2021-05-14T13:54:02-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 390806429 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN LANG 7156232331 112 EAST FIFTH AVENUE ANTIGO WI 54409 TYLER HACK CFO 7156232331 2021-04-22 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-04-21 2019 2022-09-23 18:48:47Z ASPIRUS LANGLADE HOSPITAL TYLER HACK 112 EAST FIFTH AVENUE ANTIGO WI 54409 182887106 0 X WWW.ASPIRUS.ORG X 1933 WI THE COMMUNITY BENEFIT CONTRIBUTION OF ASPIRUS LANGLADE HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. 10 6 594 123 261280 -116332 55723 230331 113932005 113182813 3139373 3183911 77713 98397 117204814 116695452 406342 156218 0 0 45863877 46516499 0 0 0 53970554 50716869 100240773 97389586 16964041 19305866 215754676 246815047 32646601 44663919 183108075 202151128 AS A MINISTRY OF JESUS WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 0 0 67046067 156218 112434739 ACUTE GENERAL CARE HOSPITAL WITH BOTH INPATIENT AND OUTPATIENT RELATED SERVICES ALONG WITH A HOSPICE PROGRAM. INPATIENTS - 1,139 ADMISSIONS WITH 3,556 PATIENT DAYS AND 267 BIRTHS; OUTPATIENTS - 9,940 EMERGENCY VISITS, 10,917 WALK IN VISITS, 27,624 IMAGING PROCEDURES, 255,020 LAB TESTS, 32,907 THERAPY TREATMENTS, AND 11,310 SPECIALTY CLINIC VISITS; SURGICAL SERVICES - 2,835 TOTAL PATIENTS TREATED; HOSPICE - 4,272 VISITS. 67046067 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 106 0 594 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X TYLER HACK 7156239215 112 EAST FIFTH AVENUE ANTIGO WI 54409 KENNETH BOWMAN PHYSICIAN RADIOLOGIST 40.00 X 561518 0 41998 DOUGLAS ARMATO PHYSICIAN RADIOLOGIST 40.00 X 430072 0 35998 STACY KOLZ 340B SYSTEM PHARMACY COORDINATOR 40.00 X 157983 0 38843 ZOEY ZOROMSKI PHARMACIST ALH UN 40.00 X 130515 0 37818 DEBORAH KITCH PHARMACIST ALH UN 40.00 X 129485 0 30184 PATRICK TINCHER JR VP- FINANCE REGIONAL OPERATIONS 2.00 50.00 X 356677 0 54014 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 & SYSTEM CIO 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 & CHRO 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 JOHN MONKS VP- OPERATIONS 2.00 40.00 X 0 250602 45380 SHERRY BUNTEN VP- PATIENT CARE & CNO 40.00 X 226797 0 44269 JANELLE MARKGRAF VP- HUMAN RESOURCES & OFF CAMP. SERV. 40.00 X 220297 0 36755 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 1.00 50.00 X 0 1351919 222225 ANDREW BARTH PRESIDENT- ASPIRUS LANGLADE HOSPITAL 50.00 1.00 X 408898 0 47616 TYLER HACK VP- FINANCE ALH 50.00 X 165064 0 19617 JESSE TISCHER SVP & PRESIDENT- REGIONAL MARKETS 1.00 50.00 X X 0 455557 71884 MIKE WINTER CHAIRMAN 1.00 X X 0 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 1.00 50.00 X 0 742406 126380 MICHAEL OLSON PHYSICIAN RADIOLOGIST 40.00 X 737013 0 49331 NOEL DEEP PHYSICIAN 1.00 40.00 X 0 512992 52183 KRISTINE FLOWERS PHYSICIAN 1.00 40.00 X 0 277181 48271 ANGELA CLOSE BOARD MEMBER 1.00 X 0 0 0 JOHN REETZ BOARD MEMBER 1.00 X 0 0 0 ANN ROLLER BOARD MEMBER 1.00 X 0 0 0 CHARLIE ZANAYED BOARD MEMBER 1.00 X 0 0 0 ANGEL ZIMMERMAN BOARD MEMBER 1.00 X 0 0 0 3524319 8370314 1761810 24 0 1 0 PROGRESSIVE ANESTHESIA SOLUTIONS PO BOX 290 ANTIGO WI 54409 CLINICAL SERVICES 1014700 ABBOTT LABORATORIES PO BOX 92679 CHICAGO IL 60675 CLINICAL SERVICES 597055 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CLINICAL SERVICES 564357 ROCHE DIAGNOSTICS CORPORATION PO BOX 660367 DALLAS TX 75266 CLINICAL SERVICES 448385 ARAMARK UNIFORM SERVICES INC 5330 INDUSTRIAL BLVD NE SUITE 616 FRIDLEY MN 55421 CLINICAL SERVICES 433101 26 212411 17920 230331 HOSPITAL SERVICES 621990 86344729 86344729 PHYSICIAN PRIMARY CLINICS 621110 16154513 16154513 OTHER OPERATING REVENUE 623990 8577267 7829193 261280 486794 ASSISTED LIVING 623000 1502200 1502200 INDEPENDENT LIVING 623990 604104 604104 113182813 3170767 3170767 128516 30119 98397 