2023-05-12T12:56:36-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 381443361 ASPIRUS KEWEENAW HOSPITAL ASPI 9063376500 205 OSCEOLA LAURIUM MI 49913 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 7158472250 2023-05-12 1 SIDNEY SCZYGELSKI 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-05-12 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 66438346 0 X WWW.ASPIRUS.ORG X 1939 MI WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 15 7 364 8 1560194 0 3753120 1929198 58311944 63229617 220123 416211 173172 231477 62458359 65806503 2211 2412 0 0 29005878 28120456 0 0 0 30582909 35955137 59590998 64078005 2867361 1728498 57422111 58039373 30243462 28873348 27178649 29166025 WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 0 0 47115180 2412 61755565 ASPIRUS KEWEENAW HOSPITAL PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, PHYSICIAN CLINIC SERVICES, AND EYE CLINIC SERVICES. 47115180 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 30 0 364 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 JENNIFER REDMAN-SCHELL VICE-CHRM/SVP-PRES. AMG 2.00 50.00 X X 0 572454 92664 JESSE TISCHER BOARD MEMBER/SVP & PRES. REG. MARKETS 2.00 50.00 X 0 644385 101649 JENNIFER WEAVER BOARD MEMBER/NURSE PRACTITIONER 2.00 50.00 X 0 104166 20417 DANIEL J LUKES DO BOARD MEMBER/PHYSICIAN 2.00 50.00 X 0 669993 44505 JONATHAN N BRUEGGEMAN BOARD MEMBER/PHYSICIAN 2.00 50.00 X 0 443961 50805 KRISTEN DMESKE NP-C BOARD MEMBER/NURSE PRACTITIONER 2.00 50.00 X 0 108310 5597 PATRICK TINCHER JR BOARD MEMBER/VP FINANCE-REG. OPERATIONS 2.00 50.00 X 0 334332 52220 MICHAEL HOLZHUETER ASST SEC./SVP-GENERAL COUNSEL 2.00 50.00 X X 0 449756 89333 MARCUS SANTINI BOARD MEMBER/PHYS. (THRU SEPT. 21) 2.00 50.00 X 0 319936 53873 JAMES LORENSON CHAIRMAN (THRU JAN '22) 2.00 X X 0 0 0 STEVEN TINTI TREASURER 2.00 1.00 X X 0 0 0 KATIE CLARK SECRETARY / REGISTERD NURSE 2.00 X X 0 0 0 RICHARD J KOUBEK PHD BOARD MEMBER 2.00 X 0 0 0 JOHN D MATONICH BOARD MEMBER 2.00 X 0 0 0 JAMES R RICHARDSON BOARD MEMBER 2.00 X 0 0 0 KIRK R SCHOTT BOARD MEMBER 2.00 X 0 0 0 LISA TWARDZIK BOARD MEMBER (THRU OCT '21) 2.00 X 0 0 0 WILLIAM W WOOD BOARD MEMBER 2.00 X 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 2684221 266094 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 915379 141626 CHRISTINE HARFF PRESIDENT - REGIONAL UP 2.00 50.00 X 0 403040 91022 BRETT DAVIS PRESIDENT-ASPIRUS HEALTH PLAN 2.00 50.00 X 0 394127 62857 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 495034 104300 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 2.00 50.00 X 0 452729 89948 LISA ROWE-PEPLINSKI VP-CARE QUALITY & PAT. SAFETY 2.00 50.00 X 0 367202 18878 PAUL VAN DEN HEUVEL VP-NETWORKS STRATEGY 2.00 50.00 X 0 340811 45098 RENEE SMITH EXECUTIVE DIRECTOR ANI 2.00 50.00 X 0 460002 93775 RUTH RISLEY-GRAY SVP & SYSTEM CNO 2.00 50.00 X 0 329902 52673 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 516494 97286 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 751984 56650 JESSICA BESSNER PHARMACIST 40.00 X 190613 0 45615 MICHAEL HAGWELL FINANCE DIRECTOR 40.00 X 166412 0 22435 RYAN GREENLEY PHARMACIST 40.00 X 149694 0 8387 AMY TARVIS PHARMACIST 30.00 10.00 X 137740 0 9399 DARCY DONNELLY CNO 40.00 X 124081 0 36646 MICHAEL MCGRAIL FORMER SVP & SYSTEM