORT, LEAD AND ADVOCATE FOR PREVENTION AND RECOVERY STRATEGIES TO DECREASE THE OCCURRENCE OF SUBSTANCE ABUSE IN COLUMBIA COUNTY. A STAFF MEMBER ALSO ATTENDED THE OVERDOSE FATALITY REVIEW MEETINGS WHICH IS A PROCESS FOR UNDERSTANDING THE RISK FACTORS AND CIRCUMSTANCES LEADING TO FATAL OVERDOSES AND IDENTIFYING OPPORTUNITIES TO PREVENT FUTURE OVERDOSES.OTHERASPIRUS DIVINE SAVIOR PARTICIPATED IN THE ASPIRUS FRUIT AND VEGETABLE PRESCRIPTION (FVRX) PROGRAM IN FY23. IN JULY 2022, SEVERAL VOUCHERS WERE GIVEN TO PATIENTS. THE PROGRAM STARTED FULLY IN MAY OF 2023. THE SEASON CONCLUDED IN FALL 2023. ASPIRUS DIVINE SAVIOR ADDED RESOURCES TO THE FINDHELP SOCIAL NEEDS PLATFORM. THE PLATFORM IS INTEGRATED INTO ASPIRUS' ELECTRONIC HEALTH RECORD AND SUPPORTS PROVIDERS IN IDENTIFYING RESOURCES TO MEET PATIENTS' SOCIAL NEEDS (E.G., TRANSPORTATION, HOUSING, FOOD). THE HOSPITAL CONTINUES TO SUPPORT THE COMMUNITY WITH ITS MEDICALLY INTEGRATED WELLNESS CENTER, LA VITA. COMMUNITY MEMBERS CAN ACCESS THE SERVICES.ASPIRUS DIVINE SAVIOR IS REPRESENTED ON THE PORTAGE AREA UNITED WAY BOARD. THE HOSPITAL ALSO PROVIDED FINANCIAL SUPPORT. THE PORTAGE AREA UNITED WAY IS AN ORGANIZATION THAT PROVIDES FUNDING TO PORTAGE AREA AGENCIES WHO PROVIDE MUCH NEEDED SERVICES TO THOSE IN OUR COMMUNITY THAT NEED IT MOST.THE HOSPITAL PROVIDED FUNDING FOR KINSHIP MENTORING. KINSHIP MENTORING MATCHES SAFE, NURTURING ADULT MENTORS WITH AREA YOUTH, SO THEY REACH THEIR FULL POTENTIAL AND BECOME POSITIVE CONTRIBUTORS TO SOCIETY.THE HOSPITAL PROVIDED FUNDING FOR A COMMUNITY SHARING SUPPER. THE COMMITTEE PREPARES A FREE MEAL WHICH IS PROVIDED IS OPEN TO ALL COMMUNITY MEMBERS.ASPIRUS DIVINE SAVIOR PROVIDES MULTIPLE PROGRAMS FOR THE COMMUNITY, INCLUDING A BRAIN HEALTH PRESENTATION AT THE AGING AND DISABILITY RESOURCE CENTER AS WELL AS SUPPORT GROUPS FOR INDIVIDUALS WITH DIABETES AND INDIVIDUALS WITH A BRAIN INJURY OR STROKE.------THE THREE NEEDS THAT WERE PRIORITIZED IN THE COMMUNITY STAKEHOLDER MEETING AND WILL NOT BE FORMALLY PURSUED BY THE HOSPITAL IN ITS IMPLEMENTATION STRATEGY ARE: - LACK OF COMMUNICATION BETWEEN PARTNERS- LACK OF HEALTH CARE PROVIDERS- TRANSPORTATION THE HOSPITAL VIEWS COMMUNICATION, HEALTH CARE PROVIDERS AND TRANSPORTATION AS CONTRIBUTORS TO THE ISSUES OF MENTAL HEALTH AND SUBSTANCE USE. WHILE THESE ARE NOT THE HOSPITAL'S FORMAL PRIORITIES, THEY MAY BE PART OF THE STRATEGY TO ADDRESS THE PRIORITY NEEDS AROUND MENTAL HEALTH AND SUBSTANCE USE. DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 13H: THE CHARITABLE CARE POLICY OF DIVINE SAVIOR HEALTHCARE, INC. ALSO ALLOWS FOR AN ADMINISTRATIVE DETERMINATION FOR A PATIENT THAT MAY UNDERGO A CATASTROPHIC EVENT OR UNIQUE CIRCUMSTANCE. THIS ADDITIONAL PROVISION ALLOWS FOR ADMINISTRATION TO MAKE A DETERMINATION THAT MAY ASSIST A PATIENT IN A UNIQUE TIME OF FINANCIAL NEED. 5 1 - ASPIRUS PORTAGE CLINIC 2817 NEW PINERY ROAD PORTAGE WI 53901 PHYSICIAN CLINIC 2 - ASPIRUS DIVINE SAVIOR WELLNESS CENTER 2815 NEW PINERY ROAD PORTAGE WI 53901 WELLNESS CENTER 3 - ASPIRUS TIVOLI COMMUNITY 2805 HUNTERS TRAIL PORTAGE WI 53901 SNF, ALF, AND HOME HEALTH PROGRAM - CLOSED FY2023 4 - ASPIRUS OXFORD CLINIC N4390 CROSSROADS CLINIC ROAD OXFORD WI 53952 PHYSICIAN CLINIC 5 - ASPIRUS PARDEEVILLE CLINIC 102 GILLETTE STREET PARDEEVILLE WI 53954 PHYSICIAN CLINIC - CLOSED FY 2023 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 6A: DIVINE SAVIOR HEALTHCARE, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S WEBSITE. 