2022-05-12T12:41:17-05:00 2021-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2020-07-01 383236977 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC ASPI 9062656121 1400 W ICE LAKE RD IRON RIVER MI 49935 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 9062656121 2022-05-06 1 SIDNEY SCZYGELSKI 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-04-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SIDNEY C SCZYGELSKI 1400 W ICE LAKE RD IRON RIVER MI 49935 38259105 0 X WWW.ASPIRUS.ORG X 1995 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 12 6 253 20 0 0 2959952 2495474 36399290 35586219 443948 81718 73412 95694 39876602 38259105 2000 700 0 0 18074128 15630520 0 0 0 22202217 21323103 40278345 36954323 -401743 1304782 38373665 37384474 34611857 31304065 3761808 6080409 WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 24796662 700 35586297 ASPIRUS IRON RIVER HOSPITAL (AIR) PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL AND PHYSICIAN CLINIC SERVICES. IN 2020, AIR HAD 432 INPATIENT ADMISSIONS AND 1,130 INPATIENT DAYS ALONG WITH 5,870 EMERGENCY DEPARTMENT VISITS WITH AN EMERGENCY PROVIDER STAFFED 24/7. AIR HAS 2 PROVIDER CLINICS, ONE ON THE HOSPITAL CAMPUS AND ONE LOCATED 15 MILES AWAY IN CRYSTAL FALLS, MI., BOTH PROVIDED 18,456 PATIENT VISITS IN 2020. THE HOSPITAL ALSO PROVIDES ICU SERVICES ALONG WITH A SWING BED PROGRAM. THE HOSPITAL ALSO HAS A FULLY FUNCTIONING LAB AND RADIOLOGY DEPARTMENTS THAT ARE SUPPLEMENTED BY A MOBILE MRI UNIT THAT VISITS THE HOSPITAL CAMPUS WEEKLY. BECAUSE OF REGIONAL AFFILIATION, AIR IS ALSO ABLE TO PROVIDE ORTHOPEDIC, OB CLINIC VISITS, CARDIOLOGY, BEHAVIORAL HEALTH AND ONCOLOGY SERVICES. 24796662 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 1 0 0 0 0 1 1 1 0 0 1 29 0 253 0 0 0 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 JESSE TISCHER DIRECTOR/SVP REGIONAL MARKETS 2.00 50.00 X 0 551417 54431 JENNY REDMAN-SCHELL VICE-CHRM/SVP, PRES ASPIRUS CLINICS 2.00 50.00 X X 0 481240 39357 JONATHAN N BRUEGGEMAN DIRECTOR/CMO-UP REGION 2.00 50.00 X 0 453924 52824 CHRIS HARFF PRESIDENT - REGIONAL UP 2.00 50.00 X X 0 370858 49687 MARCUS SANTINI DIRECTOR/PHYSICIAN 2.00 50.00 X 0 323075 52713 JENNIFER E WEAVER DIRECTOR/FNP 2.00 50.00 X 0 109982 36518 KRISTEN MESKE DIRECTOR/NP (THRU OCT) 40.00 X 127716 0 5917 JAMES LORENSON CHAIRMAN 2.00 X X 0 0 0 STEVEN TINTI TREASURER 2.00 1.00 X X 0 0 0 KATIE CLARK SECRETARY 2.00 X X 0 0 0 JOHN D MATONICH DIRECTOR 2.00 X 0 0 0 KIRK R SCHOTT DIRECTOR/PHYSICIAN 2.00 X 0 0 0 WILLIAM W WOOD DIRECTOR 2.00 X 0 0 0 ELIZABETH F TWARDZIK DIRECTOR (THRU OCT) 2.00 X 0 0 0 RICHARD J KOUBEK DIRECTOR (THRU OCT) 2.00 X 0 0 0 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1316596 71205 SIDNEY SCYZGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 861658 62993 GLENN E DOBSON SENIOR FINANCIAL ANALYST 40.00 X 161146 0 35247 RAE KAARE CHIEF ADMNISTRATIVE OFFICER - AIR 40.00 X 98459 52915 36325 JOHN HEISLER SVP, CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 571823 43247 RENEE SMITH SVP, SYSTEM CHIEF NURSING OFFICER 2.00 50.00 X 0 506661 49619 TODD RICHARDSON SVP SYSTEM CMOS 2.00 50.00 X 0 455671 52263 RUTH RISLEY-GRAY SVP, SYSTEM CHIEF NURSING OFFICER 2.00 50.00 X 0 419745 45966 MICHAEL MCGRAIL SVP, SYSTEM CHIEF MEDICAL OFFICER 2.00 50.00 X 0 426022 0 RICK NEVERS SVP - REG. OPS. SYS. INT. OFFICER 2.00 50.00 X 0 371883 30050 PATRICK TINCHER JR VP-FINANCE REGIONAL OPERATIONS 2.00 50.00 X 0 294390 54241 GRACE TOUSIGNANT VP - REGIONAL