98397 98397 66168379 6300 66157711 3824 10668 2476 13144 13144 116695452 112434739 261280 3769102 X 156218 156218 36949444 30835925 6113519 1691211 1691211 5603557 3738114 1865443 2272287 2272287 2139 2139 16483 16483 23367216 9388220 13978996 124277 14834 109443 170351 100476 69875 2317880 27035 2290845 1370739 438899 931840 88464 53265 35199 64938 44293 20645 986104 986104 4896135 2434281 2461854 274168 107075 167093 SUPPLIES 15227762 14379971 847791 BAD DEBT EXPENSE 947944 947944 EQUIPMENT 296332 238727 57605 DUES AND SUBSCRIPTIONS 272688 144613 128075 293249 32679 260570 97389586 67046067 30343519 0 33162029 10102612 15911280 71391130 14779334 12826027 2133295 1843790 1422821 259361 102115751 53036029 52327812 49079722 88530712 91976205 3953686 3982461 3533707 5353739 215754676 246815047 7490968 5596144 7316959 23887356 23734041 1268277 8016775 32646601 44663919 X 183108075 201647584 503544 183108075 202151128 215754676 246815047 X 19305866 -271656 8843 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6389 6389 0 PART II-B, LINE 1: ASPIRUS LANGLADE HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE WHA HAS NOTIFIED ASPIRUS LANGLADE HOSPITAL THAT APPROXIMATELY $4,172 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. ASPIRUS LANGLADE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, ASPIRUS LANGLADE HOSPITAL PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT APPROXIMATELY $2,217 OF THE FEES PAID BY ASPIRUS LANGLADE HOSPITAL IN FY2020 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 1382049 1382049 41236200 15116200 26120000 624378 624378 0 58642140 37254301 21387839 230984 41150 189834 49079722 DEFERRED COMPENSATION 1377872 OTHER LONG-TERM LIABILITIES 221006 LEASE LIABILITIES 127779 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 4730451 RELATED PARTY RECEIVABLES 1559667 8016775 115543187 -271656 -880609 -1152265 116695452 0 116695452 96508977 -880609 -880609 97389586 0 97389586 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 30,119. BAD DEBT EXPENSE -908,252. GAIN ON DISPOSAL -2,476. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -908,252. RENTAL EXPENSES 30,119. GAIN ON DISPOSALS -2,476. 1 1 X 1 X 1 X 1 1 1 0 1 1 1269863 1269863 0.01320 11783485 8179788 3603697 0.03740 13053348 8179788 4873560 0.05060 2414877 1998278 416599 0.00430 91170 91170 0.00090 1238161 1121309 116852 0.00120 64295 0 0.00000 3744208 3183882 624621 0.00640 16797556 11363670 5498181 0.05700 1 365490 22940616 22306662 633954 X 1 1 1 1 ASPIRUS LANGLADE HOSPITAL 112 E 5TH AVENUE ANTIGO WI 54409 1055 X X X ASPIRUS LANGLADE HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE SUPPLEMENTAL INFORMATION 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 HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/FINANCIAL/FINANCIAL-ASSIST X HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/FINANCIAL/FINANCIAL-ASSIST X HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/FINANCIAL/FINANCIAL-ASSIST X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 5: KEY INFORMANT INTERVIEWS WERE CONDUCTED, THE LISTING INCLUDES INDIVIDUALS FROM THE VARIOUS TWELVE SECTORS. (YOUTH, PARENTS, BUSINESSES, MEDIA, SCHOOLS, YOUTH SERVING ORGANIZATIONS, LAW ENFORCEMENT, RELIGIOUS/FRATERNAL ORGANIZATIONS, CIVIC OR VOLUNTEER GROUPS HEALTHCARE PROFESSIONS, STATE OR LOCAL GOVERNMENTAL AGENCIES). ALL COMMUNITY MEMBERS HAD THE OPPORTUNITY TO TAKE A PUBLIC OPINION SURVEY BY AN ONLINE LINK OR PAPER. OVER 600 COMMUNITY MEMBERS TOOK THE SURVEY THAT WAS REFERENCED ABOVE. ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 6B: IT WAS COMPLETED IN COLLABORATION WITH THE LANGLADE COUNTY HEALTH DEPARTMENT. ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 7D: LINE 7A & 10A:HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/CHNAS/ALH-CHNA%202019-22.PDF ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 11: THE CAUSES OF COMMUNITY HEALTH PROBLEMS ARE ALL ENCOMPASSING, AND ONE AGENCY CANNOT IMPROVE THEM INDEPENDENTLY. BECAUSE OF THESE COMPLEXITIES, THESE PROBLEMS REQUIRE A SYSTEM PERSPECTIVE AND MULTI-PERSPECTIVE AND MULTI-FACETED APPROACH. THE ABILITY TO PARTNER EFFECTIVELY WITH OTHER INDIVIDUALS AND ORGANIZATIONS, BOTH INSIDE AND OUTSIDE THE COMMUNITY, IS ESSENTIAL TO DOING THE WORK OF BUILDING HEALTHY COMMUNITIES.COLLABORATING ACROSS THE COMMUNITY ALLOWS THE COMMUNITY TO 1) LEVERAGE EXISTING ASSETS IN THE COMMUNITY CREATING THE OPPORTUNITY FOR BROADER IMPACT 2) AVOID UNNECESSARY DUPLICATION OF PROGRAMS OR SERVICES THEREBY MAXIMIZING THE USES OF RESOURCES 3) INCREASE THE CAPACITY OF COMMUNITY MEMBERS TO ENGAGE IN CIVIL DIALOGUE AND COLLABORATIVE PROBLEM SOLVING TO POSITION THE COMMUNITY TO BUILD ON AND SUSTAIN HEALTH IMPROVEMENT ACTIVITIES.THE FOLLOWING TOP HEALTH PRIORITIES WERE IDENTIFIED FOR LANGLADE COUNTY:1. SUBSTANCE ABUSE AND MENTAL HEALTH2. CHRONIC DISEASE PREVENTION AND MANAGEMENT3. ACCESS AND AFFORDABILITY OF HEALTHCARE SERVICESFOR STRATEGIES, PLEASE REFER TO THE FILE "CHNA 2019-2022 FINAL"STRATEGIES ARE HIGHLIGHTED IN YELLOW IN THE WORD DOCUMENT (ON PAGES 7-10). ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 5 1 - ASPIRUS ANTIGO CLINIC 110 E 5TH AVE ANTIGO WI 54409 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES 2 - ASPIRUS ELCHO CLINIC W10618 CLINIC ST ELCHO WI 54428 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES 3 - ASPIRUS BIRNAMWOOD CLINIC 400 RAILROAD BIRNAMWOOD WI 54414 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES 4 - ROSALIA GARDENS 525 FLIGHT RD ANTIGO WI 54409 ASSISTED LIVING 5 - PINE MEADOWS 525 FLIGHT RD ANTIGO WI 54409 SENIOR HOUSING 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 HOSPICE AND DIALYSIS PROGRAMS OF ASPIRUS LANGLADE HOSPITAL. ASPIRUS LANGLADE USED A COST TO CHARGE RATIO TO ESTIMATE THE COST OF EACH DEPARTMENT AND USED INTERNAL DEPARTMENT REPORTS TO DETERMINE THE DIRECT REVENUE OFFSET. THE DIALYSIS PROGRAM HAD AN ESTIMATED COST OF $1,276,523 WITH DIRECT REVENUE OFFSET OF $1,121,309 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 947,944. PART II, COMMUNITY BUILDING ACTIVITIES: ASPIRUS LANGLADE HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. ASPIRUS LANGLADE 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. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY OTHER HEALTH SERVICES. THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES FOCUS ON EFFORTS TO ENRICH THE LIVES OF COMMUNITY MEMBERS WHO ARE STRUGGLING WITH ISSUES THAT MAY HAVE A NEGATIVE IMPACT ON THEIR HEALTH. PART III, LINE 2: TOTAL BAD DEBT MULTIPLIED BY THE COST TO CHARGE RATIO. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY:IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, ASPIRUS LANGLADE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, ASPIRUS LANGLADE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), ASPIRUS LANGLADE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. ANY SHORTFALL IS TREATED AS A COMMUNITY BENEFIT SINCE THE HOSPITAL IS PROVIDING SERVICES AT A LOSS WHICH ARE ESSENTIAL TO THE COMMUNITY. THE AMOUNTS OF MEDICARE ALLOWANCE COSTS ARE DETERMINED USING THE PRINCIPLES OF MEDICARE REIMBURSEMENT. PART III, LINE 9B: UPON A PATIENT'S 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: KEY INFORMANT INTERVIEWS, COMMUNITY SURVEY, HEALTH AND SOCIAL DATA AND TRENDS TO DETERMINE WHETHER THERE IS AN UNMET NEED WITHIN THE COMMUNITY. 