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 ASPIRUS SKILLED NURSING FACILITIES/EXTENDED CARE UNITS. DIVINE SAVIOR HEALTHCARE, INC. UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. SKILLED NURSING FACILITIES/EXTENDED CARE UNIT REPORTED COSTS OF $60,639 WITH OFFSETTING REVENUE OF $98,796. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24E, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $2,712,565. PART II, COMMUNITY BUILDING ACTIVITIES: ONE OF THE PRIMARY FACTORS IMPACTING A PERSON'S HEALTH IS THEIR INCOME. IN GENERAL, INDIVIDUALS WITH LOW INCOME HAVE SHORTER LIFESPANS AND LOWER QUALITY OF LIFE (FROM A PHYSICAL HEALTH PERSPECTIVE). ASPIRUS' INVOLVEMENT IN WORKFORCE AND/OR ECONOMIC DEVELOPMENT BOARDS HELPS THE COMMUNITY GAIN STRENGTH IN TERMS OF A DIVERSE ECONOMY, WELL-PAYING JOBS (TO SUPPORT A HIGHER INCOME) AND THE INFRASTRUCTURE (E.G., CHILD CARE) NEEDED FOR A ROBUST ECONOMY. EVERY COMMUNITY DESERVES STRONG HEALTH CARE SERVICES. IN ORDER TO HAVE A STRONG HEALTH CARE SYSTEM, A STRONG HEALTH CARE WORKFORCE IS NEEDED. ONE WAY TO EXPAND THE PIPELINE OF HEALTH CARE WORKERS IS TO OFFER OPPORTUNITIES ABOUT HEALTH CARE CAREERS TO YOUTH STILL IN SCHOOL. HEALTH CAREERS INFORMATION CAN INCREASE YOUNG PEOPLE'S INTEREST IN HEALTH CAREERS AND INCREASE THE NUMBER OF NEW HEALTH CARE WORKERS IN THE FIELD. 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 FROM 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 REGIONAL BOARD OF DIRECTORS, WITH LOCAL REPRESENTATION. HOSPITAL BOARD MEMBERS ARE FROM MULTIPLE SECTORS, INCLUDING ACADEMIA, INDUSTRY/BUSINESS, PHILANTHROPY, FINANCE, AND HEALTHCARE.- SUPPORTS ITS STAFF IN PARTICIPATING ON AND PRESENTING TO COMMUNITY BOARDS AND COMMITTEES THAT PROVIDE INSIGHT ON LOCAL CIRCUMSTANCES.- REVIEWS FUNDING REQUESTS TO THE HOSPITAL 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 COLUMBIA COUNTY, ALTHOUGH IT DOES SERVE NEIGHBORING COUNTIES INCLUDING MARQUETTE AND ADAMS. THE HOSPITAL IS LOCATED IN COLUMBIA COUNTY, POPULATION 58,488. COLUMBIA COUNTY IS CLASSIFIED AS URBAN (ALTHOUGH IT ALSO HAS RURAL AREAS) AND IT COVERS 765 SQUARE MILES AND HAS 76.4 PEOPLE PER SQUARE MILE. HERE ARE SOME DETAILS ABOUT ITS POPULATION: PERSONS UNDER 18 YEARS OLD: 21%PERSONS 65 YEARS AND OVER: 18.4%WHITE PERSONS: 95.3%AFRICAN AMERICAN PERSONS: 1.7%HISPANIC OR LATINO: 3.7%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 5.1%HIGH SCHOOL GRADUATE OR HIGHER: 93.3%PERSONS BELOW POVERTY LEVEL: 6.9%MEDIAN HOUSEHOLD INCOME: $69,262PERCENT UNINSURED: 6%PERCENT USING PUBLIC INSURANCE (MEDICAID, MEDICARE, VETERANS BENEFITS, ETC.): 32.5%NUMBER OF HOSPITALS IN THE COUNTY: 2 (INCLUDING ASPIRUS DIVINE SAVIOR HOSPITAL)COLUMBIA COUNTY IS NOT A DESIGNATED HEALTH PROFESSIONS SHORTAGE AREA (HPSA) FOR MENTAL HEALTH, DENTAL CARE OR PRIMARY CARE. THE CITY OF PORTAGE (IN COLUMBIA COUNTY) IS A POPULATION-DESIGNATED HPSA FOR MENTAL HEALTH. NEIGHBORING MARQUETTE AND ADAMS COUNTIES ARE SHORTAGE AREAS FOR MENTAL HEALTH, DENTAL CARE AND PRIMARY CARE. 