CMO 0.00 0.00 X 0 449085 0 768540 12207303 1753752 51 1 1 0 WAPITI MEDICAL GROUP LIMITED 107 FLYNN DRIVE SUITE 600 MILBANK SD 57252 CONTRACT LABOR - PROVIDERS 2427024 COMPHEALTH INC PO BOX 972651 DALLAS TX 753972651 CONTRACT LABOR - PROVIDERS 643663 CLAYTON CHARLES MD LLC 1100 S STATE RD 7 SUITE 200A MARGATE FL 33068 CONTRACT LABOR - PROVIDER 582500 STAFFENCY LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACT LABOR - PROVIDER 580110 MICHAEL BEST & FRIEDRICH LLP 790 N WATER ST SUITE 2500 MILWAUKEE WI 53202 LAWYER FEES 418710 14 1889602 39596 1929198 NET PATIENT SERVICE REVENUE 621990 58383182 58383182 PHARMACY REVENUE 446110 4181815 2648263 1533552 CONTRACT SERVICE REVENUE 621110 228563 228563 436057 436057 63229617 283973 283973 77392 0 77392 77392 26642 50750 732681 31400 570478 61365 162203 -29965 132238 132238 CAFETERIA REVENUE 624200 94123 94123 E.H.R INCENTIVE 621110 59500 59500 VENDING REVENUE 624200 462 462 154085 65806503 61755565 1560194 561546 X 2412 2412 22786456 19783849 3002607 827197 646034 181163 3647658 3157308 490350 859145 654341 204804 744118 744118 4140 4140 903 903 9438159 9214953 223206 43921 43921 135107 91857 43250 26775 17727 9048 721869 54701 667168 134984 64021 70963 729509 729509 2498948 2172713 326235 371567 212000 159567 MEDICAL SUPPLIES 9122244 9122244 CORPORATE ALLOCATIONS 8776358 8776358 HOSPITAL ASSESSMENT PAY 1376089 1376089 REPAIRS & MAINTENANCE 798833 668524 130309 1031613 522987 508626 64078005 47115180 16962825 0 10385664 13378488 1422975 1062744 7689399 9528629 890058 1487847 99513 54443 51159377 30585271 19953917 20574106 5132449 4794738 1403949 1702167 10444187 5456211 57422111 58039373 4413665 4268199 597566 893030 17024037 16867875 8208194 6844244 30243462 28873348 X 26890703 28878079 287946 287946 27178649 29166025 57422111 58039373 X 1728498 -825112 1083990 X 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 4140 4140 0 PART II-B, LINE 1: ASPIRUS KEWEENAW HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND MHA HAVE NOTIFIED ASPIRUS KEWEENAW THAT APPROXIMATELY $4,140 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 874763 874763 35511425 21184754 14326671 14384227 9400517 4983710 388962 388962 20574106 DUE FROM ASPIRUS KEWEENAW ENTERPRISES 2037785 DUE FROM OTHER ENTITIES 7897 DUE FROM ASPIRUS INC. 3117434 INSURANCE RECEIVABLE 242421 DEFERRED COMPENSATION 50674 5456211 LONG TERM INSURANCE PAYABLE 187150 ASBESTOS LIABILITY 21448 MEDICARE REFUNDABLE ADVANCE 3117434 OPERATING LEASE LIABILITY 142608 FINANCE LEASE OBLIGATIONS 28774 DEFERRED COMPENSATION 50674 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3296156 6844244 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, 2022. 1 1 X 1 X 1 X 1 1 1 0 1 1 413022 413022 0.00650 12237743 7307260 4930483 0.07730 12650765 7307260 5343505 0.08380 3518 3518 0.00010 15258603 13449491 1809112 0.02840 3138 3138 0.00000 18979 18979 0.00030 15284238 13449491 1834747 0.02880 27935003 20756751 7178252 0.11260 3843 3843 0.00010 3843 3843 0.00010 1 110945 0 11299000 11067879 231121 X 1 1 1 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 WWW.ASPIRUS.ORG 1060000151 X X X X PHYSICIAN CLINIC & PHARMACY ASPIRUS KEWEENAW HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X 1 21 1 WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 0 1 X 200.000000000000 300.000000000000 X X X 1 1 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 KEWEENAW HOSPITAL PART V, SECTION B, LINE 5: THE WESTERN UPPER PENINSULA COMMUNITY MEMBERS PROVIDED INPUT ON THE TOP COMMUNITY HEALTH NEEDS THROUGH THE 2021 UPPER PENINSULA COMMUNITY HEALTH ISSUES AND PRIORITIES SURVEY (UPCHIPS). THE SURVEY WAS COMPLETED BY 3500 ADULTS IN THE REGION. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 6A: ASPIRUS KEWEENAW HOSPITAL COLLABORATED WITH THE OTHER THREE ASPIRUS HOSPITALS IN THE REGION -- ASPIRUS ONTONAGON, ASPIRUS IRON RIVER, AND ASPIRUS IRONWOOD. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 6B: ASPIRUS KEWEENAW HOSPITAL COLLABORATES WITH THE WESTERN U.P. HEALTH DEPARTMENT ON MANY COMMUNITY HEALTH IMPROVEMENT EFFORTS. THE HEALTH DEPARTMENT RECEIVED A GRANT FROM THE MICHIGAN HEALTH ENDOWMENT FUND TO CONDUCT THE UPPER PENINSULA COMMUNITY HEALTH ISSUES AND PRIORITIES SURVEY (2021 UPCHIPS) AND SHARE THE RESULTS WITH THE ASPIRUS HOSPITALS. ASPIRUS DID NOT PAY ANY CONSULTANTS OR VENDORS. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 11: OVER THE PAST YEAR (JULY 1, 2021-JUNE 30, 2022), ASPIRUS KEWEENAW HOSPITAL HAS WORKED TO ADDRESS THE HEALTH ISSUES IDENTIFIED IN THE PREVIOUS CHNA. ALTHOUGH MANY EFFORTS HAVE BEEN SUCCESSFUL, THE HOSPITAL'S EFFORTS HAVE BEEN HAMPERED BY COMMUNITY HEALTH IMPROVEMENT STAFF VACANCIES AND COVID-19 AND ITS RIPPLE EFFECT ON COMMUNITY OUTREACH AND PUBLIC EVENTS/PROGRAMS.THE HOSPITAL'S PRIORITY HEALTH ISSUES FROM THE PREVIOUS CHNA INCLUDED: THE IMPORTANCE OF PREVENTION THE IMPACT OF AN AGING POPULATION EXPANDED ACCESS TO CARE VIA THE EVOLVING AFFORDABLE CARE ACT THE POWERFUL CORRELATION BETWEEN SOCIO-ECONOMIC STATUS AND POOR HEALTHTO ADDRESS THESE NEEDS, THE HOSPITAL APPLIED THE FIRST HEALTH AREA PREVENTION AS A WAY TO ADDRESS THE OTHER THREE HEALTH AREAS AGING POPULATION, ACCESS TO CARE, AND SOCIAL AND ECONOMIC FACTORS THAT INFLUENCE HEALTH. HIGHLIGHTS OF THE HOSPITAL'S EFFORTS ARE BELOW. HEALTHY EATING AND NUTRITION COMMUNITY OUTREACH WITH THE INTENTION OF PROVIDING EDUCATION AND INFORMATION ON HEALTHY LIVING FOR PREVENTION AND AWARENESS OF CHRONIC DISEASES, THE HOSPITAL: PARTICIPATED IN LOCAL SCHOOL WELLNESS FAIRS BY HAVING A TABLE WITH HEALTHY EATING INFORMATION, MODELS AND EDUCATION; SUPPORTED A DIETICIAN BEING AVAILABLE AT LOCAL EVENTS TO PROMOTE HEALTHY EATING AND PREVENTION; HAD A BOOTH AT THE LOCAL WELLNESS FAIR AT THE FARMERS MARKET; PARTICIPATED IN THE ASPIRUS FRUIT AND VEGETABLE PRESCRIPTION PROGRAM. FITNESS AND EXERCISE PROGRAMMINGWITH THE INTENTION OF SUPPORTING AND PROVIDING THE COMMUNITY WITH FITNESS PROGRAMS THAT WORK TOWARDS PREVENTING CHRONIC DISEASE AND OTHER HEALTH CONCERNS IN OUR LOCAL POPULATION, THE HOSPITAL: COLLABORATED WITH LOCAL BUSINESSES AND ORGANIZATIONS TO OFFER A CORPORATE HOSPITAL FITNESS CENTER MEMBERSHIP TO THEIR EMPLOYEES; OFFERED A FREE TWO-WEEK WELLNESS BENEFIT FOR THOSE WHO FINISH CARDIAC REHAB. POLICY AND ENVIRONMENTAL CHANGE WITH THE INTENTION OF IMPROVING HEALTHY BEHAVIORS THROUGH POLICY AND ENVIRONMENTAL CHANGE, THE HOSPITAL: PARTICIPATED IN LOCAL WELLNESS FAIRS, OFFERING SNACKS, RECIPES, EDUCATION AND INFORMATION ON PROVIDERS AND SERVICES; PROVIDED SEVERAL COMMUNITY