PAT. CARE & CNO 2.00 30.00 X 0 267199 34314 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 475604 56304 JAMISON GOULD CHIEF CRNA 2.00 40.00 X 272007 0 49859 MEDHAT FANOUS PHYSICIAN 40.00 X 627420 0 44284 TAKI RIDA PHYSICIAN 40.00 X 325880 0 29587 DONALD PATTON PHYSICIAN 40.00 X 276413 0 39589 MARITES ANSAY PHYSICIAN 40.00 X 269037 0 29625 MATTHEW SONGER PHYSICIAN 40.00 X 260875 0 5118 CARI LOGEMANN SVP-GEN. COUNSEL (THRU 06/20) 2.00 50.00 X 0 437354 22668 2418953 8748017 1083951 18 1 1 0 INNOVA EMERGENCY SERVICES 700 N COLORADO BLVD SUITE 109 DENVER CO 80206 EMERGENCY DEPT PROVIDERS 1949238 ORTHOPEDIC SOLUTIONS N10565 GRANDVIEW LN IRONWOOD MI 49938 LOCUM DOCTOR 475000 JOHN MAESAKA MD 15730 CTY RD 28 GOSHEN IN 46528 LOCUM DOCTOR 382700 TELEHEALTH SOLUTIONS PLLC PO BOX 1813 SPARTANBURG SC 29304 ELECTRONIC MEDICAL SERVICES 288850 UPPER PENINSULA HEALTH CARE SOLUTIONS 853 WEST WASHINGTON ST MARQUETTE WI 49855 MOBILE MRI SERVICES 280375 9 2461538 33936 32936 2495474 PATIENT SERVICE REVENUE 621110 32975362 32975362 PHARMACY REVENUE 446110 2012559 2012559 CONTRACT SERVICE REVENUE 621110 44824 44824 553474 553474 35586219 3988 3988 54401 0 54401 54401 54401 77730 0 77730 77730 77730 CAFETERIA SALES 621990 41215 41215 78 78 41293 38259105 35586297 0 177334 X 700 700 488865 425904 62961 12196380 9411068 2785312 63369 63369 2055651 1553086 502565 826255 625017 201238 78719 78719 5157 5157 1619 1619 5855509 5596367 259142 14316 14316 50857 25231 25626 12660 10547 2113 722739 95197 627542 33453 16556 16897 333908 358 333550 1899928 500485 1399443 141387 28777 112610 CORPORATE ALLOCATIONS 5411314 1120265 4291049 MEDICAL SUPPLIES 4334257 4295425 38832 HOSPITAL TAX 886721 886721 REPAIRS & MAINTENANCE 800587 526416 274171 739972 565263 174709 36954323 24796662 12157661 0 906229 947166 141866 254895 2990850 3097557 690350 748090 1163559 931677 47419501 26208638 21919674 21210863 10561137 10194226 38373665 37384474 3354829 3426008 2119883 298923 17653404 17200700 11483741 10378434 34611857 31304065 X 3761808 6080409 3761808 6080409 38373665 37384474 X 1304782 34625 979194 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5157 5157 0 PART II-B, LINE 1: MEMBERSHIP DUES ARE PAID TO THE MICHIGAN HOSPITAL ASSOCIATION (MHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). A PORTION OF THOSE DUES ARE COMMITTED TO LOBBYING PURPOSES. MHA INVOICE STATES 18.5% OF $10,490 ($1,941) GOES FOR LOBBYING ON INVOICE COVERING THE PERIOD OF 7/1/20-6/30/21. SIMILARLY, AHA DUES COMMITTED TO LOBBYING WAS 25.56% OF $12,583 ($3,216). 210026 210026 35007754 17294951 17712803 11851907 8871558 2980349 349814 42129 307685 21210863 RELATED PARTY RECEIVABLES 9747142 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 35000 INVESTMENT IN UNCOLSOLIDATD AFFILIATES 394408 NONCURRENT ASSETS LIMITED AS TO USE - DEFERRED COMPENSATION 1045 OPERATING LEASE ROU ASSET 16631 10194226 RELATED PARTY PAYABLES 4 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1737440 MEDICARE REFUNDABLE ADVANCES 8057517 FINANCE LEASE LIABILITY 126561 DEFERRED COMPENSATION 1045 OPERATING LEASE LIABILITY 16170 LONG TERM FICA 213914 LONG TERM INSURANCE 32000 LONG TERM PENSION 181324 DEFERRED POSTRETIREMENT BENEFITS 12459 10378434 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, 2021. ASPIRUS' FEDERAL INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED JUNE 30, 2017, AND PRIOR YEARS. ASPIRUS' WISCONSIN AND MICHIGAN STATE INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED JUNE 30, 2016, AND PRIOR YEARS. 