2021-05-13T06:23:17-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 390868982 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC ASPI 7154229292 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 7154229292 2021-05-03 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-05-03 2019 2022-09-23 18:48:47Z SIDNEY C SCZYGELSKI 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 176247087 0 X WWW.ASPIRUS.ORG X 1912 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 12 6 770 256 488501 0 1690864 5000378 147997043 149926655 4857908 3078879 292319 322783 154838134 158328695 425815 62500 0 0 59013825 58680770 0 0 95580 71810461 75174663 131250101 133917933 23588033 24410762 216644695 210052304 68043027 77413866 148601668 132638438 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 104551328 62500 149095929 ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. OWNS AND OPERATES THE FOLLOWING ENTITIES: (1) ASPIRUS RIVERVIEW HOSPITAL, ESTABLISHED IN 1912; (2) THE OUTPATIENT ASPIRUS RIVERVIEW THERAPIES; (3) ASPIRUS RIVERVIEW CLINICS - THIS SERVICE INCLUDES CLINICS IN WISCONSIN RAPIDS, NEKOOSA, THE ROME-LAKES AREA, AND ADAMS CLINIC ESTABLISHED IN 2019; (4) THE ASPIRUS UW CANCER CENTER. ASPIRUS RIVERVIEW CANCER CENTER OPENED IN 2003 IN COOPERATION WITH US COMPREHENSIVE CANCER CENTER, MADISON; (5) ASPIRUS RIVERVIEW DENTAL CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THIS CLINIC IN 2009 TO SERVE RESIDENTS OF SOUTH WOOD COUNTY WHO ARE COVERED BY BADGER CARE/MEDICAID; (6) ASPIRUS RIVERVIEW WOUND AND HYPERBARIC CENTER. THE CENTER OPENED IN 2010 AND IS MANAGED BY HEALOGICS; (7) ASPIRUS HEART & VASCULAR CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THE CLINIC IN 2016, STAFFING IT WITH A FULL-TIME CARDIOLOGIST AND NURSE PRACTITIONER; (8) ASPIRUS DOCTORS CLINIC WAS PURCHASED AS OF 1/1/17. (9) ASPIRUS RIVERVIEW BEHAVIORAL HEALTH CLINIC WAS ESTABLISHED IN 2018. IT PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AND IS STAFFED BY PSYCHIATRISTS, NURSE PRACTITIONERS AND LICENSED CLINICAL SOCIAL WORKERS.ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT, AND IT PROVIDES MEASURABLE IMPROVEMENT IN HEALTH ACCESS, HEALTH STATUS, AND THE USE OF HEALTH CARE RESOURCES. IN ADDITION, THE PROGRAMS AND SERVICES CONSIDERED COMMUNITY BENEFITS SHOULD MEET ONE OR MORE OF THE FOLLOWING CRITERIA: *SUPPORTS THE ORGANIZATION'S COMMUNITY-BASED MISSION *TARGETS THE PROBLEMS OF THE POOR OR MEDICALLY UNDERSERVED *IMPACTS THE HEALTH STATUS OF THE IDENTIFIED COMMUNITY *REDUCES COMMUNITY HEALTH COSTS *IS ACCESSIBLE TO THE ENTIRE TARGET COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY *STIMULATES EXTERNAL COMMUNITY PARTNERSHIPS *IMPROVES THE ACCESS TO NEEDED HEALTH CARE SERVICESFONEMED IS A FREE, CONFIDENTIAL TELEPHONE SERVICE THE COMMUNITY CAN CALL AFTER THE CLINICS ARE CLOSED TO GET ROUTINE HEALTH ADVICE OR GENERAL HEALTH INFORMATION FROM A REGISTERED NURSE. APPROXIMATELY 1,470 PERSONS BENEFITED FROM THIS PROGRAM.COALITION BUILDING: THE HEALTHY PEOPLE WOOD COUNTY OBESITY PREVENTION TEAM IS FOCUSING EFFORTS ON BUILDING ENVIRONMENTS AND POLICIES WHICH CAN SUPPORT HEALTHY BEHAVIOR CHANGE IN TERMS OF DIET AND EXERCISE. REPRESENTATIVES FROM ASPIRUS RIVERVIEW SERVE ON THE SAFE KIDS COALITION, WORKING TO PREVENT INJURY AND DEATH IN CHILDREN AGED 0-14. THE COMMUNITY RELATIONS ASSISTANT REPRESENTS ASPIRUS RIVERVIEW ON THE 3-0 DAY COMMITTEE (OUR BODIES, OUR RESPONSIBILITIES). THE COMMITTEE ORGANIZES A TEEN CONFERENCE ANNUALLY FOCUSING ON REDUCING AT-RISK BEHAVIOR IN JUNIOR AND SENIOR HIGH STUDENTS. APPROXIMATELY 30 PERSONS BENEFITED FROM THESE COALITIONS. ASPIRUS RIVERVIEW DENTAL CLINIC IN WISCONSIN RAPIDS IS OPEN TO PATIENTS WHO HAVE MEDICAID OR BADGER CARE INSURANCE COVERAGE. THIS INSURANCE IS NOT TYPICALLY ACCEPTED BY INDEPENDENT DENTAL