PRESENTATIONS.SMOKING / DRUG CESSATION PROGRAMSWITH THE INTENTION OF SUPPORTING SMOKING AND DRUG CESSATION EDUCATION WITH A DIRECTED EFFORT TOWARD ADOLESCENTS AND FAMILIES, THE HOSPITAL MADE SMOKING CESSATION TREATMENT INFORMATION AVAILABLE AT EVERY VISIT; COLLABORATED WITH THE HEALTH DEPARTMENT AND THE WIC PROGRAM FOR SMOKING CESSATION EFFORTS FOR MOTHERS; COLLABORATED WITH LOCAL LAW ENFORCEMENT FOR SHARPS AND MEDICATION DISPOSAL. NEEDS NOT ADDRESSED AND WHYFROM THE MOST RECENT (AUGUST 2021) REGIONAL COMMUNITY SURVEY, THE TOP-SELECTED ISSUES WERE: HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES DRUG ABUSE LACK OF HEALTH INSURANCE UNEMPLOYMENT, WAGES, AND ECONOMIC CONDITIONSFROM THIS LIST, ASPIRUS KEWEENAW IS ADDRESSING DRUG ABUSE (SUBSTANCE USE). THE OTHER THREE ISSUES WERE NOT SELECTED FOR THE FOLLOWING REASONS. THE LACK OF AFFORDABLE HEALTH INSURANCE IS OF HIGH CONCERN FOR MANY PEOPLE IN THE UPPER PENINSULA. ASPIRUS PROVIDES FINANCIAL ASSISTANCE FOR PATIENTS WHO STRUGGLE TO AFFORD CARE. ASPIRUS HOSPITALS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE THE AVAILABILITY AND THE AFFORDABILITY OF HEALTH INSURANCE, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. UNEMPLOYMENT, WAGES, AND ECONOMIC CONDITIONS ARE IMPORTANT ISSUES FOR ASPIRUS. ASPIRUS WORKS TO PAY FAIR WAGES AND PROVIDE REASONABLE BENEFITS PACKAGES. ASPIRUS HOSPITALS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE ECONOMIC CONDITIONS, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 3 1 - ASPIRUS HOUGHTON CLINIC 1000 CEDAR STREET HOUGHTON MI 49931 CLINIC & OUTPATIENT THERAPY 2 - ASPIRUS KEWEENAW OUTPATIENT THERAPIES 25680 COPPER KING WAY LAURIUM MI 49913 OUTPATIENT THERAPY 3 - ASPIRUS KEWEENAW LAKE LINDEN CLINIC 110 CALUMET STREET LAKE LINDEN MI 49945 CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF THE FOLLOWING (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY): PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200% EQUITY ALLOWANCE IS $75,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G., DAIRY FARM) IS EVALUATED INDIVIDUALLY ON A CASE-BY-CASE BASIS. CASH ASSETS IN EXCESS OF $4,000 AT THE TIME OF APPLICATION. SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS AND IRREVOCABLE BURIAL TRUST FUNDS. TOTAL NET ASSETS CANNOT EXCEED 800% OF FEDERAL POVERTY GUIDELINES. THIS INCLUDES ALL ASSETS INCLUDING CASH ASSETS ABOVE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990, SCHEDULE H IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR FORM 990. PART I, LINE 7G: THE COST OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE ASPIRUS KEWEENAW CLINICS. ASPIRUS KEWEENAW HOSPITAL UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $271,347. PART II, COMMUNITY BUILDING ACTIVITIES: ASPIRUS KEWEENAW HOSPITAL, INC., IN ADDITION TO PROVIDING SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. ASPIRUS KEWEENAW HOSPITAL, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. IN ADDITION TO INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: EMERGENCY SERVICES, RESPIRATORY THERAPY, OCCUPATIONAL THERAPY, PHYSICAL THERAPY, FAMILY PRACTICE CLINICS, AND LABORATORY AND PATHOLOGY SERVICES. 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 3. COLLECTION PHONE CALLS 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 FIRST BILLING TO THE PATIENT.) 