2024-05-15T09:52:09-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 391390638 ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS INC ASPI 7158472250 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 JERRY M YANG SVP - CHIEF FINANCIAL OFFICER 7158472250 2024-05-14 1 JERRY YANG 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 234434051 0 X WWW.ASPIRUS.ORG X 1981 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 9 5 1069 4 0 0 2969186 758211 186677096 232268990 12230 -849647 289351 365481 189947863 232543035 3234 43638 0 0 95892047 115490766 0 0 0 104036314 125321824 199931595 240856228 -9983732 -8313193 127420805 133447495 83063990 80866363 44356815 52581132 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 205100189 43638 231850948 ASPIRUS RHINELANDER HOSPITAL IS A 63-BED HOSPITAL CAMPUS (MAX 49 STAFFED DURING FY), AND ASPIRUS TOMAHAWK HOSPITAL IS A 18-BED CAMPUS, BOTH OF WHICH PROVIDE SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2023, ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS SERVICED THE COMMUNITY THROUGH A TOTAL OF APPROXIMATELY 10,580 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR APPROXIMATELY 115,863 OUTPATIENT VISITS, WHICH INCLUDED APPROXIMATELY 4,067 OUTPATIENT SURGERIES AND APPROXIMATELY 14,452 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.BEGINNING IN DECEMBER OF 2021, THE VARIOUS ASPIRUS CLINICS IN THE REGION WERE ALL REORGANIZED SO THAT THEY WERE INCLUDED UNDER ASPIRUS RHINELANDER HOSPITAL. 205100189 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 0 0 1 1 1 0 0 1 0 0 1069 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 5 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 JESSE TISCHER VICE CHAIR/SVP & PRESIDENT-REG. MKTS. 1.00 50.00 X X 0 781575 128595 ERIC ANDERSON BOARD MEMBER/SVP-SERV. LINE & PAT. EXP. 1.00 50.00 X 0 519926 106843 AMY SLETTE MD BOARD MEMBER/PHYSICIAN 1.00 50.00 X 0 236921 42607 HOLLY BEEDE-MCKINNEY BOARD MEMBER/NURSE PRACTITIONER 1.00 50.00 X 0 154588 8884 JUDY SMOLAREK RN CHAIR 1.00 2.00 X X 0 0 0 STEVE LAKING SECRETARY/TREASURER (THRU 09/22) 1.00 2.00 X X 0 0 0 SISTER ELIZABETH AMMAN OP BOARD MEMBER (THRU 04/23) 1.00 2.00 X 0 0 0 KELLY COURT SECRETARY/TREASURER 1.00 2.00 X X 0 0 0 KATE FERREL BOARD MEMBER 1.00 2.00 X 0 0 0 FATHER JIM FOSDICK BOARD MEMBER 1.00 2.00 X 0 0 0 ARTHUR C HELGERSON DDS BOARD MEMBER 1.00 2.00 X 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1799938 311110 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 1911464 144118 TERESA THEILER (NV) PRESIDENT-ASPIRUS NORTH DIV. 1.00 50.00 X 0 359198 69630 BRIAN KIEF (NV) PRES.-ASPIRUS SOUTH & SW DIV. 1.00 50.00 X 311163 0 38822 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 2.00 50.00 X 0 672916 123676 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 2.00 50.00 X 0 539401 110893 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 534868 104438 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 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 2.00 50.00 X 0 321116 49427 JANELLE KOMMERS-MARKGRAF VP-HUMAN RESOURCES NORTH REGION 2.00 50.00 X 0 236917 44327 TYLER HACK VP-FINANCE NORTH REGION 2.00 50.00 X 0 246807 27314 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 2.00 50.00 X 0 348443 48718 GREG SHAW VP-FINANCE NORTH REGION 2.00 50.00 X 0 220782 30975 LORI KNITT VP-PATIENT CARE & CNO 2.00 50.00 X 220343 0 27280 JASON TROXELL VP-CHIEF ADMIN OFFICER 2.00 50.00 X 0 182836 40204 STEVEN BROWN CLINICAL MEDICAL PHYSICIST 40.00 X 0 866824 46562 ANTHONY RUTKOWSKI PHARMACY MANAGER 40.00 X 0 824067 45728 CHIRASAKD RATANAWONG PHARMACIST 40.00 X 0 745961 43476 JOHNATHAN CURRIE PHARMACY SUPERVISOR 40.00 X 