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. - PROMOTES AND HOSTS 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 WI 1 THREE BRIDGES RECOVERY WISCONSIN INC 441 GARFIELD STREET WISCONSIN RAPIDS WI 54494 825015616 501(C)(3) 10000 0 SUBSTANCE ABUSE/ADDITION RECOVERY PROGRAM SUPPORT HARBOR RECOVERY CENTER PO BOX 803 PORTAGE WI 53901 873034870 501(C)(3) 10000 0 SUBSTANCE ABUSE/ADDITION RECOVERY PROGRAM SUPPORT 2 0 PART I, LINE 2: WHEN COMMUNITY BENEFIT FUNDS ARE DONATED TO LOCAL AGENCIES TO COMPLETE COMMUNITY HEALTH IMPROVEMENT EFFORTS, ASPIRUS REQUESTS A FORMAL REPORT AT THE CONCLUSION OF THE FISCAL YEAR. 1 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 JESSE TISCHER VICE CHAIR/SVP & PRES. REG. MKTS. 0 580082 0 150199 0 51294 0 18561 0 110034 0 910170 0 50242 MICHAEL HOLZHUETER ASSIST. SEC./SVP-GENERAL COUNSEL 0 479018 0 135622 0 58276 0 18672 0 105004 0 796592 0 55822 MICHAEL WALTERS FORMER KE/VP-SEN. SYS. PHYS. EXEC. 0 516368 0 106505 0 77005 0 17894 0 36720 0 754492 0 75493 JOSHUA M POGORELEC DO BOARD MEMBER/PHYSICIAN 0 661553 0 20000 0 5665 0 15184 0 35024 0 737426 0 0 JOESPH MUELLER PHYSICIAN 0 589365 0 40000 0 5432 0 17894 0 34071 0 686762 0 0 DOUGLAS ARNOLD PHYSICIAN 0 595952 0 0 0 5540 0 17894 0 41326 0 660712 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 INFORMATION OFFICER 0 378807 0 112026 0 44035 0 18079 0 86359 0 639306 0 39964 ERIC ANDERSON CHAIR/SVP-SERVICE & 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 BRAD ROGOWSKI PHYSICIAN 0 497695 0 20000 0 6242 0 17894 0 35326 0 577157 0 0 DEBRA BALL SVP & CHIEF HR OFFICER 0 349805 0 106987 0 2047 0 13179 0 90374 0 562392 0 0 MICHAEL KUKLINSKI PHYSICIAN 0 441804 0 40000 0 5495 0 17894 0 37012 0 542205 0 0 WALTER KAO PHYSICIAN 0 508019 0 0 0 11613 0 9150 0 684 0 529466 0 0 SUSAN H KRECKMAN MD BOARD MEMBER/PHYSICIAN 0 341512 0 0 0 6117 0 18710 0 31974 0 398313 0 0 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 0 267466 0 51102 0 2548 0 18436 0 30991 0 370543 0 0 BRIAN KIEF (NV) BOARD MEMBER/PRESIDENT-ADS 0 308548 0 0 0 2615 0 9472 0 29350 0 349985 0 0 SCOTT REMMICH VP-CHIEF COMPLIANCE OFFICER 0 251612 0 49272 0 3609 0 17778 0 27558 0 349829 0 0 JANIS BAUMAN VP-PATIENT CARE & CNO 236800 0 24740 0 30285 0 17528 0 15094 0 324447 0 23371 0 KIMBERLY JOHNSON VP-PATIENT CARE & CNO 0 211632 0 32803 0 778 0 13955 0 27682 0 286850 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH 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. PART I, LINES 4A-B MICHAEL DECKER RECEIVED A SEVERANCE PLAN PAYMENT OF $412,205 DURING CALENDAR YEAR 2022. SCHEDULE J, PART I, LINE 4B FILING ORGANIZATION INFORMATION - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: J. BAUMAN $23,371 SCHEDULE J, PART I, LINE 4B RELATED PARTY INFORMATION - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $195,109 J. TISCHER $50,242 J. MATHESON $32,339 M. HOLZHUETER $55,822 T. RICHARDSON $39,963 M. WALTERS $75,493 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 2020-06-29 39808745 REFUND 2008 ISSUE 0 0 0 A 2490571 39808745 139675 39669070 2020 0 1 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REVENUE BONDS, SERIES 2020 BONDS (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY DIVINE SAVIOR HEALTHCARE, INC. (EIN 39-0806250). THE PROCEEDS OF THE SERIES 2020 BONDS WERE USED TO REFINANCE THE DIVINE SAVIOR