4. SOUND BUSINESS JUDGMENT ESTABLISHES THAT THERE WAS NO LIKELIHOOD OF RECOVERY AT ANY TIME IN THE FUTURE. II. BAD DEBT RECOVERIES A. PAYMENTS ON MONTHLY REMITTANCE ADVICES FROM OUTSIDE COLLECTION AGENCIES WILL BE POSTED TO EACH INDIVIDUAL ACCOUNT. B. 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. C. 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 ASPIRUS KEWEENAW 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, 2022 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: UPON A PATIENTS APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENTS ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORK QUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT. PART VI, LINE 2: THE ORGANIZATION MEETS WITH A LOCAL FEDERALLY QUALIFIED HEALTH CENTER TO CONSULT AND DETERMINE HOW TO MEET THE HEALTH CARE NEEDS IN THE ORGANIZATION'S GEOGRAPHICAL AREA. IN ADDITION, THE ORGANIZATION ITSELF EVALUATES ITS' OWN SERVICES OFFERED IN THEIR SERVICE AREA AND EVALUATES OTHER SERVICES THAT COULD BE PROVIDED TO BENEFIT THE COMMUNITY SERVED. 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 ORGANIZATION PROVIDES SERVICES PRIMARILY TO THE ELDERLY AND FRAIL OF NORTHERN HOUGHTON AND KEWEENAW COUNTIES. THE LARGEST CITIES IN THESE REGIONS INCLUDE HOUGHTON, HANCOCK, LAURIUM AND CALUMET. COMPARED TO MICHIGAN AS A WHOLE, HOUGHTON AND KEWEENAW COUNTIES HAVE: FEWER PEOPLE PER SQUARE MILE; A HIGHER PERCENTAGE OF INDIVIDUALS WHO ARE CAUCASIAN; A LOWER PERCENTAGE OF INDIVIDUALS WHO ARE HISPANIC; A LOWER MEDIAN HOUSEHOLD INCOME; A SIMILAR LEVEL OF INDIVIDUALS IN POVERTY; A SIMILAR PERCENTAGE OF HIGH SCHOOL GRADUATES; A LOWER PERCENTAGE OF HOUSEHOLDS WHERE A LANGUAGE OTHER THAN ENGLISH IS THE PRIMARY LANGUAGE. PART VI, LINE 5: THE BOARD OF DIRECTOR'S IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION PROVIDES, FREE OF CHARGE TO THE LOCAL SCHOOL, AN ATHLETIC TRAINER. PART VI, LINE 6: ASPIRUS KEWEENAW IS A PART OF THE ASPIRUS, INC. SYSTEM WITH THE MAIN BASE IN WAUSAU WI. TOGETHER WE PROMOTE THE MISSION AND WORK COLLABORATIVELY TO SHARE THE PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. THE COMBINED EFFORTS ARE ABLE TO PROVIDE THE SMALLER COMMUNITIES WITH THE ACCESS TO CARE THAT THEY MAY NOT OTHERWISE BE ABLE TO HAVE. ALSO, AS PART OF THIS SYSTEM ARE 3 OTHER UPPER PENINSULA OF MI HOSPITALS AND 11 OTHER HOSPITAL SYSTEMS IN WI ALONG WITH POST-ACUTE CARE PROGRAMS, MANY PROVIDER CLINICS, AMBULANCE SERVICE AND LONG-TERM CARE. PART VI, LINE 7, REPORTS FILED WITH STATES MI X 1 1 0 1 0 0 0 0 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 1051076 0 1629342 0 3803 0 17346 0 248748 0 2950315 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 610115 0 177495 0 127769 0 20196 0 121430 0 1057005 0 112143 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 0 289961 0 426149 0 35874 0 13626 0 43024 0 808634 0 25179 JESSE TISCHER BOARD MEMBER/SVP & PRES. REG. MARKET 0 501025 0 142821 0 539 0 11714 0 89935 0 746034 0 0 DANIEL J LUKES DO BOARD MEMBER/PHYSICIAN 0 662071 0 600 0 7322 0 17346 0 27159 0 714498 0 0 JENNIFER REDMAN-SCHELL VICE-CHRM/SVP-PRES. AMG 0 405520 0 113119 0 53815 0 17346 0 75318 0 665118 0 51368 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 0 