0 713644 46355 TIMOTHY RIPPLE PHARMACIST 40.00 X 0 710510 43689 531506 13889573 1882774 44 0 1 0 STAFFENCY LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACT LABOR 4142754 HAYES HEALTHCARE LLC PO BOX 88122 CHICAGO IL 606801122 PHYSICIAN SERVICES 1901860 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN SERVICES 1156565 COMPASS GROUP USA INC PO BOX 102289 ATLANTA GA 303682289 CONTRACT LABOR 1003465 FOCUSONE SOLUTIONS LLC PO BOX 850861 MINNEAPOLIS MN 554850861 CONTRACT LABOR 951291 25 730372 27839 758211 PATIENT SERVICE REVENUE 621990 195393558 195393558 LAB REVENUE 621500 21562372 21562372 PHARMACY REVENUE 456110 13991635 13991635 CONTRACT SERVICE REVENUE 900099 903383 903383 418042 418042 232268990 4353 4353 202795 0 202795 202795 202795 1000000 1854000 -854000 -854000 -854000 33846 37016 -3170 -3170 CAFETERIA/VENDING REVENUE 722514 165856 165856 165856 232543035 231850948 0 -66124 43638 43638 399644 399644 94343461 87665685 6677776 2604250 2486794 117456 12558854 11161235 1397619 5584557 4864220 720337 16466 16466 20357856 19844218 513638 10484 9484 1000 416641 326066 90575 226875 152609 74266 3279393 1052433 2226960 305208 266090 39118 120 120 2491055 387379 2103676 10789098 4173839 6615259 293193 9352 283841 MEDICAL SUPPLIES 40951654 40883217 68437 CORPORATE ALLOCATIONS 33033426 20404659 12628767 REPAIRS AND MAINTENANCE 5203332 4175431 1027901 BAD DEBT 2686479 2686479 5260544 4507241 753303 240856228 205100189 35756039 0 9400 11507 452313 483297 28297904 28802082 4148773 5078758 352038 289761 105760415 16048792 91673258 89711623 164807 272756 2322312 8797711 127420805 133447495 11676942 10011497 419936 0 68647572 69559538 2319540 1295328 83063990 80866363 X 44192008 52308376 164807 272756 44356815 52581132 127420805 133447495 X -8313193 16537510 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 16466 16466 0 PART II-B, LINE 1: ASPIRUS RHINELANDER & TOMAHAWK 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 $16,466 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 6497016 6497016 76883479 5685628 71197851 17944 10184 7760 21384305 10352349 11031956 977671 631 977040 89711623 340B RECEIVABLE 210861 OPERATING LEASE ASSET 233704 DUE FROM AFFILIATES 116280 ESTIMATED THIRD PARTY PAYOR SETTELEMENTS RECEIVABLE 6759558 DEFERRED COMPENSATION 245556 FINANCE LEASE ASSET 1231752 8797711 DUE TO AFFILIATES 121933 ESTIMATED THIRD PARTY PAYOR PAYABLES 694135 DEFERRED COMPENSATION 245556 OPERATING LEASE LIABILITY 233704 1295328 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 1507332 1507332 0.00630 33839146 20278406 13560740 0.05690 35346478 20278406 15068072 0.06320 38445 38445 0.00020 22316 22316 0.00010 43638 43638 0.00020 104399 104399 0.00050 35450877 20278406 15172471 0.06370 1 958800 0 29243053 41214267 -11971214 X 1 1 2 1 ASPIRUS RHINELANDER HOSPITAL 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 WWW.ASPIRUS.ORG/FIND-A-LOCATION/ASPIRU 138 X X X 2 ASPIRUS TOMAHAWK HOSPITAL 401 WEST MOHAWK DRIVE TOMAHAWK WI 54487 WWW.ASPIRUS.ORG/FIND-A-LOCATION/ASPIRU 1016 X X X X ASPIRUS RHINELANDER HOSPITAL 1 0 1 1 X X X X X X X X X 22 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS X 1 22 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 TOMAHAWK HOSPITAL 2 1 1 1 X X X X X X X X X 22 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS X 1 22 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 1 X 0 0 ASPIRUS RHINELANDER HOSPITAL PART V, SECTION B, LINE 2: THE HOSPITAL WAS ACQUIRED BY ASPIRUS, INC. IN AUGUST 2021 (FY22). ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 2: THE HOSPITAL WAS ACQUIRED BY ASPIRUS, INC. IN AUGUST 2021 (FY22). ASPIRUS RHINELANDER HOSPITAL PART V, SECTION B, LINE 5: AS PART OF THE ASPIRUS EAGLE RIVER HOSPITAL, ASPIRUS RHINELANDER HOSPITAL AND HOWARD YOUNG MEDICAL CENTER'S FY23 (SPRING 2023) COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, MULTIPLE OPPORTUNITIES FOR COMMUNITY INPUT WERE CONDUCTED. ALL INPUT OPPORTUNITIES WERE LED BY ONEIDA COUNTY HEALTH DEPARTMENT WITH COLLABORATION BY VILAS COUNTY HEALTH DEPARTMENT, FOREST COUNTY HEALTH DEPARTMENT, MARSHFIELD CLINIC HEALTH SYSTEM AND ASPIRUS. THE UNIVERSITY OF WISCONSIN-STOUT WAS CONTRACTED FOR SOME OF THE COMMUNITY INPUT OPPORTUNITIES. COMMUNITY SURVEYA COMMUNITY SURVEY WAS CONDUCTED IN WINTER 2022-23. THE SURVEY WAS DEVELOPED AND DISSEMINATED BY THE COMMUNITY PARTNERS LISTED ABOVE. SPECIFIC OUTREACH WAS MADE TO INDIVIDUALS: IN THE LGBTQ+ COMMUNITY; WHO ARE HISPANIC; IN RECOVERY; ACCESSING FOOD PANTRIES; ACCESSING HOMELESS SHELTERS; ACCESSING AGING AND DISABILITY RESOURCE CENTER SERVICES; ATTENDING THE LOCAL COLLEGE; ACCESSING DAY CARE SERVICES; ACCESSING LIBRARY SERVICES; ACCESSING WIC NUTRITION SERVICES; AND OTHERS. KEY INFORMANT INTERVIEWSAPPROXIMATELY 35 KEY INFORMANT INTERVIEWS WERE CONDUCTED IN EARLY 2023. INTERVIEW QUESTIONS FOCUSED ON THE ORGANIZATIONS' LEADERS' PERCEPTIONS OF NEEDS AND BARRIERS FOR THE POPULATION THEY SERVED. KEY INFORMANTS WERE FROM SCHOOLS, LAW ENFORCEMENT, HUMAN SERVICE CENTERS, SUBSTANCE USE RECOVERY ORGANIZATIONS, HEALTH DEPARTMENTS, LIBRARIES, FOOD PANTRIES, JOB SERVICES, HEALTH CARE, ELECTED OFFICIALS AND MORE. LEADERS FROM MULTIPLE BANDS OF AMERICAN INDIANS WERE ALSO INTERVIEWED. FOCUS GROUPS NINE FOCUS GROUPS WERE COMPLETED AND RESULTS WERE ANALYZED BY UW-STOUT, HOWEVER, THE FOCUS GROUP RESULTS WERE NOT AVAILABLE AT THE TIME OF THE HOSPITALS' PRIORITIZATION PROCESS. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 5: FOR THE CHNA COMPLETED IN FY23 (SPRING 2023), COMMUNITY MEMBERS FROM LINCOLN COUNTY PROVIDED INPUT ON THE TOP COMMUNITY HEALTH NEEDS THROUGH A COMMUNITY SURVEY, KEY INFORMANT INTERVIEWS, A COMMUNITY FORUM AND A COALITION PRIORITIZATION PROCESS. THE COMMUNITY SURVEY WAS COMPLETED BY 752 ADULTS IN FALL 2022 (SEPTEMBER-OCTOBER). THE SURVEY WAS DISTRIBUTED BY MULTIPLE COMMUNITY PARTNERS INCLUDING THE HEALTH DEPARTMENT, SOCIAL SERVICE AGENCIES, AND MORE. RESPONDENTS WERE ASKED ABOUT THEIR TOP COMMUNITY HEALTH CONCERNS AS WELL AS THE STRENGTHS OF THE COMMUNITY. TO FILL SOME GAPS NOTICED IN THE SURVEY, FIVE KEY INFORMANT INTERVIEW RESULTS WERE CONDUCTED IN NOVEMBER 2022. REPRESENTED SECTORS INCLUDED MANUFACTURING, AGENCIES SERVING VULNERABLE POPULATIONS, COMMUNITY ORGANIZATIONS, YOUTH GROUP, AND COMMUNITY LEADER. INTERVIEW QUESTIONS WERE ABOUT COMMUNITY STRENGTHS, CHALLENGES, OPPORTUNITIES AND THREATS. A COMMUNITY FORM WAS HELD IN JANUARY 2023 TO REVIEW DATA AND ROOT CAUSES OF HEALTH ISSUES. OVER 60 COMMUNITY STAKEHOLDERS WERE INVITED. THE LINCOLN COUNTY HEALTH DEPARTMENT FACILITATED AND CONTRIBUTED TO THE DISCUSSION. LASTLY, THE LIVE WILL LINCOLN PARTNERS LINCOLN COUNTY HEALTH DEPARTMENT, UNIVERSITY OF WISCONSIN-EXTENSION, ASPIRUS, LINCOLN COUNTY DEPARTMENT OF SOCIAL SERVICES AND THE AGING AND DISABILITY RESOURCE CENTER MET REGULARLY TO REVIEW DATA, SHAPE THE PROCESS AND FINALIZE THE RESULTS. ASPIRUS RHINELANDER HOSPITAL PART V, SECTION B, LINE 6A: FOR THE CHNA COMPLETED IN FY23 (SPRING 2023), THE HOSPITAL COLLABORATED WITH ASPIRUS EAGLE RIVER HOSPITALS, HOWARD YOUNG MEDICAL CENTER (PART OF ASPIRUS), AND MARSHFIELD MEDICAL CENTER-MINOCQUA. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 6A: FOR THE CHNA COMPLETED IN FY23 (SPRING 2023), ASPIRUS TOMAHAWK HOSPITAL COLLABORATED WITH ASPIRUS MERRILL HOSPITAL. ASPIRUS RHINELANDER HOSPITAL PART V, SECTION B, LINE 6B: FOR THE CHNA COMPLETED IN FY23 (SPRING 2023), ASPIRUS RHINELANDER HOSPITAL COLLABORATED WITH THE FOREST COUNTY HEALTH DEPARTMENT, THE ONEIDA COUNTY HEALTH DEPARTMENT AND THE VILAS COUNTY HEALTH DEPARTMENT. ASPIRUS RHINELANDER HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS RHINELANDER HOSPITAL. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 6B: FOR THE CHNA COMPLETED IN FY23 (SPRING 2023), ASPIRUS TOMAHAWK HOSPITAL COLLABORATED WITH THE LINCOLN COUNTY HEALTH DEPARTMENT. ASPIRUS TOMAHAWK HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS TOMAHAWK HOSPITAL. ASPIRUS RHINELANDER HOSPITAL 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. THE HOSPITAL IS IN RURAL NORTHERN WISCONSIN. BECAUSE OF THAT SETTING, COMMUNITY HEALTH EFFORTS ARE FREQUENTLY COMPLETED WITH OTHER REGIONAL PARTNERS, INCLUDING OTHER ASPIRUS HOSPITALS. THE FOLLOWING DESCRIPTIONS ARE REFLECTIVE OF ASPIRUS RHINELANDER, ASPIRUS EAGLE RIVER AND HOWARD YOUNG MEDICAL CENTER (ALSO WITH ASPIRUS) UNLESS OTHERWISE INDICATED. IN FY23, ASPIRUS RHINELANDER HOSPITAL'S SIGNIFICANT NEEDS WERE: MENTAL HEALTH; ALCOHOL AND OTHER DRUG USE; CHRONIC DISEASE. THE HOSPITAL ADDRESSED THOSE NEEDS IN THE FOLLOWING WAYS. MENTAL HEALTH AND ALCOHOL AND OTHER DRUG USE IN PART DUE TO THE KNOWLEDGE AND CAPACITY THAT THE RHINELANDER-BASED ASPIRUS KOLLER BEHAVIORAL HEALTH UNIT (PART OF THE HEALTH CARE SYSTEM) BRINGS TO THE AREA, THE HOSPITALS ARE A STRONG AND VALUED RESOURCE FOR COMMUNITY MENTAL HEALTH AND SUBSTANCE USE PREVENTION EFFORTS. STAFF EXPERTISE IS SHARED INTERNALLY AS WELL AS EXTERNALLY. EFFORTS ARE DESCRIBED BELOW. COALITION: ASPIRUS STAFF PARTICIPATED IN THE COMMUNITY OUTREACH PREVENTION EDUCATION (COPE) COALITION, WHICH IS THE REGION'S MENTAL HEALTH PROMOTION AND SUBSTANCE USE PREVENTION COALITION. ASPIRUS KOLLER BEHAVIORAL HEALTH STAFF CO-CHAIR THE MENTAL HEALTH AND SUICIDE PREVENTION SUBCOMMITTEE OF THE COALITION. SUBCOMMITTEE ACTIVITIES ARE DESCRIBED BELOW. - THE SUBCOMMITTEE CONDUCTED A NUMBER OF ACTIVITIES, INCLUDING: DEVELOPING A STRATEGY AROUND REDUCED ACCESS TO SUICIDE MEANS; PROMOTING AWARENESS (E.G., FOR MAY MENTAL HEALTH MONTH, SEPTEMBER SUICIDE PREVENTION WEEK, AND WORLD MENTAL HEALTH DAY (OCTOBER)). - QUESTION, PERSUADE, REFER (QPR) TRAININGS FOCUSED ON SUICIDE PREVENTION WERE COORDINATED BY THE SUBCOMMITTEE. OVER 150 PEOPLE WERE TRAINED IN QPR IN FY23. - THE SUBCOMMITTEE CREATED AND DISTRIBUTED STICKERS PROMOTING THE NEW 988 CRISIS LINE WITH THE QR CODE FOR MENTAL AND HEALTH AND SUBSTANCE USE/ABUSE SUPPORT AVAILABLE 24/7. IN FY23, ASPIRUS KOLLER BEHAVIORAL HEALTH STAFF ALSO: - PROVIDED MEDIA INTERVIEWS ON MENTAL HEALTH ISSUES. - ORGANIZED A MENTAL HEALTH SUMMIT, HELD IN MAY 2023. OVER 65 PEOPLE ATTENDED. THE KEYNOTE SPEAKER FOCUSED ON LGBTQ+. THE SUMMIT FEATURED NATIONAL AND LOCAL PRESENTERS. - PARTICIPATED IN THE ZERO SUICIDE MEETINGS. THE PURPOSE OF ZERO SUICIDE IS TO REDUCE THE RISK OF BEHAVIORAL HEALTH PATIENTS COMMITTING SUICIDE AFTER BEING DISCHARGED. CHRONIC DISEASEPRIOR TO THE PANDEMIC, THE REGION HAD A STRONG CHRONIC DISEASE PREVENTION COALITION. THE BACKBONE OF THAT COALITION WAS A HEALTH DEPARTMENT. WITH THE PANDEMIC DEMANDS ON THE HEALTH DEPARTMENT, THE COALITION WAS PAUSED AND HAS NOT RESUMED. THE HOSPITALS' OWN EFFORTS ARE OUTLINED BELOW. - ASPIRUS RHINELANDER HOSPITAL BIRTH CENTER STAFF CONTINUED TO SUPPORT BREASTFEEDING. BREASTFEEDING IS KNOWN TO REDUCE THE RISK OF OBESITY AND SOME CHRONIC DISEASES. LACTATION CONSULTANTS ARE ON-STAFF. THE DEPARTMENT MONITORS THE BREASTFEEDING RATE TO ENSURE THEY ARE CONTINUING TO MEET THEIR CORE MEASURE GOAL. DEVELOPMENT OF COMMUNITY EDUCATION IS IN