1 1 X 1 X 1 X 1 1 0 1 1 272778 272778 0.00750 6487279 4036171 2451108 0.06700 6760057 4036171 2723886 0.07450 1375 1375 0.00000 1375 1375 0.00000 6761432 4036171 2725261 0.07450 1 146001 0 9606234 9593898 12336 X 1 1 1 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 WWW.ASPIRUS.ORG 732-410 X X X X ASPIRUS IRON RIVER HOSPITAL & CLINICS I 1 0 0 1 X X X X X X X X X X 18 1 1 0 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X X 1 18 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 3J: IMPLEMENTATION STRATEGY AND BUDGET PROJECTIONS. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS GATHERED FROM A WIDE ARRAY OF PUBLISHED SOURCES, FROM A SURVEY OF 4,820 RESIDENTS OF THE 15 COUNTIES, AND FROM HEALTH CARE PROVIDERS. EXTERNAL, OR SECONDARY, DATA SOURCES INCLUDE THE US CENSUS BUREAU AND ITS AMERICAN COMMUNITY SURVEY, AS WELL AS STATISTICS COMPILED BY THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION, AND OTHER GOVERNMENT AND PRIVATE AGENCIES. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: ASPIRUS KEWEENAW HOSPITAL AND ASPIRUS IRONWOOD HOSPITAL ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 7D: WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: USING A SET OF CATEGORIES AND THE DATA WITHIN, ASPIRUS IRON RIVER IDENTIFIED FOUR MAJOR PRIORITY AREAS THAT IMPACT EACH OF THE UPPER PENINSULA COUNTIES AND IRON COUNTY, WI. FOR THE PURPOSES OF THE ASPIRUS IRON RIVER CHNA, AND TO FULFILL THE REQUIREMENTS SET FORTH BY THE PPACA, ASPIRUS IRON RIVER HAS TAKEN THE FOUR OVERALL PRIORITIES AND WILL BE ADDRESSING THESE NEEDS AND LOOKING TO MAKE AN IMPACT ON THE FUTURE OF OUR COMMUNITIES. THE FOUR MAJOR PRIORITY AREAS THAT WILL BE THE FOCUS ARE: 1. HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES, 2. DRUG ABUSE, 3. LACK OF HEALTH INSURANCE, 4. UNEMPLOYMENT, WAGES AND ECONOMIC CONDITIONS. BASED ON THE INDIVIDUAL DATA FOR IRON COUNTY, ASPIRUS IRON RIVER HOSPITAL WILL CONTINUE TO FOCUS ON THE FOLLOWING IN ORDER TO MAKE THE GREATEST COMMUNITY IMPACT: 1. THE IMPACT ON AN AGING POPULATION, 2. THE IMPORTANCE OF PREVENTION, 3. THE POWERFUL CORRELATION BETWEEN SOCIO-ECONOMIC STATUS AND POOR HEALTH, 4. EXPANDED ACCESS TO CARE VIA THE EVOLVING AFFORDABLE CARE ACT. ASPIRUS IRON RIVER ALSO HAD THE FOLLOWING IMPLEMENTATION STRATEGIES: 1. FOCUS HUMAN RESOURCE AND LOCAL PUBLIC RELATIONS RESOURCES ON HEALTHY EATING, NUTRITION COMMUNITY OUTREACH AND WELLNESS, 2. SUPPORT THE DIABETES EDUCATION PROGRAM TO GROW PATIENT ENCOUNTERS BY 5% ANNUALLY OVER 3 YEARS ALONG WITH A FOCUS ON STROKE AWARENESS AND PREVENTION, 3. REACH 50% OF IRON COUNTY POPULATION ANNUALLY WITH "HOW TO" INFORMATION REGARDING POSITIVE DISEASE PREVENTION BEHAVIORS AND ACCESS TO SERVICES, 4. CONTINUE TO SUPPORT SMOKING AND RUN CESSATION EDUCATION WITH A DIRECTED EFFORT TOWARDS ADOLESCENTS AND FAMILIES. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 13H: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 2 1 - ASPIRUS IRON RIVER CLINIC 814 S ICE LAKE ROAD IRON RIVER MI 49935 PHYSICIAN PRACTICES, REHAB AND OUTPATIENT CLINIC 2 - CRYSTAL FALLS CLINIC 1328 US HWY 2 CRYSTAL FALLS MI 49920 FAMILY PRACTICE 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 WAS A COST-TO-CHARGE RATIO. PART I, LN 7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $374,361 WAS EXCLUDED FROM THE DENOMINATOR. 