357568 0 105424 0 53502 0 17346 0 79940 0 613780 0 50634 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 0 382299 0 111001 0 1734 0 17346 0 86954 0 599334 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 315463 0 89914 0 54625 0 17346 0 76429 0 553777 0 53547 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 0 322706 0 94649 0 35374 0 16347 0 73601 0 542677 0 26065 MICHAEL HOLZHUETER ASST SEC./SVP-GENERAL COUNSEL 0 399152 0 25600 0 25004 0 8700 0 80633 0 539089 0 0 JONATHAN N BRUEGGEMAN BOARD MEMBER/PHYSICIAN 0 402125 0 41317 0 519 0 17346 0 33459 0 494766 0 0 CHRISTINE HARFF PRESIDENT - REGIONAL UP 0 312209 0 87267 0 3564 0 15384 0 75638 0 494062 0 0 BRETT DAVIS PRESIDENT-ASPIRUS HEALTH PLAN 0 260587 0 127333 0 6207 0 16557 0 46300 0 456984 0 0 MICHAEL MCGRAIL FORMER SVP & SYSTEM CMO 0 0 0 0 0 449085 0 0 0 0 0 449085 0 449085 PATRICK TINCHER JR BOARD MEMBER/VP FINANCE-REG. OPERATI 0 262964 0 52409 0 18959 0 16349 0 35871 0 386552 0 7837 LISA ROWE-PEPLINSKI VP-CARE QUALITY & PAT. SAFETY 0 287310 0 55655 0 24237 0 17283 0 1595 0 386080 0 22695 PAUL VAN DEN HEUVEL VP-NETWORKS STRATEGY 0 302649 0 31790 0 6372 0 11252 0 33846 0 385909 0 0 RUTH RISLEY-GRAY SVP & SYSTEM CNO 0 213913 0 91534 0 24455 0 17417 0 35256 0 382575 0 19718 MARCUS SANTINI BOARD MEMBER/PHYS. (THRU SEPT. 21) 0 300734 0 3078 0 16124 0 17346 0 36527 0 373809 0 0 JESSICA BESSNER PHARMACIST 163179 0 24392 0 3042 0 10463 0 35152 0 236228 0 0 0 MICHAEL HAGWELL FINANCE DIRECTOR 151389 0 13689 0 1334 0 8619 0 13816 0 188847 0 0 0 DARCY DONNELLY CNO 104458 0 19620 0 3 0 6162 0 30484 0 160727 0 0 0 RYAN GREENLEY PHARMACIST 142960 0 6480 0 254 0 7695 0 692 0 158081 0 0 0 PART I, LINE 1A PAUL VAN DEN HEUVEL ($4,050) HAD A TAXABLE HOUSING ALLOWANCE. PART I, LINE 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, ASPIRUS KEWEENAW HOSPITAL RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICIES 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: J. REDMAN-SCHELL $51,368 S. SCZYGELSKI $112,143 P. TINCHER JR. $7,837 J. MATHESON $26,065 J. HARDESTY $21,288 L. ROWE-PEPLINSKI $22,695 M. BREWER $24,855 M. MCGRAIL $449,085 R. SMITH $53,547 R. RISLEY-GRAY $19,718 T. RICHARDSON $50,634 J. HEISLER $25,179 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 97712DMG9 2015-05-07 16997543 NEW CONSTRUCTION 0 0 0 A 200000 17005943 242015 16763928 2017 0 0 1 1 A 0 1 1 0 0 0.00500 0.00500 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K, PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2015 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. (EIN 38-3236977); AND ASPIRUS KEWEENAW HOSPITAL (EIN 38-1443361). INFORMATION REGARDING THE SERIES 2015 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2015 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2015 BONDS.] PART III - LINE 3A AND 3B: ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS KEWEENAW HOSPITAL, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW LEASE AGREEMENTS, MANAGEMENT, AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. 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 ASPIRUS, INC. IS THE SOLE CORPORATE AND VOTING MEMBER OF ASPIRUS KEWEENAW HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS IS A REGIONAL BOARD FOR THE UP. THE BOARD OF DIRECTORS IS COMPRISED OF TEN DIRECTORS FROM ASPIRUS, INC. 