THE PLANNING STAGES, WITH THE HOPE THAT SOME OFFERINGS, ALONG WITH SOME SUPPORT GROUPS, WILL BE AVAILABLE SOON. - EACH OF THE THREE HOSPITALS OFFERED 'FIT FOR LIFE' EXERCISE CLASSES IN A SUPERVISED SETTING FOR CARDIAC REHAB PATIENTS WHO HAVE COMPLETED THEIR TREATMENT PLAN. THE HOSPITALS OFFER THE CLASSES AT A REDUCED RATE, INCURRING LOSSES ON THE OFFERING. EACH HOSPITAL CONTRIBUTED HUNDREDS OF IN-KIND HOURS EVERY YEAR FOR THIS PROGRAM. - ASPIRUS HEALTH, PRIMARILY THROUGH CARE MANAGEMENT, IMPLEMENTS A FRUIT AND VEGETABLE PRESCRIPTION (FVRX) PROGRAM ACROSS THE SYSTEM. PATIENTS WITH CHRONIC DISEASE ARE SCREENED FOR FOOD INSECURITY AND 'PRESCRIBED' FRUITS AND VEGETABLES. THE FVRX CAN BE USED LIKE CASH AT THE LOCAL FARMERS MARKET. (EAGLE RIVER FARMERS MARKET ONLY.)- - - - - - - - - - - -FOR THE CHNA AND IMPLEMENTATION STRATEGY BEING IMPLEMENTED IN FY23, THE HOSPITAL CHOSE TO FOCUS ITS EFFORTS ON THE PRIORITIES LISTED ABOVE (MENTAL HEALTH, AODA, CHRONIC DISEASE). IN THE PRIORITIZATION PROCESS, THE FOLLOWING HEALTH ISSUES WERE RANKED LOWER: CHILD ABUSE AND GRADUATION RATES. THESE WERE NOT NAMED AS PRIORITIES SO EFFORTS COULD BE FOCUSED ON THE TOP THREE SELECTED. IN ADDITION, IT WAS SUGGESTED THAT THE YOUTH COMPONENTS SHOULD BE WOVEN INTO THE SELECTED PRIORITIES WHEN POSSIBLE, WHICH COULD HAVE AN IMPACT ON CHILD ABUSE AND GRADUATION RATES. ASPIRUS TOMAHAWK HOSPITAL 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 TOMAHAWK HOSPITAL'S SIGNIFICANT NEEDS WERE: NUTRITION AND HEALTHY FOOD; ORAL HEALTH; MENTAL HEALTH AND ALCOHOL AND OTHER DRUG USE. THE HOSPITAL ADDRESSED THOSE NEEDS IN THE FOLLOWING WAYS. NUTRITION AND HEALTHY FOOD ASPIRUS TOMAHAWK ACTIVELY PARTICIPATED IN THE LINCOLN COUNTY NUTRITION COALITION. THE HOSPITAL AND/OR COALITION CONDUCTED A NUMBER OF NUTRITION AND HEALTHY FOOD-RELATED EFFORTS, INCLUDING TWO HEALTHY COOKING DEMONSTRATIONS. APPROXIMATELY 30 FAMILIES WITH CHILDREN ENROLLED IN HEADSTART AND FAMILIES WHO WERE WIC (WOMEN, INFANT, CHILDREN)-ELIGIBLE, PARTICIPATED. PARTICIPANTS RECEIVED CROCKPOTS AND NINJA CHOPPERS AS PART OF THE DEMONSTRATIONS. A FEW COOKBOOKS WERE ALSO GIVEN AWAY. ASPIRUS TOMAHAWK HOSPITAL DONATED $5000 TO INCREASE ACCESS TO FRESH FRUITS AND VEGETABLES. FUNDING SUPPORTED: - TRIPLE-YOUR-BUCKS COUPONS AND THE ELECTRONIC BENEFIT TRANSFER (EBT) MACHINE FEES AT THE LOCAL FARMERS MARKET. THE COUPONS ARE SPECIFICALLY FOR INDIVIDUALS WHO PARTICIPATE IN THE FOODSHARE PROGRAM. THE AVAILABILITY OF THE EBT MACHINE INCREASES THE ACCESSIBILITY OF THE MARKET FOR INDIVIDUALS PARTICIPATING IN FOODSHARE. - A FRUIT AND VEGETABLE PRESCRIPTION PROGRAM. ASPIRUS HEALTH, PRIMARILY THROUGH CARE MANAGEMENT, IMPLEMENTS A FRUIT AND VEGETABLE PRESCRIPTION (FVRX) PROGRAM ACROSS THE SYSTEM. PATIENTS WITH CHRONIC DISEASE ARE SCREENED FOR FOOD INSECURITY AND 'PRESCRIBED' FRUITS AND VEGETABLES. THE FVRX CAN BE USED LIKE CASH AT THE LOCAL FARMERS MARKET.THE HOSPITAL OFFERED 'FIT FOR LIFE' EXERCISE CLASSES IN A SUPERVISED SETTING FOR CARDIAC REHAB PATIENTS WHO HAVE COMPLETED THEIR TREATMENT PLAN. THE HOSPITAL OFFERS THE CLASSES AT A REDUCED RATE, INCURRING LOSSES ON THE OFFERING.ORAL HEALTH -- NO ORAL HEALTH-RELATED ACTIVITIES WERE CONDUCTED. MENTAL HEALTH AND ALCOHOL AND OTHER DRUG USEASPIRUS TOMAHAWK IS AN ACTIVE PARTICIPANT IN THE COUNTY'S MENTAL HEALTH AND AODA COALITION. THE COALITION PARTNERS HAVE COMPLETED MANY ACTIVITIES, SOME OF WHICH THE HOSPITAL FUNDED. ACTIVITIES INCLUDED: - PUBLIC AWARENESS AND SOCIAL NORMS CAMPAIGNS (E.G., HOPELINE, SMALL TALKS, KNOW METH, ADVERSE CHILDHOOD EXPERIENCES [ACES], PARENT PACT, SOCIAL HOST AWARENESS). THE NEW NATIONAL MENTAL HEALTH HOTLINE 988 WAS PROMOTED. THE HOSPITAL