2021-05-13T06:20:54-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 260806477 ASPIRUS ONTONAGON HOSPITAL INC ASPI 9068848000 601 SEVENTH STREET ONTONAGON MI 49953 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 9068848000 2021-05-03 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-05-03 2019 2022-09-23 18:48:47Z MATT HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 14541942 0 X WWW.ASPIRUS.ORG X 2007 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 8 5 140 9 0 0 27812 150295 14813769 14379600 4718 3440 10423 8228 14856722 14541563 7362 2400 0 0 7627151 7347274 0 0 0 7930337 6936811 15564850 14286485 -708128 255078 7486038 13314651 4279449 10542085 3206589 2772566 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 1 8867542 2400 14383419 ASPIRUS ONTONAGON HOSPITAL, INC. (AOH) OPERATES SEVERAL HEALTHCARE SERVICE LINES INCLUDING AN 18-BED CRITICAL ACCESS HOSPITAL, THREE PHYSICIAN CLINICS, AND A 39-BED SKILLED NURSING UNIT. AOH STRIVES TO OFFER THE BEST CARE POSSIBLE TO THE RESIDENTS OF ONTONAGON COUNTY AND THE SURROUNDING AREA. AOH IS COMMITTED TO KEEPING HEALTHCARE DECISIONS LOCAL, TO PROVIDE A SUCCESSFUL COMMUNITY HOSPITAL FOR GENERATIONS TO COME. FOR THE YEAR ENDED JUNE 30, 2020, AOH SERVICED THE COMMUNITY THROUGH 392 INPATIENT DAYS, 184 SWING BED INPATIENT DAYS, 12,731 SKILLED NURSING FACILITY DAYS OF CARE, AND 12,640 OUTPATIENT VISITS. IN ADDITION, THE FAMILY PRACTICE CLINIC HAD 5,698 VISITS, THE U.P. CLINIC HAD 818 VISITS AND THE ONCOLOGY CLINIC HAD 127 VISITS. AOH PROVIDES A SIGNIFICANT AMOUNT OF SERVICES TO PATIENTS UNDER ITS CHARITY CARE POLICY OR TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS. THESE PROGRAMS OFTEN REIMBURSE AOH AT RATES WELL BELOW THE COST OF CARING FOR THESE INDIVIDUALS. ADDITIONAL INFORMATION ON THE COST OF PROVIDING THIS CARE CAN BE FOUND IN SCHEDULE H TO THE FORM 990. 8867542 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 33 0 140 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 X RICHARD CHALTRY PHYSICIAN 40.00 X 128227 0 17867 TERRENCE ASPLUND PHYSICIAN 40.00 X 120573 0 19286 DYLAN TAYLOR CHIEF ADMINISTRATIVE OFFICER 40.00 X 113370 0 17074 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 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 CHIEF NURSING OFFICER 2.00 50.00 X 0 454475 44140 STEPHEN BREWER VP- HEART VASCULAR & TERTIARY ACI 2.00 50.00 X 0 279378 67262 LORI PECK VP- REVENUE CYCLE 2.00 50.00 X 0 261660 32868 JOHN MONKS VP- OPERATIONS 2.00 50.00 X 0 250602 45380 GRACE TOUSIGNANT VP- REGIONAL PATIENT CARE & CNO 2.00 50.00 X 0 249273 34901 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1351919 222225 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 742406 126380 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-ASPIRUS