CLINICS. APPROXIMATELY 3,480 PERSONS BENEFITED FROM THIS PROGRAM IN 2020. THE LIFELINE PROGRAM IS A 24 HOUR A DAY PERSONAL RESPONSE SYSTEM. A LIFELINE UNIT IS INSTALLED IN THE "SUBSCRIBER'S" HOME AND OPERATES THROUGH THEIR PHONE LINE. HE/SHE WEARS A "PERSONAL HELP BUTTON", WHICH THEY USE TO ALERT LIFELINE SIMPLY BY PRESSING THE BUTTON. THERE IS ALSO AN AUTO ALERT PERSONAL HELP BUTTON, WHICH ALERTS LIFELINE AUTOMATICALLY IF THE SUBSCRIBER FALLS. A LIFELINE "MONITOR" ANSWERS THE CALL THROUGH THE LIFELINE UNIT, AND THEY CALL THE SUBSCRIBER. AFTER THEY DETERMINE WHAT KIND OF HELP IS NEEDED, THEY CALL THE SUBSCRIBER'S "RESPONDERS", WHICH ARE FRIENDS, NEIGHBORS, OR RELATIVES THAT CAN CHECK ON THE SUBSCRIBER, OR IF THE SUBSCRIBER NEEDS MORE PROFESSIONAL HELP THE MONITOR WILL CALL FOR IT IMMEDIATELY. THE LIFELINE PROGRAM HELPS PEOPLE THAT WOULD OTHERWISE BE UNABLE TO REMAIN IN THEIR HOMES. IT PROVIDES THEM WITH FREEDOM AND SECURITY TO DO SO, WHILE ALSO PUTTING THEIR FAMILY AT EASE. OUR PROGRAM HELPS MANY PEOPLE IN WISCONSIN RAPIDS AND THE SURROUNDING AREA. THIS PAST YEAR APPROXIMATELY 143 PEOPLE BENEFITED FROM THE LIFELINE PROGRAM THAT ASPIRUS RIVERVIEW HOSPITAL OFFERS.VULNERABLE PEOPLE OF ALL AGES INCLUDING THE ELDERLY CAN REMAIN IN THEIR HOME AND BE SELF-SUFFICIENT BY RECEIVING A HOME DELIVERED MEAL THAT MEETS THEIR SPECIFIC NUTRITION REQUIREMENTS. HEALTH CONDITIONS OR PHYSICAL DISABILITIES RESTRICT THE ABILITY OF INDIVIDUALS TO REMAIN INDEPENDENT. THE HOME DELIVERED MEALS PROGRAM PROVIDES NUTRITION THAT IS MEDICALLY THERAPEUTIC TO ADDRESS THE SPECIAL NEEDS OF CLIENTS DIAGNOSED WITH DIABETES, CARDIAC AND PULMONARY ISSUES, RETINAL DISEASE, GLUTEN INTOLERANCE, WEIGHT LOSS DUE TO CANCER AND CHEWING AND SWALLOWING PROBLEMS. THE PROGRAM ALSO MEETS THE NEEDS OF CARETAKERS OF THE MENTALLY AND PHYSICALLY HANDICAPPED OR ALZHEIMER'S OR OTHER DEMENTIA DISORDERS BY PROVIDING MEALS TO ALLOW THEM TO CARE FOR THEIR LOVED ONES. NUTRITION EDUCATION IS ALSO OFFERED. COMMUNITY VOLUNTEERS DELIVER HOT LUNCHES MONDAY - FRIDAY AS WELL AS BROWN BAG MEALS FOR WEEKENDS. FOOD IS PREPARED WITH CONSIDERATION FOR EACH CLIENT'S PERSONAL PREFERENCES AS WELL AS DIETARY RESTRICTIONS. IN 2020, 18,862 MEALS WERE DELIVERED. IN AN EFFORT TO MEET THE COMMUNITY NEEDS OF STUDENTS IN THE WISCONSIN RAPIDS AREA, ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. OFFERS THE OPPORTUNITY FOR INTERESTED STUDENTS TO EXPERIENCE A GLIMPSE OF THE ROLE OF ITS PROFESSIONAL STAFF. THIS SERVICE IS MADE AVAILABLE TO STUDENTS WHO ARE INTERESTED IN LEARNING MORE ABOUT HEALTH CAREERS. IN 2020, ASPIRUS RIVERVIEW HAD 25 JOB SHADOW PARTICIPANTS.ASPIRUS RIVERVIEW OFFERS A FREE SEMINAR ENTITLED UNDERSTAND YOUR JOINT PAIN. THIS SEMINAR DISCUSSED WHAT YOU CAN DO ABOUT KNEE, HIP, AND OTHER JOINT PAIN. ATTENDANTS ALSO LEARNED ABOUT ARTHRITIS, THE CAUSES AND SYMPTOMS, AND TREATMENT OPTIONS INCLUDING MEDICATIONS, NUTRITION, EXERCISE, ALTERNATIVE TREATMENTS, AND NEW CONCEPTS IN JOINT REPLACEMENT. ASPIRUS RIVERVIEW OFFERS MONTHLY EVENTS TO ALL WOMEN IN THE SURROUNDING COMMUNITIES. THE EVENTS ARE FREE OF CHARGE AND EDUCATE WOMEN ON VARIOUS HEALTH TOPICS THAT COULD AFFECT THEM AND/OR MEMBERS OF THEIR FAMILIES. VARIOUS HEALTH TOPICS COVERED WERE CANCER, DIABETES, JOINT REPLACEMENT, AND IMMUNIZATIONS. IN 2020, NEARLY 920 INDIVIDUALS BENEFITED FROM THESE EVENTS.ASPIRUS RIVERVIEW COORDINATES AND FACILITATES SEVERAL SUPPORT GROUPS FOR INDIVIDUALS AND THEIR LOVED ONES WHO ARE DEALING WITH CHRONIC DISEASE, CANCER OR LOSS. THE SUPPORT GROUPS INCLUDE BOTH MEN'S AND WOMEN'S CANCER, DIABETES, CELIAC DISEASE, ARTHRITIS AND LOSS. IN ADDITION, LACTATION SPECIALISTS FROM THE ASPIRUS RIVERVIEW FAMILY BIRTHPLACE OFFER BREASTFEEDING SUPPORT TO NEW MOTHERS. APPROXIMATELY, 635 INDIVIDUALS BENEFITED FROM THESE PROGRAMS.ASPIRUS RIVERVIEW OFFERS