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, CONSISTING OF THREE NOMINATED BY THE FOUNDATION BOARD OF TRUSTEES AND THREE NOMINATED BY ASPIRUS, INC. WITH CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD, AND ELECTED BY ASPIRUS, INC., TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTOR FROM EACH HOSPITAL, CONSISTING OF PHYSICIANS IN THE ACTIVE CATEGORY OF THE MEDICAL STAFF AT THE HOSPITAL, NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE DIRECTORS OF THE ORGANIZATION: 1) CHANGE OR AMEND THE ARTICLES OF INCORPORATION OR BYLAWS; 2) CHANGE THE MISSION, PURPOSE, OR SCOPE OF THE CORPORATION; 3) RATIFICATION OR REMOVAL OF DIRECTORS OR OFFICERS; 4) CHANGE THE FORMULA OR METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION; 5) APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS, STRATEGIC AND LONG-RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATED ALL 990 AND 990-T INFORMATION, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 AND THE 990-T ARE REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND ARE MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH DIRECTOR'S DESK OR OTHER MEANS OF ELECTRONIC RETRIEVAL. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, BOARD MEMBERS ARE REQUIRED TO DISCLOSE CONFLICTS TO THE BOARD. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS. AN INTERESTED PERSON IS A DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST. AFTER DISCLOSURE, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING MEMBERS SHALL DECIDE IF A CONFLICT EXISTS. THE MEMBER WILL ABSTAIN FROM VOTING ON THIS ISSUE IF A CONFLICT OF INTEREST IS DISCOVERED. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS KEWEENAW HOSPITAL 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 HAS DEEMED THAT ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART IX, LINE 11G CONTRACT/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,757,101. MANAGEMENT AND GENERAL EXPENSES 101,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,859,068. DISPENSING FEE 340B: PROGRAM SERVICE EXPENSES 563,499. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 563,499. LAB PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 894,149. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 894,149. LINEN CONTRACT: PROGRAM SERVICE EXPENSES 204. MANAGEMENT AND GENERAL EXPENSES 117,474. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,678. OTHER SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,765. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,765. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS - AWH 312,419. INTERCOMPANY TRANSFERS - AI 1,787,475. INTERCOMPANY TRANSFERS - ACI -448,272. INTERCOMPANY TRANSFERS - AOH -345,864. INTERCOMPANY TRANSFERS - VNA -1,319. INTERCOMPANY TRANSFERS - AIW -156,130. INTERCOMPANY TRANSFERS - AIR -85,845. INTERCOMPANY TRANSFERS - ARH 7,927. INTERCOMPANY TRANSFERS - ADS 210. INTERCOMPANY TRANSFERS - ASP 4,122. INTERCOMPANY TRANSFERS - ARN 9,279. INTERCOMPANY TRANSFERS - AER -15. OTHER CHANGES IN NET ASSETS 3. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF ASPIRUS, INC. THE PARENT ORGANIZATION, ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE CONSOLIDATED AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE IN THIS PROCESS IN THE PAST YEAR. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE WI 501 (C) 3 LINE 12B, II N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 333 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS MEDICAL GROUP INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS ONTONAGON INC 601 SEVENTH STREET ONTONAGON MI 49953 260806477 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTH CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS VNA HOME HEALTH INC 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTGAGE WI 53901 390806250 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD HOSPITAL & CLINICS INC 135 S GIBSON STREET MEDFORD WI 54451 390964813 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD FOUNDATION INC 135 S GIBSON STREET MEDFORD WI 54451 391777081 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL & CLINICS INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 390808443 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL FOUNDATION INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 391657410 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS STANLEY HOSPITAL & CLINICS INC 1120 PINE STREET STANLEY WI 54768 390807065 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL & CLINICS INC 601 S CENTER AVENUE MERRILL WI 54452 390808503 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL FOUNDATION INC 601 S CENTER AVENUE MERRILL WI 54452 391627755 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS INC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391390638 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS EAGLE RIVER HOSPITAL & CLINICS INC 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 THE HOWARD YOUNG MEDICAL CENTER INC 240 MAPLE STREET WOODRUFF WI 54568 390873606 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 HOWARD YOUNG HEALTH CARE INC 240 MAPLE STREET WOODRUFF WI 54568 391499115 HEALTHCARE WI 501 (C) 3 LINE 12B, II ASPIRUS INC 1 ASPIRUS MEDICAL GROUP - NORTHERN WISCONSIN 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391965593 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI N/A 0 0 THE WESTWOOD CONFERENCE CENTER LLC 333 PINE RIDGE BLVD WAUSAU WI 54401 571184256 REAL ESTATE INVESTMENT WI N/A 0 0 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI ASPIRUS KEWEENAW HOSPITAL C 83659 725282 1.00000 1 ASPIRUS HEALTH VENTURES 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 1 ASPIRUS CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 842513742 ASSOCIATION WI N/A C 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 ASPIRUS WAUSAU HOSPITAL INC I 77972 COST ASPIRUS WAUSAU HOSPITAL INC O 169561 COST ASPIRUS WAUSAU HOSPITAL INC P 169019 COST ASPIRUS WAUSAU HOSPITAL INC Q 99706 COST ASPIRUS INC C 4197307 COST ASPIRUS INC I 70989 COST ASPIRUS INC M 9399552 COST ASPIRUS INC O 29118551 COST ASPIRUS INC P 13412224 COST ASPIRUS INC Q 102597 COST ASPIRUS MEDICAL GROUP INC J 50750 COST ASPIRUS MEDICAL GROUP INC O 535785 COST ASPIRUS ONTONAGON HOSPITAL INC M 139615 COST ASPIRUS ONTONAGON HOSPITAL INC O 59644 COST ASPIRUS ONTONAGON HOSPITAL INC Q 710849 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC O 189669 COST ASPIRUS IRON RIVER HOSPITAL & CLINICS INC O 143930 COST