CLINICS 2.00 50.00 X 0 450779 79716 CHRISTINE HARFF PRESIDENT-REGIONAL UP 2.00 50.00 X 0 196756 18363 JR RICHARDSON SECRETARY/TREASURER 2.00 2.00 X X 0 0 0 JESSE TISCHER SVP & PRESIDENT- REGIONAL MARKETS 2.00 50.00 X 0 455557 71884 PATRICK TINCHER JR VP- FINANCE REGIONAL OPERATIONS 2.00 50.00 X 0 356677 54014 MARCUS SANTINI PHYSICIAN 2.00 50.00 X 0 330058 44708 JONATHAN BRUEGGEMAN PHYSICIAN 2.00 50.00 X 0 312591 48155 JENNIFER WEAVER NURSE PRACTITIONER 2.00 50.00 X 97404 0 38135 KIRK SCHOTT BOARD TRUSEE/CONTRACTED PHYSICIAN 1.00 40.00 X 0 0 0 BILL WOOD BOARD TRUSTEE 1.00 1.00 X 0 0 0 459574 9025496 1517416 4 0 1 0 ERX LLC 9724 KINGSTON PIKE STE 1300 KNOXVILLE TN 37922 CONTRACTED ER PHYSICIANS 1369240 NORTHERN X RAY COMPANYNXC IMAGING 2118 FOURTH AVENUE SOUTH MINNEAPOLIS MN 554042642 IMAGING EQUIPMENT 119524 2 137182 13113 150295 NET PATIENT REVENUE 621110 13385789 13385789 340B REVENUE 900099 789709 789709 CONTRACT SERVICE REVENUE 621110 94328 94328 FOOD SERVICE REVENUE 722210 76395 76395 FITNESS CENTER REVENUE 621110 17193 17193 16186 16186 14379600 3819 3819 8228 0 8228 8228 8228 379 -379 -379 -379 14541563 14383419 0 7849 X 2400 2400 5695071 4310235 1384836 140087 109444 30643 1113887 789754 324133 398229 302811 95418 953 953 1986847 1801733 185114 18049 1082 16967 86847 48909 37938 60708 60708 229899 12147 217752 27341 16017 11324 1021 1021 90293 14 90279 604632 265419 339213 CORPORATE ALLOCATION 1911522 1911522 MEDICAL SUPPLIES/EXP 1218773 937643 281130 EQUIPMENT RENTAL/MAINTE 343426 252451 90975 HOSPITAL ASSESSMENT PAY 294412 294412 62088 17483 44605 14286485 8867542 5418943 0 657205 944319 237490 186995 2170879 2595645 136868 104242 68940 48138 9282012 5069058 4027424 4212954 187232 5222358 7486038 13314651 1855029 4242204 1970695 3888805 364960 231834 88765 2179242 4279449 10542085 X 3206589 2768844 3722 3206589 2772566 7486038 13314651 X 255078 -689101 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 502 502 0 PART II-B, LINE 1: ASPIRUS ONTONAGON HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HEALTH CARE ASSOCIATION (AHCA), HEALTH CARE ASSOCIATION OF MICHIGAN (HCAM), ASSOCIATION OF NUTRITION & FOODSERVICE PROFESSIONALS (ANFP), NATIONAL ASSOCIATION OF RURAL HEALTH CLINICS (NARHC), AND MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHCA, HCAM, AMA, NARHC, AND MHA HAVE NOTIFIED ASPIRUS ONTONAGON HOSPITAL THAT APPROXIMATELY $502 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 59006 59006 2823189 1039510 1783679 6305103 4029548 2275555 94714 94714 4212954 DUE FROM OTHER RELATED ENTITIES 12031 DUE FROM AI-COVID 5210327 5222358 ASBESTOS LIABILITY 56765 LONG-TERM INSURANCE LIABILITY 32000 NET BONDS PAYABLE 1967477 LONG-TERM FICA LIABILITY 54266 FINANCE LEASE LIABILITY 