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: ASPIRUS LANGLADE HOSPITAL SERVES THE POPULATION OF LANGLADE COUNTY AND SURROUNDING COUNTIES. LANGLADE COUNTY IS A RURAL COUNTY WITH NO TOWNS OF ANY SIGNIFICANT SIZE. THE POPULATION IS AGING AND PROJECTIONS INDICATE 50% OF THE POPULATION WILL BE OVER 64 YEARS OF AGE BY 2020. VERY LITTLE GROWTH IS PROJECTED FOR THE SERVICE AREA IN THE COMING YEARS. LANGLADE COUNTY HAS TRADITIONALLY SEEN HIGH RATES OF UNEMPLOYMENT. THERE ARE NO OTHER HOSPITALS IN THE IMMEDIATE AREA THAT SERVE LANGLADE COUNTY. THERE ARE HOSPITALS IN RHINELANDER AND IN WAUSAU; HOWEVER, DEPENDING UPON LOCATION IN LANGLADE COUNTY, THESE FACILITIES WOULD BE FAIRLY FAR AWAY. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPRISED OF 9 INDIVIDUALS FROM THE SURROUNDING AREA. OF THESE 10 BOARD MEMBERS, 6 ARE INDEPENDENT. THE HOSPITAL DOES EXTEND PRIVILEGES TO ALL QUALIFIED LOCAL PHYSICIANS. THE HOSPITAL PARTICIPATES IN LOCAL HEALTH FAIRS AND PROVIDES FREE SCREENINGS THROUGH THESE HEALTH FAIRS. PART VI, LINE 6: ASPIRUS LANGLADE HOSPITAL IS A PARTNER WITH ASPIRUS, INC. (ASPIRUS) A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. LANGLADE HOSPITAL WORKS WITH ASPIRUS TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES THEY SERVE. A NUMBER OF REPRESENTATIVES FROM ASPIRUS HAVE ROLES ON THE BOARD OF DIRECTORS OF LANGLADE HOSPITAL AND TOGETHER PROMOTE THE MISSION OF ASPIRUS. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTH CARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES TO IMPROVING THE HEALTH OF ALL IT SERVES. ASPIRUS WORKS COLLABORATIVELY WITH OTHERS WHO SHARE ITS PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. ASPIRUS AND LANGLADE HOSPITAL WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE TO PROVIDE HIGH QUALITY CARE TO MEMBERS OF COMMUNITIES WHICH OTHERWISE WITHOUT THE EFFORTS OF A COMBINED PARTNERSHIP MAY NOT HAVE ACCESS TO THIS CARE LOCALLY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 MENOMINEE INDIAN TRIBE OF WISCONSIN PO BOX 910 KESHENA WI 54409 391205576 87657 RED ROBIN/MENOMINEE TRANSIT SERVICES 1 0 PART I, LINE 2: THE ORGANIZATION PROVIDES BOARD APPROVED CAPITAL DISTRIBUTIONS, WAGES AND BENEFITS TO RELATED ENTITIES AND NON-RELATED ENTITIES; NO FORMAL MONITORING IS REQUIRED. X 1 0 X X X X X 0 1 0 0 0 0 0 0 0 KENNETH BOWMAN PHYSICIAN RADIOLOGIST 549707 0 80 0 11731 0 16832 0 25166 0 603516 0 0 0 DOUGLAS ARMATO PHYSICIAN RADIOLOGIST 393795 0 80 0 36197 0 16327 0 19671 0 466070 0 29500 0 STACY KOLZ 340B SYSTEM PHARMACY COORDINATOR 157535 0 49 0 399 0 8733 0 30110 0 196826 0 0 0 ZOEY ZOROMSKI PHARMACIST ALH UN 130357 0 74 0 84 0 6820 0 30998 0 168333 0 0 0 DEBORAH KITCH PHARMACIST ALH UN 129236 0 74 0 175 0 6957 0 23227 0 159669 0 0 0 PATRICK TINCHER JR VP- FINANCE REGIONAL OPERATIONS 274699 0 42396 0 39582 0 15181 0 38833 0 410691 0 32760 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 & SYSTEM CIO 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 & CHRO 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 JOHN MONKS VP- OPERATIONS 0 191583 0 36077 0 22942 0 12836 0 32544 0 295982 0 17632 SHERRY BUNTEN VP- PATIENT CARE & CNO 186483 0 36400 0 3914 0 11689 0 32580 0 271066 0 0 0 JANELLE MARKGRAF VP- HUMAN RESOURCES & OFF CAMP. SERV 180216 0 33802 0 6279 0 11048 0 25707 0 257052 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 920866 0 410719 0 20334 0 16832 0 205393 0 1574144 0 0 ANDREW BARTH PRESIDENT- ASPIRUS LANGLADE HOSPITAL 324722 0 83712 0 464 0 16832 0 30784 0 456514 0 0 0 TYLER HACK VP- FINANCE ALH 136067 0 25511 0 3486 0 7265 0 12352 0 184681 0 0 0 JESSE TISCHER SVP & PRESIDENT- REGIONAL MARKETS 0 374250 0 80770 0 537 0 1971 0 69913 0 527441 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 536087 0 132967 0 73352 0 19582 0 106798 0 868786 0 60259 MICHAEL OLSON PHYSICIAN RADIOLOGIST 716810 0 14280 0 5923 0 16832 0 32499 0 786344 0 0 0 NOEL DEEP PHYSICIAN 0 505759 0 0 0 7233 0 16832 0 35351 0 565175 0 0 KRISTINE FLOWERS PHYSICIAN 0 270608 0 0 0 6573 0 14934 0 33337 0 325452 