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 RECEIVABLE 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 8: THE COSTING METHODOLOGY USED TO DETERMINE ALLOWABLE COSTS REPORTED ABOVE IS THE COST TO CHARGE RATIO. PART III, LINE 9B: UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENT'S 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: ASPIRUS IRON RIVER HOSPITAL & CLINICS USES HEALTH AND SOCIAL DATA AND TRENDS FOR THE SAME TO DETERMINE POSSIBLE UNMET NEEDS WITH THE COMMUNITY IT SERVES. IT ALSO USES ITS TEAM MEMBERS' INVOLVEMENT IN COMMUNITY EVENTS TO USE AS A THERMOMETER FOR WHAT IS NEEDED. 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. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH 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 CHNA GIVES A DETAILED BREAKDOWN OF THE COMMUNITY THAT ASPIRUS IRON RIVER SERVES ALONG WITH THE DETAILS ABOUT THE SEVERE CHALLENGES TO A RURAL COMMUNITY WITH A SIGNIFICANT AGING POPULATION. PART VI, LINE 5: ASPIRUS IRON RIVER HAS A REGIONAL BOARD OF DIRECTORS THAT INCLUDES SEVERAL INDIVIDUALS FROM THE COMMUNITY WITH A FOCUS ON HAVING THEM BE INDEPENDENT (I.E., HAVING NO DIRECT TIES TO THE HOSPITAL SYSTEM). MEDICAL PRIVILEGES ARE EXTENDED TO ALL LOCAL, QUALIFIED PROVIDERS. THROUGH MANY OPPORTUNITIES IN THE COMMUNITIES THAT WE SERVE, INVESTMENTS ARE MADE BACK INTO THE COMMUNITY INCLUDING DONATIONS TO SUPPORT LOCAL, HEALTH INSPIRED ACTIVITIES ANNUALLY. THESE OPPORTUNITIES RELATE TO THE SCHOOLS, ELDERLY CARE SERVICES, AMERICAN CANCER SOCIETY, HEALTH SCREENING, AND OTHERS. PART VI, LINE 6: ASPIRUS IRON RIVER 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 4 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 1 X X X X 1 1 0 0 0 0 0 0 0 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 0 992466 0 321290 0 2840 0 17196 0 54009 0 1387801 0 0 SIDNEY SCYZGELSKI SR. VP OF FINANCE/CFO 0 571336 0 102719 0 187603 0 20046 0 42947 0 924651 0 174000 MEDHAT FANOUS PHYSICIAN 562440 0 53108 0 11872 0 11232 0 33052 0 671704 0 0 0 JOHN HEISLER SVP, CHIEF HUMAN RESOURCES OFFICER 0 339009 0 66240 0 166574 0 17196 0 26051 0 615070 0 152214 JESSE TISCHER DIRECTOR/SVP REGIONAL MARKETS 0 458373 0 92613 0 431 0 11473 0 42958 0 605848 0 0 RENEE SMITH SVP, SYSTEM CHIEF NURSING OFFICER 0 381673 0 68268 0 56720 0 17196 0 32423 0 556280 0 55911 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXP. 0 399509 0 67809 0 8286 0 17196 0 39108 0 531908 0 0 JENNY REDMAN-SCHELL VICE-CHRM/SVP, PRES ASPIRUS CLINICS 0 411201 0 69616 0 423 0 17196 0 22161 0 520597 0 0 TODD RICHARDSON SVP SYSTEM CMOS 0 341475 0 67414 0 46782 0 17196 0 35067 0 507934 0 43823 JONATHAN N BRUEGGEMAN DIRECTOR/CMO-UP REGION 0 423385 0 25000 0 5539 0 17196 0 35628 0 506748 0 0 RUTH RISLEY-GRAY SVP, SYSTEM CHIEF NURSING OFFICER 0 309508 0 60518 0 49719 0 20046 0 25920 0 465711 0 41695 CARI LOGEMANN SVP-GEN. COUNSEL (THRU 06/20) 0 228246 0 78456 0 130652 0 15527 0 7141 0 460022 0 129488 MICHAEL MCGRAIL SVP, SYSTEM CHIEF MEDICAL OFFICER 0 0 0 0 0 426022 0 0 0 0 0 426022 0 425671 CHRIS HARFF PRESIDENT - REGIONAL UP 0 309269 0 59238 0 2351 0 15293 0 34394 0 420545 0 0 RICK NEVERS SVP - REG. OPS. SYS. INT. OFFICER 0 263896 0 64103 0 43884 0 17172 0 12878 0 401933 0 39905 MARCUS SANTINI DIRECTOR/PHYSICIAN 0 301396 0 5555 0 16124 0 17196 0 35517 0 375788 0 0 TAKI RIDA PHYSICIAN 287450 0 33000 0 5430 0 10720 0 18867 0 355467 0 0 0 PATRICK TINCHER JR VP-FINANCE REGIONAL OPERATIONS 0 253982 0 33626 0 6782 0 16372 0 37869 0 348631 0 0 JAMISON GOULD CHIEF CRNA 261552 0 5000 0 5455 0 13730 0 36129 0 321866 0 0 0 DONALD PATTON PHYSICIAN 261273 0 15140 0 0 0 