PRECEPTORSHIP OPPORTUNITIES TO STUDENTS ENROLLED IN AREA NURSING PROGRAMS. THIS STRUCTURED PROGRAM PROVIDES INSTRUCTION, DIRECTION AND GUIDANCE TO STUDENTS WHO ARE NOT EMPLOYEES OF ASPIRUS RIVERVIEW. THE PROGRAM MEETS THE REQUIREMENTS FOR COURSE CREDIT IN A HEALTHCARE SETTING. IN 2020, 153 STUDENTS BENEFITED FROM PRECEPTORSHIP OPPORTUNITIES.ASPIRUS RIVERVIEW HELD MONTHLY WORKSHOPS ON HOW TO COMPLETE AN ADVANCED DIRECTIVE AND APPOINT A HEALTHCARE POWER OF ATTORNEY. ADDITIONAL PRESENTATIONS WERE GIVEN TO THE WISCONSIN RAPIDS ROTARY CLUB IN AN EVENING SEMINAR. IN 2020, 54 PEOPLE RECEIVED THIS EDUCATION.ASPIRUS RIVERVIEW IS A BUSINESS SITE FOR PROJECT SEARCH - AN INTERNATIONAL PROGRAM THAT PROVIDES YOUNG ADULTS WITH COGNITIVE AND PHYSICAL DISABILITIES WITH ON-SITE INTERNSHIPS. ASPIRUS RIVERVIEW PROVIDES CLASSROOM SPACE AND 10-WEEK INTERNSHIPS IN VARIOUS DEPARTMENTS. AT THE END OF THE YEAR, STUDENTS HAVE GAINED VALUABLE SOCIAL AND EMPLOYMENT SKILLS THAT WILL HELP THEM FIND GAINFUL EMPLOYMENT IN THE COMMUNITY. IN 2020, 24 STUDENTS BENEFITED FROM THIS PROGRAM. 104551328 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 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 0 0 0 1 75 0 770 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X SIDNEY SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 STACI SOVA NURSE PRACTITIONER 40.00 X 184228 0 38898 DENISE KNIPRATH NURSE PRACTITIONER 40.00 X 178857 0 28583 JACOB MALOOLY PHYSICIAN ASSISTANT 40.00 X 132624 0 39379 MELODY DEARTH DIRECTOR- FACILITIES & SUPPORT SERVICES 40.00 X 132241 0 19514 MATTHEW MALOOLY PHARMACIST 40.00 X 129762 0 42002 CARI LOGEMANN SVP & GENERAL COUNSEL 2.00 50.00 X 0 527198 91251 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 2.00 50.00 X 0 527876 83274 RICK NEVERS SVP- REGIONAL OPERATIONS SIO 2.00 50.00 X 0 468168 87163 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 449876 93739 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 443960 90922 JENNIFER REDMAN-SCHELL SVP & PRESIDENT- ASPIRUS CLINICS 2.00 50.00 X 0 450779 79716 RENEE SMITH EXECUTIVE DIRECTOR ANI 2.00 50.00 X 0 457632 47266 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 458655 41443 RUTH RISLEY-GRAY SVP & SYSTEM CNO 2.00 50.00 X 0 454475 44140 STEPHEN BREWER VP- HEART VASCULAR & TERTIARY ACI 2.00 40.00 X 0 279378 67262 LORI PECK VP- REVENUE CYCLE 2.00 40.00 X 0 261660 32868 NANCY ROTH-MALLEK VP- FINANCE 40.00 X 217782 0 43493 KIMBERLY JOHNSON VP- PATIENT CARE & CNO 40.00 X 214093 0 42518 REBECCA PHILLIP DIRECTOR- PHARMACY 40.00 X 198184 0 23324 LISA SKIBBA VP- ANCILLARY SERVICES 40.00 X 169553 0 41559 JESSICA FOX VP- HUMAN RESOURCES ARH 40.00 X 155593 0 19862 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 1.00 50.00 X 0 1351919 222225 ANDREW BARTH INTERIM PRES ARH/PRES ALH (THRU FEBRUARY) 1.00 50.00 X 0 408898 47616 SIDNEY C SCZYGELSKI SR. VP OF FINANCE/CFO 1.00 50.00 X X 0 742406 126380 JON HARDESTY VP - CORPORATE HUMAN RESOURCES 1.00 40.00 X X 0 285585 61084 TODD BURCH PRESIDENT-ASPIRUS RIVERVIEW 40.00 X X 0 152345 34725 MARY JO CARSON BOARD SECRETARY (THRU APRIL) 1.00 X X 0 0 0 MARY IRONSIDE BOARD VICE-CHAIR 1.00 X X 0 0 0 MARTIN J LOY BOARD SECRETARY 1.00 X X 0 0 0 DAVID STARK BOARD CHAIR 1.00 50.00 X X 0 0 0 BONITA KOLRUD MD DIRECTOR 1.00 40.00 X 0 497723 49501 JESSE TISCHER TREASURER &SVP & PRESIDENT-REGIONAL MKTS 1.00 50.00 X 0 455557 71884 CRAIG R FLINDERS DO DIRECTOR (THRU APRIL) 1.00 40.00 X 0 353585 48619 STEVEN BERLYN DIRECTOR 1.00 X 0 0 0 MICHAEL BOVEE DIRECTOR 1.00 X 0 0 0 MARY MERDAN DIRECTOR 1.00 X 0 0 0 SHELLY MONDEIK DIRECTOR 1.00 X 0 0 0 1712917 9027675 1760210 32 0 1 0 TEAM HEALTH CENTRAL GROUP PO BOX 634850 CINCINNATI OH 452634850 ER SERVICE 6191700 MIRON CONSTRUCTION 1471 MCMAHON DRIVE NEENAH WI 54957 CONSTRUCTION SERVICES 4749131 TWEETGAROT MECHANICAL