FUNDED THE BILLBOARD PROMOTION OF THE COUNTY MENTAL HEALTH RESOURCE GUIDE. - COMMUNITY PRESENTATIONS ABOUT MENTAL HEALTH AND SUBSTANCE ABUSE. - THE DISTRIBUTION OF POSTERS, CARDS, AND RELATED VISUAL MATERIALS (E.G., SUICIDE PREVENTION HOTLINE POSTERS). - FAMILY FUN PACKS THAT PROVIDED FAMILIES WITH ACTIVITIES AND RESOURCES. ORIGINALLY DEVELOPED IN RESPONSE TO SOCIAL ISOLATION NEEDS EARLY IN THE PANDEMIC, THE FAMILY FUN PACKS CONTINUED TO BE IN DEMAND AND WERE DISTRIBUTED IN SUMMER 2022 AND SUMMER 2023. ASPIRUS TOMAHAWK PROVIDED FUNDING FOR THE GRIT AND PERSEVERANCE PROGRAM TO BE PRESENTED TO ALL 6TH 8TH GRADE STUDENTS IN THE TOMAHAWK SCHOOL DISTRICT. ASPIRUS TOMAHAWK SUPPORTED THE MENTAL MINGLE PROGRAM THAT'S PRESENTED TO MENTORS, VOLUNTEERS AND STAFF ON YOUTH MENTAL HEALTH ISSUES AND CONCERNS. PRELIMINARY DISCUSSIONS WERE HELD ON THE OPPORTUNITY TO START A RAISE YOUR VOICE MENTAL HEALTH CLUB IN THE TOMAHAWK SCHOOL DISTRICT (SIMILAR TO THE CLUB IN A NEIGHBORING COMMUNITY). TOMAHAWK OTHERTHE HOSPITAL FUNDED HELMETS AND SUPPLIES FOR THE BIKE RODEO. - - - - - - - - - - - -FROM THE CHNA AND IMPLEMENTATION STRATEGY BEING IMPLEMENTED IN FY23, ALL SIGNIFICANT NEEDS WERE PRIORITIZED BY THE HOSPITAL. ASPIRUS RHINELANDER HOSPITAL PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 8 1 - ASPIRUS RHINELANDER CLINIC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 OUTPATIENT PHYSICIAN CLINIC 2 - ASPIRUS TOMAHAWK CLINIC 401 WEST MOHAWK TOMAHAWK WI 54487 OUTPATIENT PHYSICIAN CLINIC 3 - ASPIRUS CRANDON CLINIC 400 WEST GLEN STREET CRANDON WI 54520 OUTPATIENT PHYSICIAN CLINIC 4 - ASPIRUS WOODRUFF CLINIC 240 MAPLE STREET WOODRUFF WI 54568 OUTPATIENT PHYSICIAN CLINIC 5 - ASPIRUS EAGLE RIVER CLINIC 930 EAST WALL STREET EAGLE RIVER WI 54521 OUTPATIENT PHYSICIAN CLINIC 6 - ASPIRUS KOLLER BEHAVIORAL HEALTH CLINIC 1020 KABEL AVENUE RHINELANDER WI 54501 BEHAVIORAL HEALTH CLINIC 7 - ASPIRUS OUTPATIENT THERAPIES-RHINELANDER 2003 EAST WINNEBAGO STREET RHINELANDER WI 54501 OUTPATIENT REHABILITATION 8 - ASPIRUS OUTPATIENT THERAPIES - TOMAHAWK 202 W MOHAWK DRIVE TOMAHAWK WI 54487 OUTPATIENT REHABILITATION 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 $2,686,479. 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 HOSPITALS:- SYSTEMATICALLY REVIEW PATIENT EXPERIENCE DATA TO UNDERSTAND OPPORTUNITIES TO ADDRESS PATIENT CONCERNS. - MAINTAIN AN INVOLVED LOCAL BOARD OF DIRECTORS, WHICH MEETS EVERY OTHER MONTH. HOSPITAL BOARD MEMBERS ARE FROM MULTIPLE SECTORS, INCLUDING FINANCE, EDUCATION, BANKING, GOVERNMENTAL PUBLIC HEALTH, HIGHER EDUCATION AND HEALTH CARE. - SUPPORT ITS STAFF IN VOLUNTEERING AT AN AREA FOOD PANTRY (RHINELANDER). - REVIEW FUNDING REQUESTS (TO THE HOSPITAL AND/OR HOSPITAL FOUNDATION) AS AN INDICATOR OF LOCAL NEEDS.- INITIATED A SOCIAL NEEDS SCREENING PROCESS THAT, OVER TIME, WILL PROVIDE INSIGHT INTO PATIENT NEEDS IN ADDITION TO THEIR IMMEDIATE CARE. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATION AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. IF ASPIRUS FINANCIAL COUNSELORS NOTICE THE PATIENT HAS NOT BEEN OFFERED AN APPLICATION WITHIN THE PAST YEAR, THEY WILL ALSO ASK IF THE PATIENT WOULD LIKE ONE MAILED OR IF THE PATIENT SHOWS FINANCIAL DISTRESS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS, WHEN APPLICABLE. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. ELEVATE PFS (CONTRACTED ENTITY) IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL PRIMARILY SERVE THE RESIDENTS OF ONEIDA COUNTY (RHINELANDER) AND LINCOLN COUNTY (TOMAHAWK) AND SURROUNDING COUNTIES IN RURAL NORTHERN WISCONSIN.ONEIDA COUNTY COVERS 1113 SQUARE MILES, WITH 34 PEOPLE PER SQUARE MILE AND AN OVERALL POPULATION OF 38,259 PEOPLE. HERE ARE SOME DETAILS ABOUT ITS POPULATION: PERSONS UNDER AGE 18: 17.1%PERSONS 65 YEARS AND OVER: 27.3%WHITE PERSONS: 95.9%AFRICAN AMERICAN PERSONS: 0.7%AMERICAN INDIAN PERSONS: 1.3%ASIAN PERSONS: 0.5%TWO OR MORE RACES: 1.6%HISPANIC OR LATINO: 1.8%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 1.6%ADULTS AGES 25 AND OVER WITH A HIGH SCHOOL DIPLOMA OR EQUIVALENT: 94.7% PERSONS IN POVERTY: 9.2%MEDIAN HOUSEHOLD INCOME: $62,660PERCENT UNINSURED: 7%PERCENT USING PUBLIC INSURANCE (MEDICAID, MEDICARE, VETERANS BENEFITS, ETC.): 45.2%NUMBER OF HOSPITALS IN ONEIDA COUNTY: 3 (INCLUDING ASPIRUS RHINELANDER HOSPITAL AND (ASPIRUS) HOWARD YOUNG MEDICAL CENTER) ONEIDA COUNTY IS A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) FOR MENTAL HEALTH. ASPIRUS TOMAHAWK HOSPITAL PRIMARILY SERVES THE RESIDENTS OF LINCOLN COUNTY AND SURROUNDING COUNTIES IN RURAL NORTH CENTRAL WISCONSIN. LINCOLN COUNTY IS A RURAL COUNTY IN CENTRAL WISCONSIN. IT COVERS 878 SQUARE MILES, WITH 32.3 PEOPLE PER SQUARE MILE AND AN OVERALL POPULATION OF 27,687 PEOPLE. HERE ARE SOME DETAILS ABOUT ITS POPULATION: PERSONS 14 YEARS AND UNDER: 14.6%PERSONS 65 YEARS AND OVER: 21.6%WHITE PERSONS: 98.4%AFRICAN AMERICAN PERSONS: 1.4%AMERICAN INDIAN PERSONS: 0.9%ASIAN PERSONS: 0.8%HISPANIC OR LATINO: 1.9%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 2.7%ADULTS AGES 25 AND OVER WITH A HIGH SCHOOL DIPLOMA OR EQUIVALENT: 92%HOUSEHOLDS IN POVERTY: 10%MEDIAN HOUSEHOLD INCOME: $61,100PERCENT UNINSURED: 7%PERCENT USING PUBLIC INSURANCE (MEDICAID, MEDICARE, VETERANS BENEFITS, ETC.): 40.3%NUMBER OF HOSPITALS IN THE COUNTY: 2 (INCLUDING ASPIRUS MERRILL HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL) LINCOLN COUNTY IS A DESIGNATED HEALTH PROFESSIONS SHORTAGE AREA (HPSA) FOR MENTAL HEALTH. PART VI, LINE 5: THE HOSPITALS PROMOTE THE HEALTH OF THE COMMUNITY THROUGH THEIR COMMUNITY HEALTH AND COMMUNITY BENEFIT WORK. ADDITIONALLY, THE HOSPITALS: - MAINTAIN A BOARD OF DIRECTORS THAT REFLECTS THE COMMUNITY. - BRING EXPERTISE INTO THE COMMUNITY THROUGH PROGRAMS, SCREENINGS, AND COMMUNITY BOARD AND ADVISORY COMMITTEE MEMBERSHIP.- PROVIDE HIGH QUALITY SERVICES AND IMPLEMENTS ONGOING QUALITY IMPROVEMENT INITIATIVES. - BUDGET FOR CUTTING EDGE TECHNOLOGIES AND EQUIPMENT THAT SUPPORT PATIENT HEALTH.- OFFER TRANSPORTATION ASSISTANCE FOR PATIENTS AS APPROPRIATE. - PROVIDE PRECEPTORS FOR HEALTH PROFESSIONS STUDENTS-IN-TRAINING, WHICH ADVANCES THE HEALTH CARE WORKFORCE. - PROVIDE ATHLETIC TRAINING TO LOCAL YOUTH ATHLETES. - OFFER MEETING SPACE TO LOCAL NON-PROFIT ORGANIZATIONS. - PROVIDE FLU SHOTS AT A HOMELESS SHELTER. (TOMAHAWK)- SUPPORT PROJECT SEARCH, WHICH ENGAGES YOUNG ADULTS WITH DISABILITIES IN WORKFORCE CAREER EXPLORATION AND TRAINING. (RHINELANDER)- PROVIDE 'STOP THE BLEED' TRAININGS. (RHINELANDER) AS PART OF A LARGER NETWORK OF ASPIRUS HEALTHCARE FACILITIES, THE HOSPITALS HAVE 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. 1 RHINELANDER AREA FOOD PANTRY 627 COON STREET RHINELANDER WI 54501 331141966 501(C)(3) 10000 0 "OUT OF THE BOX" PROGRAM, WHICH PROVIDED INFORMATION AND EDUCATION ON HEALTHY EATING SCHOOL DISTRICT OF TOMAHAWK 1048 EAST KING ROAD TOMAHAWK WI 54487 390992650 GOVERNMENT 7000 0 TRAINING OPPORTUNITIES FOR FAMILIES AND COMMUNITY MEMBERS TO ADDRESS POOR MENTAL HEALTH, AODA AND SEXUAL ASSAULT AWARENESS. LINCOLN COUNTY HEALTH DEPARTMENT 801 NORTH SALES STREET MERRILL WI 54452 396005714 GOVERNMENT 7000 0 THE COMMUNITY MENTAL HEALTH COALITION PROGRAMS AND ACTIVITIES (E.G., BILLBOARDS); COMMUNITY HEALTH NEEDS ASSESSMENT LISTENING SESSIONS, FOCUS GROUPS AND COMMUNITY FORUMS. 3 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. 