13187 0 26402 0 316002 0 0 0 GRACE TOUSIGNANT VP - REGIONAL PAT. CARE & CNO 0 191897 0 24789 0 50513 0 10975 0 23339 0 301513 0 48116 MARITES ANSAY PHYSICIAN 261236 0 0 0 7801 0 15660 0 13965 0 298662 0 0 0 MATTHEW SONGER PHYSICIAN 255875 0 5000 0 0 0 5118 0 0 0 265993 0 0 0 GLENN E DOBSON SENIOR FINANCIAL ANALYST 151584 0 375 0 9187 0 8865 0 26382 0 196393 0 0 0 RAE KAARE CHIEF ADMNISTRATIVE OFFICER - AIR 81429 52434 16314 481 716 0 6430 5070 13392 11433 118281 69418 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRON RIVER HOSPITAL & CLINIC, 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, LINES 4A-B SCHEDULE J, PART I, LINE 4A - SEVERANCE PAY MICHAEL MCGRAIL RECEIVED SEVERANCE PAY TOTALING $426,022 FOR CALENDAR YEAR 2020. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(7) DISTRIBUTION: S. SCZYGELSKI $174,000 C. LOGEMANN $129,488 J. HEISLER $152,214 M. MCGRAIL $425,671 R. NEVERS $39,905 T. RICHARDSON $43,823 R. RISLEY-GRAY $41,695 R. SMITH $55,911 G. TOUSIGNANT $48,116 KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31. EMPLOYER CONTRIBUTIONS: THE CONTRIBUTION MADE BY THE EMPLOYER IS A THREE-TIERED STRUCTURE DEPENDING UPON THE EXECUTIVE'S POSITION, WHICH ARE AS FOLLOWS: 9% FOR VICE PRESIDENT, 13% FOR SENIOR LEADERSHIP COUNCIL, AND 15% FOR THE CEO. 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; 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 463003AA1 2015-05-07 19765185 REFUND 2008 ISSUE 0 0 0 A 315000 19765185 2010 1 0 1 1 A 0 0 1 0 0 0 0 1 A 0 1 0 0 0 0 1 0 1 A 1 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, LINES 3A AND 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS IRON RIVER 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. X 2 VENTILATORS 2 32936 FAIR MARKET VALUE 0 0 0 0 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 B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 INFORMATION, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS THEN 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 HOSPITAL'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, ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CHIEF ADMINISTRATIVE OFFICER, 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 A COPY OF THE FILE FORM 990 IS AVAILABLE TO THE PUBLIC THROUGH REQUEST FROM ANY MEMBER OF THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,159,266. MANAGEMENT AND GENERAL EXPENSES 259,142. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,418,408. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 287,842. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 287,842. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 722,587. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 722,587. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,426,672. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,426,672. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS - AWH 370,816. EQUITY TRANSFERS - AI 321,209. EQUITY TRANFERS - AMG 339,013. EQUITY TRANSFERS - AOH -2,597. EQUITY TRANSFERS - VNA -38,171. EQUITY TRANSFERS - AIW -340,425. EQUITY TRANSFERS - ARH 42,422. EQUITY TRANSFERS - ADS 125. EQUITY TRANSFERS - AKH 286,802. FORM 990, PART XII, LINE 3B THE ORGANIZATION IS REQUIRED TO BE INCLUDED IN A SINGLE AUDIT FOR THE YEAR ENDED 06/30/2021. THE DEADLINE FOR THIS FILING FALLS AFTER THE DEADLINE FOR THE 990 FOR THE SAME FISCAL YEAR END. THE SINGLE AUDIT WILL NOT BE FINALIZED AT THE TIME OF THIS SUBMISSION. 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