INC 2545 LARSEN ROAD GREEN BAY WI 54307 CONSTRUCTION/ELECTRICAL 2274416 ELLIS STONE CONSTRUCTION CO PO BOX 366 STEVENS POINT WI 54481 CONSTRUCTION SERVICES 1015449 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 PATHOLOGY FEE 573864 18 10173 67720 4647961 274524 5000378 PATIENT SERVICES 621500 148883403 148883403 FOOD 722514 238388 238388 HEALTH INCENTIVE PROGRAMS 624200 212526 212526 LAB SERVICE FOR NON PATIENTS 621500 173580 173580 418758 314921 103837 149926655 73294 73294 621455 298672 322783 322783 322783 20621387 17615802 3005585 3005585 3005585 3918 10173 3918 0 158328695 149095929 488501 3743887 62500 62500 1102112 673854 428258 46186869 39714465 6401170 71234 2214705 2212402 2303 6167115 4205415 1939431 22269 3009969 2991982 17987 127746 127746 69555 69555 17500 17500 12866428 11309778 1556650 226414 2292 224122 794416 588406 206010 461018 197179 263839 5113969 3285311 1828658 167589 105519 59993 2077 2235 2235 1865039 4114 1860925 7382476 4241843 3140633 275146 187133 88013 MEDICAL SUPPLIES 23499275 22647773 851502 CORPORATE ALLOCATION 16720179 8078781 8641398 BAD DEBT 3885343 3885343 HOSPITAL TAX 1989060 1989060 -288725 29492 -318217 133917933 104551328 29271025 95580 49956 87122 59274242 17160459 21794880 19392055 2531999 2885869 687790 507199 184656184 105025939 83790905 79630245 47643283 70146619 871640 20242736 216644695 210052304 11736408 17640214 2139389 1946369 54087589 53271027 79641 4556256 68043027 77413866 X 146587023 130770486 2014645 1867952 148601668 132638438 216644695 210052304 X 24410762 -1697601 -38676391 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11700 11700 0 PART II-B, LINE 1: THE PERCENTAGES THAT ARE SPECIFIC FOR LOBBYING PURPOSES ARE AS FOLLOWS: 23.32% OF THE AMERICAN HOSPITAL ASSOCIATION TOTALING $4,380, 16.96% OF THE WISCONSIN HOSPITAL ASSOCIATION TOTALING $7,059 AND OTHER MINOR ACTIVITY OF $261 MAKING THE GRAND TOTAL OF DUES DIRECTED TOWARDS LOBBYING $11,700. 3765872 3765872 84225869 42638065 41587804 71385580 62387874 8997706 25278863 25278863 79630245 CASH VALUE OF LIFE INSURANCE 459113 DUE FROM ASPIRUS INC 19582148 DUE FROM ASPIRUS CLINICS, INC 167593 DUE FROM ASPIRUS WAUSAU HOSPITAL 27078 DUE FROM VISITING NURSE ASSOCIATION 492 DUE FROM ASPIRUS IRONWOOD HOSPTIAL & CLINICS, INC 46 DUE FROM DHS 6266 20242736 RETIREE HEALTHCARE BENEFITS 12081 MEDICARE PAYABLE 3664287 OTHER LIABILITIES 879888 4556256 1 1 X 1 X 1 X 1 1 1 0 1 1 1357196 105490 1251706 0.00930 18545624 12207660 6337964 0.04730 19902820 12313150 7589670 0.05660 259985 96072 163913 0.00120 920999 920999 0.00690 5731727 4012046 1719681 0.01280 49621 49621 0.00040 124754 97101 27653 0.00020 7087086 4205219 2881867 0.02150 26989906 16518369 10471537 0.07810 1041608 1041608 0.00780 3458 3458 0.00000 2702 2702 0.00000 1047768 1047768 0.00780 1 1344550 17409064 20693749 -3284685 X 1 0 1 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54495 HTTP://WWW.ASPIRUS.ORG/MAIN/HOME.ASPX WI #11 X X X ASPIRUS RIVERVIEW HOSPITAL & CLINICS IN 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X 1 18 1 WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 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 RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: INPUT WAS GATHERED FROM PERSONS WHO REPRESENT THE COMMUNITY IN THE FOLLOWING WAYS: 1) A COMMUNITY-WIDE SURVEY 2) FOCUS GROUPS WITH DISENFRANCHISED POPULATIONS 3) A FORUM WITH COMMUNITY STAKEHOLDERS. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: MARSHFIELD CLINIC HEALTH SYSTEMS - MARSHFIELD, WI ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6B: WOOD COUNTY HEALTH DEPARTMENT ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: ADDRESSING THE NEEDS:1. BEHAVIORAL HEALTH: IN RESPONSE TO THE NEED FOR ADDITIONAL BEHAVIORAL HEALTH SERVICES, ASPIRUS RIVERVIEW HOSPITAL ESTABLISHED AN OUTPATIENT BEHAVIORAL HEALTH SERVICE. IN FY 2020, 6,628 PEOPLE RECEIVED SERVICES. 