0 1 0 0 0 0 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 1228335 0 567185 0 4418 0 18619 0 292491 0 2111048 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 649845 0 1057600 0 204019 0 20794 0 123324 0 2055582 0 195109 STEVEN BROWN CLINICAL MEDICAL PHYSICIST 0 837466 0 17500 0 11858 0 9150 0 37412 0 913386 0 0 JESSE TISCHER VICE CHAIR/SVP & PRESIDENT-REG. MKTS 0 580082 0 150199 0 51294 0 18561 0 110034 0 910170 0 50242 ANTHONY RUTKOWSKI PHARMACY MANAGER 0 800757 0 17500 0 5810 0 9150 0 36578 0 869795 0 0 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 0 479018 0 135622 0 58276 0 18672 0 105004 0 796592 0 55822 CHIRASAKD RATANAWONG PHARMACIST 0 738639 0 0 0 7322 0 9150 0 34326 0 789437 0 0 JOHNATHAN CURRIE PHARMACY SUPERVISOR 0 692354 0 15750 0 5540 0 9150 0 37205 0 759999 0 0 TIMOTHY RIPPLE PHARMACIST 0 666534 0 17500 0 26476 0 9150 0 34539 0 754199 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 BOARD MEMBER/SVP-SERV. LINE & PAT. E 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 DEBRA BALL SVP & CHIEF HR OFFICER 0 349805 0 106987 0 2047 0 13179 0 90374 0 562392 0 0 TERESA THEILER (NV) PRESIDENT-ASPIRUS NORTH DIV. 0 310350 0 47497 0 1351 0 8447 0 61183 0 428828 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 BRIAN KIEF (NV) PRES.-ASPIRUS SOUTH & SW DIV. 308548 0 0 0 2615 0 9472 0 29350 0 349985 0 0 0 JANELLE KOMMERS-MARKGRAF VP-HUMAN RESOURCES NORTH REGION 0 203520 0 29058 0 4339 0 14791 0 29536 0 281244 0 0 AMY SLETTE MD BOARD MEMBER/PHYSICIAN 0 231159 0 0 0 5762 0 7517 0 35090 0 279528 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 LORI KNITT VP-PATIENT CARE & CNO 212364 0 0 0 7979 0 5771 0 21509 0 247623 0 0 0 JASON TROXELL VP-CHIEF ADMIN OFFICER 0 171834 0 0 0 11002 0 5386 0 34818 0 223040 0 0 HOLLY BEEDE-MCKINNEY BOARD MEMBER/NURSE PRACTITIONER 0 152573 0 0 0 2015 0 8111 0 773 0 163472 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & 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 M. HOLZHUETER $55,822 J. TISCHER $50,242 T. RICHARDSON $39,964 J. MATHESON $32,339 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 69386269 REVENUE BONDS SERIES 2021 0 0 0 A 69386269 494301 68891968 2021 0 0 1 1 A 0 1 1 1 0 0.00800 0.00800 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 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 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. PART III, LINE 9 SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES THAT WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. 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 10 VOTING DIRECTORS ALLOCATED AS FOLLOWS. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS, TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., AND TWO PROVIDER CLASS DIRECTORS 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 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 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 XI, LINE 9: INTERCOMPANY TRANSERS - AWH 1,593,109. INTERCOMPANY TRANSERS - AI 6,620,542. INTERCOMPANY TRANSERS - AMG 1,523,356. INTERCOMPANY TRANSERS - AOH -182. INTERCOMPANY TRANSERS - VNA -3,338. INTERCOMPANY TRANSERS - AIR 240,027. INTERCOMPANY TRANSERS - ARH 4,472. INTERCOMPANY TRANSERS - ADS -312,548. INTERCOMPANY TRANSERS - AMH -7,540. INTERCOMPANY TRANSERS - AKH 455,376. INTERCOMPANY TRANSERS - ASP 224,470. INTERCOMPANY TRANSERS - ATH 5,115,185. INTERCOMPANY TRANSERS - ASH 126,505. INTERCOMPANY TRANSERS - AMR -1,774. INTERCOMPANY TRANSERS - AER 86,675. INTERCOMPANY TRANSERS - HYMC 759,402. INTERCOMPANY TRANSERS - AMNW 5,824. OTHER CHANGES IN NET ASSETS 107,949. 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