HEALTHCARE, INC., SERIES 2016 BONDS (REFINANCING OF SERIES 2006 BONDS) AND SERIES 2019 BONDS (REFINANCING OF SERIES 2009, 2012, 2014 BONDS). INFORMATION REGARDING THE SERIES 2020 BONDS IS REPORTED IN SCHEDULE K FOR THAT ORGANIZATION. FOR THE ENTITY THAT BORROWED FUNDS, THE INFORMATION REPORTED IN PART I, PART II AND PART III OF SCHEDULE K RELATES ONLY TO THE PORTION OF THE SERIES 2020 BONDS LOANED TO THE ORGANIZATION. FOR THE ENTITY THAT BORROWED FUNDS, THE INFORMATION REPORTED IN PART IV OF SCHEDULE K RELATES TO THE ENTIRE ISSUE OF THE SERIES 2020 BONDS. PART III, LINES 2, 3A, AND 3B: ASPIRUS, INC., THE PARENT ORGANIZATION OF DIVINE SAVIOR HEALTHCARE, 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. PART III, LINE 9: SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. INVESTMENT ACCOUNT (EQUITY SECURITIES, FIXED INCOME, ETC) 2023-01-01 81890068 FMV (HI/LO DAILY AVERAGE) 391328331 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 501(C)(3) 0 0 0 0 PART II THE ORGANIZATION TRANSFERRED THEIR INVESTED RESERVE ASSETS TO THEIR PARENT AND SUPPORTING ORGANIZATION, ASPIRUS INC. IN JANUARY OF 2023. FORM 990, PART III, LINE 3 THE EXTENDED CARE PROGRAM OFFERED BY THE ORGANIZATION ENDED IN FEBRUARY OF 2023. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS TRAVIS HAMELE AND CHAD STEVENSON HAD A FAMILY RELATIONSHIP. 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 11 VOTING DIRECTORS ALLOCATED AS FOLLOW. THERE SHALL BE FOUR CLASSES OF VOTING DIRECTORS: THE COMMUNITY CLASS, ASPIRUS CLASS, PROVIDER CLASS, AND SISTERS OF DIVINE SAVIOR (SDS) CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS (APPROVED BY MEMBER), TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTOR NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. AND ONE SDS CLASS DIRECTOR NOMINATED AND ELECTED BY SDS. 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 OFFICER; 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 REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND IS 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 PURPOSES OF DETERMINING COMPENSATION, DIVINE SAVIOR HEALTHCARE, INC. RELIES 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 AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G LAB FEES: PROGRAM SERVICE EXPENSES 829,871. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 829,871. CONTRACT NURSING AND OTHER LABOR FEES: PROGRAM SERVICE EXPENSES 11,445,209. MANAGEMENT AND GENERAL EXPENSES 286,438. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,731,647. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,346,605. MANAGEMENT AND GENERAL EXPENSES 1,258,622. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,605,227. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS - AWH 609,720. INTERCOMPANY TRANSFERS - AI -29,584,452. INTERCOMPANY TRANSFERS - ACI 898,159. INTERCOMPANY TRANSFERS - VNA 1,140. INTERCOMPANY TRANSFERS - AIW 61. INTERCOMPANY TRANSFERS - AIR -201. INTERCOMPANY TRANSFERS - ARH 31,861. INTERCOMPANY TRANSFERS - AKH -207. INTERCOMPANY TRANSFERS - ASP 44,471. INTERCOMPANY TRANSFERS - ASH -21. INTERCOMPANY TRANSFERS - AMH 725. INTERCOMPANY TRANSFERS - AMR 588. INTERCOMPANY TRANSFERS - ARN 7,410. INTERCOMPANY TRANSFERS - HYMC 25,787. 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