2. SUBSTANCE USE: ASPIRUS RIVERVIEW HOSPITAL INTRODUCED A PEER COUNSELING PROGRAM TO HELP THOSE WANTING HELP WITH SUBSTANCE ADDITION. THE PEER COUNSELORS ARE AVAILABLE 24 HOURS A DAY/SEVEN DAYS A WEEK AND WILL COME TO THE EMERGENCY ROOM TO MEET WITH PATIENTS WHO ARE THERE DUE TO AN OVERDOSE. PEER COUNSELORS HAVE ALSO BEEN PROVIDED SPACE WITHIN THE CLINIC. IN ADDITION, ASPIRUS RIVERVIEW STARTED A MEDICATION-ASSISTED TREATMENT PROGRAM TO SUSTAIN THE RECOVERY OF PATIENTS STRUGGLING TO OVERCOME ADDICTION. 3. ACTIVE COMMUNITIES AND COMMUNITY FOOD SYSTEMS: IN COLLABORATION WITH THE WOOD COUNTY HEALTH DEPARTMENT, ASPIRUS RIVERVIEW HOSPITAL FUNDED A FRUIT/VEGETABLE PRESCRIPTION PROGRAM AT THE LOCAL FARMER'S MARKET. PROVIDERS CAN PROVIDE LOW-INCOME PATIENTS AND THEIR FAMILIES WITH A PRESCRIPTION AND VOUCHER TO PURCHASE FRESH PRODUCE FROM THE MARKET. THE PROGRAM ENSURES THAT LOCALLY SOURCED, FRESH PRODUCE IS AVAILABLE FOR PATIENTS AND FAMILIES WHO OTHERWISE WOULD NOT BE ABLE TO AFFORD IT. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 7 1 - ASPIRUS UW CANCER CENTER 410 DEWEY STREET WISCONSIN RAPIDS WI 54495 CANCER CENTER 2 - ASPIRUS RIVERVIEW CLINIC WI RAPIDS 420 DEWEY STREET PO BOX 8080 WISCONSIN RAPIDS WI 54495 CLINIC 3 - ASPIRUS RIVERVIEW CLINIC NEKOOSA 1015 ANGELUS DRIVE NEKOOSA WI 54457 CLINIC 4 - ASPIRUS RIVERVIEW CLINIC ROME 1160 ROME CENTER DRIVE TOWN OF ROME NEKOOSA WI 54457 CLINIC 5 - ASPIRUS RIVERVIEW DENTAL 820 TWO MILE AVENUE WISCONSIN RAPIDS WI 54494 DENTAL CLINIC 6 - ASPIRUS DOCTORS CLINIC 2031 PEACH STREET WISCONSIN RAPIDS WI 54494 CLINIC 7 - ASPIRUS RIVERVIEW CLINIC ADAMS 419 N OAK STREET ADAMS WI 53910 CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF: 1) 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. 2) 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. 3) 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 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSE, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION. PART I, LINE 7G: THE ABOVE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE PALLIATIVE CARE, ASPIRUS RIVERVIEW CLINIC ROME, ASPIRUS RIVERVIEW CLINIC ADAMS, ASPIRUS RIVERVIEW CLINIC NEKOOSA AND BEHAVIORAL HEALTH CLINIC. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. THE PALLIATIVE CARE REPORTED COSTS OF $139,348 WITH OFFSETTING REVENUE OF $16,454. THE ASPIRUS RIVERVIEW CLINIC ROME REPORTED COSTS OF $1,282,822 WITH OFFSETTING REVENUE OF $1,135,820. THE ASPIRUS RIVERVIEW CLINIC ADAMS REPORTED COSTS OF $973,195 WITH OFFSETTING REVENUE OF $453,755. THE ASPIRUS RIVERVIEW CLINIC NEKOOSA REPORTED COSTS OF $1,732,663 WITH OFFSETTING REVENUE OF $1,220,878. THE BEHAVIORAL HEALTH CLINIC REPORTED COSTS OF $1,603,699 WITH OFFSETTING REVENUE OF $1,185,140. 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 $3,885,343. PART II, COMMUNITY BUILDING ACTIVITIES: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: CARDIOLOGY, CANCER CENTER, CLINIC SERVICES, DENTAL SERVICES, DIAGNOSTIC IMAGING, BIRTHING CENTER, LABORATORY SERVICES, RESPIRATORY CARE, SLEEP LAB, WOMEN'S SERVICES, SURGICAL SERVICES, AND REHABILITATION SERVICES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATIONS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. 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 THE FORM 990. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. SOMETIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED FINANCIAL ASSISTANCE APPLICATION AND ARE SCREENED THROUGH THE PRESUMPTIVE ELIGIBILITY PROCESS BUT MAY BE TRANSFERRED TO THE COLLECTION AGENCY REGARDLESS OF ALL THESE EFFORTS. PART III, LINE 8: THE AMOUNT OF MEDICARE ALLOWABLE COSTS WAS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD HAVE THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNT LISTED FOR MEDICARE REVENUE DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT ASPIRUS RIVERVIEW HOSPITAL, PHYSICIAN SERVICES PROVIDED AT THE OUTLYING CLINIC LOCATIONS, AND A SIGNIFICANT PORTION OF LAB SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE AND OUTPATIENT LAB SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ASPIRUS RIVERVIEW HOSPITAL PROVIDES TO THE COMMUNITY AND THE SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY THE HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED BASED ON MEDICARE REGULATIONS. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR. 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: REPRESENTATIVES FROM ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. ACTIVELY PARTICIPATE IN HEALTHY PEOPLE WOOD COUNTY (HPWC). THE PURPOSE OF HPWC IS TO ESTABLISH PRIORITIES AND RECOMMEND STRATEGIES TO ENHANCE THE QUALITY OF LIFE, HEALTH STATUS, AND THE ENVIRONMENT IN WOOD COUNTY. IN ORDER TO ACCOMPLISH THIS, MULTIPLE PARTNERS WORK TOGETHER TO ANALYZE HEALTH DATA, QUALITY OF LIFE INDICATORS AND THE COMMUNITY'S PERCEPTION OF HEALTH. IN MARCH 2015, ASPIRUS RIVERVIEW BEGAN COLLABORATING WITH THE WOOD COUNTY PUBLIC HEALTH DEPARTMENT, MINISTRY SAINT JOSEPHS HOSPITAL AND MARSHFIELD CLINIC ON A COMPREHENSIVE HEALTH NEEDS ASSESSMENT. HEALTH NEEDS ARE BEING DETERMINED AND PRIORITIZED THROUGH COMMUNITY SURVEYS, STAKEHOLDER FOCUS GROUPS AND RECENT HEALTH DATA. 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 AS 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: ASPIRUS RIVERVIEW HOSPITAL AND CLINICS OWNS AND OPERATES THE FOLLOWING ENTITIES: (1) ASPIRUS RIVERVIEW HOSPITAL; (2) THE OUTPATIENT ASPIRUS RIVERVIEW THERAPIES; (3) ASPIRUS RIVERVIEW CLINIC, THIS SERVICE INCLUDES CLINICS IN WISCONSIN RAPIDS, NEKOOSA, THE ROME-LAKES AREA, AND ADAMS CLINIC ESTABLISHED IN 2019. (4) THE ASPIRUS UW CANCER CENTER; AND (5) ASPIRUS RIVERVIEW DENTAL CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THIS CLINIC IN 2009 TO SERVE RESIDENTS OF SOUTH WOOD COUNTY. RIVERVIEW DENTAL CLINIC IN WISCONSIN RAPIDS IS OPEN TO PATIENTS WHO HAVE MEDICAID OR BADGER CARE INSURANCE COVERAGE. THIS INSURANCE IS NOT TYPICALLY ACCEPTED BY INDEPENDENT DENTAL CLINICS. APPROXIMATELY 3,480 PERSONS BENEFITED FROM THIS PROGRAM IN FISCAL YEAR 2020. WHILE MANY RIVERVIEW PATIENTS COME FROM WOOD COUNTY, AN INCREASING NUMBER ARE COMING TO US FROM SURROUNDING COUNTIES - SPECIFICALLY THOSE ALONG THE INTERSTATE 39 CORRIDOR: MARATHON, PORTAGE, WAUPACA, ADAMS, JUNEAU, WAUSHARA, MARQUETTE, COLUMBIA, AND DANE. FOR THE UW CANCER CENTER-RIVERVIEW IN 2020, OVER 17% OF ALL PATIENTS CAME FROM THESE SAME COUNTIES-NOT INCLUDING OUR "HOME" COUNTY OF WOOD. IN THE RIVERVIEW "SERVICE AREA" THERE ARE SEVERAL FEDERALLY DESIGNATED "MEDICALLY UNDERSERVED AREAS." THEY ARE WOOD COUNTY (THE CENTRAL PART BETWEEN MARSHFIELD AND WISC. RAPIDS), PORTAGE COUNTY (PART), ADAMS COUNTY (ALL), WAUSHARA COUNTY (ALL), MARQUETTE COUNTY (ALL), JUNEAU COUNTY (THE NORTHERN HALF), MARATHON COUNTY (PART), AND CLARK COUNTY (ALL). THERE ARE SCATTERED INDIAN TRIBAL LANDS IN WOOD COUNTY, JUNEAU COUNTY, AND ADAMS COUNTY (ALL HO CHUNK), THESE WOULD BE CONSIDERED "MEDICALLY UNDERSERVED POPULATIONS" PER FEDERAL DESIGNATION. OTHER HOSPITALS IN OUR SERVICE AREA INCLUDE: MARSHFIELD MEDICAL CENTER IN MARSHFIELD, MINISTRY - ST. MICHAEL'S HOSPITAL IN STEVENS POINT, MOUNDVIEW MEMORIAL HOSPITAL IN FRIENDSHIP, AND HESS MEMORIAL HOSPITAL IN MAUSTON. PART VI, LINE 5: AS A COMMUNITY-BASED ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS PROVIDES SERVICES AND EDUCATIONAL OPPORTUNITIES EITHER FREE OF CHARGE OR AT A NOMINAL FEE IN AN ATTEMPT TO PROVIDE THESE OPPORTUNITIES TO THOSE MEMBERS OF THE COMMUNITIES WHO OTHERWISE MAY NOT BE ABLE TO AFFORD