36916 OPERATING LEASE LIABILITY 31818 2179242 1 1 X 1 X 1 X 1 1 1 0 1 1 120435 120435 0.00840 3405640 3533896 0 0.00000 3526075 3533896 120435 0.00840 2526 2526 0.00020 1560732 1213630 347102 0.02430 3581 3581 0.00030 1566839 1213630 353209 0.02480 5092914 4747526 473644 0.03320 1 155432 3627906 3608917 18989 X 1 1 1 1 ASPIRUS ONTONAGON HOSPITAL INC 601 S SEVENTH STREET ONTONAGON MI 49953 X X X X PHYSICIAN CLINIC, SKILLED NURSING FACILITY ASPIRUS ONTONAGON HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE PART V, PAGE 8 X 1 18 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.ASPIRUS.ORG/PAY-BILL-FINANCIAL-ASSISTANCE X HTTPS://WWW.ASPIRUS.ORG/PAY-BILL-FINANCIAL-ASSISTANCE X HTTPS://WWW.ASPIRUS.ORG/PAY-BILL-FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 5: AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS, ASPIRUS ONTONAGON HOSPITAL APPOINTED A STEERING COMMITTEE WHICH IS MADE UP OF REPRESENTATIVES FROM MAJOR CROSS-SECTIONS OF COMMUNITY LEADERS AND EXPERTS THAT HAVE A STRONG UNDERSTANDING OF THE HEALTH NEEDS OF THE REGION AND RURAL COMMUNITIES, FROM THE UNDERSERVED MINORITIES TO THE GENERAL POPULATION. SURVEYS WERE SENT TO 23,800 RANDOM HOUSEHOLDS ACROSS THE WESTERN UPPER PENINSULA. 4,800 WERE RETURNED. ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:- ASPIRUS IRON RIVER- ASPIRUS IRONWOOD- ASPIRUS KEWEENAW- HELEN NEWBERRY JOY HOSPITAL- MUNISING MEMORIAL HOSPITAL- OSF ST. FRANCIS HOSPITAL- SCHOOLCRAFT MEMORIAL HOSPITAL- U.P. HEALTH SYSTEM-BELL- U.P. HEALTH SYSTEM-MARQUETTE- U.P. HEALTH SYSTEM-PORTAGE- WAR MEMORIAL HOSPITAL ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 6B: CENTRAL U.P. PLANNING & DEVELOPMENT REGIONAL COMMISSION, CHIPPEWA COUNTY HEALTH DEPARTMENT, COPPER COUNTRY COMMUNITY MENTAL HEALTH, DICKENSON COUNTY HEALTHCARE SYSTEM, DICKINSON-IRON DISTRICT HEALTH DEPARTMENT, GOGEBIC COUNTY COMMUNITY MENTAL HEALTH, LUCE-MACKINAC-ALGER-SCHOOLCRAFT DISTRICT HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT, MICHIGAN HEALTH ENDOWMENT FUND, MICHIGAN TECHNOLOGICAL UNIVERSITY, NORTHCARE NETWORK, NORTHPOINTE BEHAVIORAL HEALTH SYSTEMS, PATHWAYS COMMUNITY MENTAL HEALTH, PUBLIC HEALTH OF DELTA & MENOMINEE COUNTIES, SUPERIOR HEALTH FOUNDATION, UPPER GREAT LAKES FAMILY HEALTH CENTER, UPPER PENINSULA HEALTH CARE SOLUTIONS, UPPER PENINSULA HEALTH GROUP, UPPER PENINSULA HEALTH PLAN, WESTERN U.P. HEALTH DEPARTMENT ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 11: HEALTH NEEDS THAT ASPIRUS WAUSAU HOSPITAL PLANS TO ADDRESS:BEHAVIORAL HEALTH:VISION: PROMOTE WELL-BEING BY PREVENTING OR INTERVENING IN MENTAL ILLNESS SUCH AS DEPRESSION OR ANXIETY, ALONG WITH PREVENTING OR INTERVENING IN SUBSTANCE ABUSE OR OTHER ADDICTIONS.GOAL STATEMENTS:-INCREASE THE PUBLIC'S AWARENESS OF THE IMPORTANCE OF GOOD MENTAL WELL-BEING AND COMMUNITY SERVICES AVAILABLE TO SUPPORT THEIR MENTAL WELL-BEING.