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 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $60,259 D. ARMATO $29,500 S. BREWER $19,731 J. HEISLER $41,623 C. LOGEMANN $41,199 J. MONKS $17,632 R. NEVERS $38,399 T. RICHARDSON $39,566 R. RISLEY-GRAY $76,355 R. SMITH $32,734 P. TINCHER JR. $32,761 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: 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 WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 97710B7X4 2013-04-12 27000592 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 A 3190000 27000592 27000592 2013 0 0 1 1 A 0 0 1 0 0 0.00200 0.00200 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WI HEALTH & EDUCATION FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/05/2018 PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2013 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (EIN 39-0964813); ASPIRUS GRAND VIEW (EIN 38-2908586); AND LANGLADE HOSPITAL HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN (EIN 39-0806429). INFORMATION REGARDING THE SERIES 2013 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 2013 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2013 BONDS.] PART III - LINE 3 AND 3B ASPIRUS, INC., A MEMBER OF ASPIRUS LANGLADE HOSPITAL, HAS A POLICY AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCE 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. MAUREEN WINTER FAMILY MEMBER OF MIKE WINTER, BOARD MEMBER 34322 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL HAS TWO MEMBERS, THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH HEALTH CORPORATION (55%) AND ASPIRUS, INC. (45%). FORM 990, PART VI, SECTION A, LINE 7A SEE EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7B. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL OPERATES UNDER THE CONTROL AND DIRECTION OF THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH HEALTH CORPORATION (RHSI), A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH AND ASPIRUS, INC. EACH OF WHICH APPOINT 3 BOARD MEMBERS AND JOINTLY APPROVE THE REMAINING MEMBERS. 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 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 LANGLADE 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 DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, NOR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G LAB PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 875,220. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 875,220. PROVIDER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 3,308,911. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,308,911. LAUNDRY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 205,024. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 205,024. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,213,583. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,213,583. PHARMACY DISPENSING FEES: PROGRAM SERVICE EXPENSES 1,942,417. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,942,417. RECRUITMENT: PROGRAM SERVICE EXPENSES 7,980. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,980. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,835,085. MANAGEMENT AND GENERAL EXPENSES 587,860. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,422,945. CORPORATE ALLOCATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 13,391,136. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,391,136. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 8,843. RELIGIOUS HOSPITALLERS OF ST JOSEPH HEALTH CORP 411 E WIS AVE STE 700 MILWAUKEE WI 53202 271341591 HEALTH CARE WI 501(C)(3) LINE 1 N/A 0 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE WI 501(C)(3) LINE 12B, II N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 ASPIRUS INC M 15710138 ASPIRUS INC O 42430310 ASPIRUS INC P 1212597