OR HAVE LOCAL ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS. PART VI, LINE 6: AS A COMMUNITY-BASED ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS PROVIDES SERVICES AND EDUCATIONAL OPPORTUNITIES EITHER FREE OF CHARGE OR AT A NOMINAL FEE IN AN ATTEMPT TO PROVIDE THESE OPPORTUNITIES TO THOSE MEMBERS OF THE COMMUNITIES WHO OTHERWISE MAY NOT BE ABLE TO AFFORD OR HAVE LOCAL ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 BOYS & GIRLS CLUB OF THE WISCONSIN RAPIDS AREA 501 17TH ST S WISCONSIN RAPIDS WI 54494 391745942 501(C)(3) 62500 ASSISTANCE WITH BUILDING (NAMING RIGHTS) 1 PART I, LINE 2: THE EXECUTIVE DIRECTOR OF ASPIRUS HEALTH FOUNDATION ADMINISTERS THE FUNDS IN THE ASPIRUS COMMUNITY PARTNER FUND (CPF). THE FUNDS FROM CPF ARE GIVEN TO COMMUNITY PROGRAMS TO INCREASE THE QUALITY OF LIFE IN THE REGION OR ARE RELATED TO HEALTH INITIATIVES. THEY ARE NOT USED, IN GENERAL, FOR SPONSORSHIPS OR MARKETING-ALBEIT, WE WORK CLOSELY WITH MARKETING WHEN DISPERSING FUNDS FROM THE ACCOUNT. AN ANNUAL BUDGET IS SET FOR THE CPF AND THROUGHOUT THE YEAR WE MAINTAIN RECORDS TO TRACK WHO GETS THE FUNDS, AMOUNTS DISPERSED, AND WHY. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 STACI SOVA NURSE PRACTITIONER 179234 0 0 0 4994 0 6192 0 32706 0 223126 0 0 0 DENISE KNIPRATH NURSE PRACTITIONER 173702 0 0 0 5155 0 8913 0 19670 0 207440 0 0 0 JACOB MALOOLY PHYSICIAN ASSISTANT 130601 0 0 0 2023 0 7075 0 32304 0 172003 0 0 0 MELODY DEARTH DIRECTOR- FACILITIES & SUPPORT SERVI 119115 0 11624 0 1502 0 7190 0 12324 0 151755 0 0 0 MATTHEW MALOOLY PHARMACIST 129686 0 0 0 76 0 7018 0 34984 0 171764 0 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 381456 0 102648 0 43094 0 16832 0 74419 0 618449 0 41199 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 0 406549 0 109773 0 11554 0 14438 0 68836 0 611150 0 0 RICK NEVERS SVP- REGIONAL OPERATIONS SIO 0 339937 0 83542 0 44689 0 19582 0 67581 0 555331 0 38399 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXP. 0 360168 0 88372 0 1336 0 16832 0 76907 0 543615 0 0 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 0 313273 0 88199 0 42488 0 16832 0 74090 0 534882 0 39566 JENNIFER REDMAN-SCHELL SVP & PRESIDENT- ASPIRUS CLINICS 0 384617 0 62473 0 3689 0 8400 0 71316 0 530495 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 359068 0 65045 0 33519 0 16832 0 30434 0 504898 0 32734 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 0 317113 0 85743 0 55799 0 16832 0 24611 0 500098 0 41623 RUTH RISLEY-GRAY SVP & SYSTEM CNO 0 291384 0 78869 0 84222 0 19582 0 24558 0 498615 0 76355 STEPHEN BREWER VP- HEART VASCULAR & TERTIARY ACI 0 216847 0 41275 0 21256 0 14216 0 53046 0 346640 0 19731 LORI PECK VP- REVENUE CYCLE 0 219881 0 40703 0 1076 0 12349 0 20519 0 294528 0 0 NANCY ROTH-MALLEK VP- FINANCE 181150 0 35840 0 792 0 11657 0 31836 0 261275 0 0 0 KIMBERLY JOHNSON VP- PATIENT CARE & CNO 178792 0 34401 0 900 0 12017 0 30501 0 256611 0 0 0 REBECCA PHILLIP DIRECTOR- PHARMACY 180231 0 17480 0 473 0 10864 0 12460 0 221508 0 0 0 LISA SKIBBA VP- ANCILLARY SERVICES 140558 0 28315 0 680 0 9099 0 32460 0 211112 0 0 0 JESSICA FOX VP- HUMAN RESOURCES ARH 129645 0 25668 0 280 0 7604 0 12258 0 175455 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 920866 0 410719 0 20334 0 16832 0 205393 0 1574144 0 0 ANDREW BARTH INTERIM PRES ARH/PRES ALH (THRU FEBR 0 324722 0 83712 0 464 0 16832 0 30784 0 456514 0 0 SIDNEY C SCZYGELSKI SR. VP OF FINANCE/CFO 0 536087 0 132967 0 73352 0 19582 0 106798 0 868786 0 60259 JON HARDESTY VP - CORPORATE HUMAN RESOURCES 0 227644 0 41672 0 16269 0 9332 0 51752 0 346669 0 15539 TODD BURCH PRESIDENT-ASPIRUS RIVERVIEW 0 111390 0 0 0 40955 0 11859 0 22866 0 187070 0 40632 BONITA KOLRUD MD DIRECTOR 0 464942 0 0 0 32781 0 15834 0 33667 0 547224 0 0 JESSE TISCHER TREASURER &SVP & PRESIDENT-REGIONAL 0 374250 0 80770 0 537 0 1971 0 69913 0 527441 0 0 CRAIG R FLINDERS DO DIRECTOR (THRU APRIL) 0 345959 0 2500 0 5126 0 14935 0 33684 0 402204 0 0 PART I, LINE 1A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE, WHEN APPLICABLE, WAS ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE - INCLUDED IN INCOME: J. REDMAN-SCHELL - $3,300 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: T. BURCH $40,632 J. HARDESTY $15,539 S. SCZYGELSKI $60,259 S. BREWER $19,731 J. HEISLER $41,623 C. LOGEMANN $41,199 R. NEVERS $38,399 T. RICHARDSON $39,566 R. RISLEY-GRAY $76,355 R. SMITH $32,734 457(F) RETIREMENT PLAN PROFILE: 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 97712DMG8 2015-05-07 26748065 REFINANCE 2008 BOND 1 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG9 2015-05-07 18738269 REFINANCE 2010 BOND 1 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DC53 2017-11-02 15000000 NEW CONSTRUCRTION 0 0 0 A 1875000 26748065 26748065 0 1 1 1 B 3570000 18738269 18738269 0 1 1 1 C 15000000 14157758 1097390 0 0 0 1 A 0 0 1 0 0 0 0 0 B 0 1 1 0 0 0.00200 0.00200 0 0 0 C 0 0 1 0 0 0 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 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, RESPECTIVELY. [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 RIVERVIEW HOSPITAL & CLINICS, INC. HAS POLICY 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 VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2017 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. (EIN 38-2908586); AND ASPIRUS ONTONAGON HOSPITAL, INC. (EIN 26-0806477). INFORMATION REGARDING THE SERIES 2017 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 2017 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2017 BONDS.] FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE SOLE MEMBER OF THE ORGANIZATION, ASPIRUS INC.: 1) CHANGE OR AMEND THE ARTICLES OF INCORPORATION OR BYLAWS; 2) CHANGE THE MISSION, PURPOSE, OR SCOPE OF THE CORPORATION; 3) RATIFICATION OR REMOVAL OF DIRECTORS OR OFFICERS; 4) CHANGE THE FORMULA OR METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION; 5) APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS, STRATEGIC AND LONG-RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 AND 990-T INFORMATION, INCLUDING THE 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 BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL MANAGERS ARE REQUIRED TO SIGN BIANNUAL CONFLICT OF INTEREST STATEMENTS. THE ORGANIZATION'S CEO AND BOARD CHAIR REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTION WHERE A CONFLICT HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS RIVERVIEW HOSPITAL & CLINIC, 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 AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: NET TRANSFER TO ASPIRUS INC. -38,666,809. RETIREE MEDICAL BENEFITS -9,582. 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 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS ONTONAGON HOSPITAL 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 KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTGAGE WI 53901 390806250 HOSPITAL WI 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 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 N/A C 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 0 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 0 0 0 ASPIRUS WAUSAU HOSPITAL INC K 59793 COST ASPIRUS WAUSAU HOSPITAL INC M 395031 COST ASPIRUS WAUSAU HOSPITAL INC O 4589044 COST ASPIRUS WAUSAU HOSPITAL INC P 205699 COST ASPIRUS INC B 3091000 COST ASPIRUS INC M 16720179 COST ASPIRUS INC O 54661584 COST ASPIRUS INC P 2599948 COST ASPIRUS CLINICS INC J 225102 COST ASPIRUS CLINICS INC M 140491 COST ASPIRUS CLINICS INC O 79477 COST ASPIRUS CLINICS INC P 495874 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.