-IMPROVE ALCOHOL & OTHER DRUG ABUSE AND MENTAL HEALTH TREATMENT SERVICES-FURTHER INTEGRATE BEHAVIORAL HEALTH WITHIN THE DELIVERY OF HEALTH CAREALCOHOL & OTHER DRUG MISUSE AND ABUSE:VISION: CREATING A CULTURE IN COMMUNITIES WHERE ALCOHOL IS USED RESPONSIBLY AND OTHER DRUGS (TOBACCO, PRESCRIPTION, AND ILLICIT) ARE NOT MISUSED.GOAL STATEMENTS:-CHANGE SOCIAL NORMS, ATTITUDES, AND BEHAVIORS AROUND SUBSTANCE USE -STRENGTHEN COMMUNITY COLLABORATION AROUND SUBSTANCE ABUSE PREVENTION-INCREASE FUNDING FOR AODA PREVENTION, TREATMENT, AND ENFORCEMENTHEALTHY START FOR CHILDREN:VISION: PREVENTING OR REDUCING THE IMPACT OF POTENTIALLY TRAUMATIC EVENTS THAT CAN HAVE NEGATIVE, LASTING EFFECTS ON HEALTH AND WELL-BEING. THESE EXPERIENCES RANGE FROM PHYSICAL, EMOTIONAL, OR SEXUAL ABUSE TO PARENTAL DIVORCE OR THE INCARCERATION OF A PARENT OR GUARDIAN.HEALTHY WEIGHT:VISION: A WEIGHT THAT LOWERS YOUR RISK FOR HEALTH PROBLEMS, INCLUDING THOSE THAT LEAD TO CHRONIC CONDITIONS, SUCH AS DIABETES, HYPERTENSION, AND CHRONIC HEART FAILURE. ACHIEVEMENT OR MAINTENANCE OF A HEALTHY WEIGHT INCLUDES HEALTHY FOOD CHOICES AND PHYSICAL ACTIVITY.GOAL STATEMENTS:-CONTINUE THE COLLECTIVE EFFORTS OF THE HEALTHY EATING ACTIVE LIVING (HEAL) COALITION, STRIVING TO MOVE TO THE "COLLABORATION" STATUS -IDENTIFY ASPECTS OF HEALTHY WEIGHT THAT ARE IMPORTANT TO MARATHON COUNTY RESIDENTS-STRENGTHEN THE LINK BETWEEN HEALTHY WEIGHT AND ECONOMIC PROSPERITY BECAUSE AWH IS A HEALTH CARE PROVIDER, IT CANNOT MEANINGFULLY IMPACT ALL ISSUES IDENTIFIED BY THE CHNA. AWH WILL NOT BE DEVELOPING STRATEGIES TO ADDRESS HEALTH NEEDS OF AGING OR ORAL HEALTH AS ONE OF THE TOP HEALTH PRIORITIES. AWH DOES HAVE POPULATION HEALTH GOALS IN ALIGNMENT WITH THE COMMUNITY ACTIVITIES FOCUSED AROUND HEALTHY AGING, BEING END OF LIFE CARE. AWH WILL CONTINUE TO COLLABORATE WITH COMMUNITY PARTNERS IN ADDRESSING THIS ISSUE AS A NEED IN THE COMMUNITY. ORAL HEALTH IS ALSO PROMOTED ACROSS PROVIDERS, NOTING THAT ORAL HEALTH IS A COMPONENT OF GOOD OVERALL HEALTH. ASPIRUS MAINTAINS A GOOD RELATIONSHIP WITH DENTAL PROVIDERS IN THE COMMUNITY FOR REFERRALS AND OTHER SERVICES. ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 13H: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. PART V, LINE 7A, CHNA HOSPITAL FACILITY WEBSITE: HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/CHNAS/AOH_CHNA-2019.PDF PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE: HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/CHNAS/AOH_CHNA-2019.PDF 4 1 - ASPIRUS ONTONAGON HOSPITAL NURSING HOME 601 SOUTH SEVENTH STREET ONTONAGON MI 49953 SKILLED NURSING FACILITY 2 - AOH FAMILY PRACTICE CLINIC 601 SOUTH SEVENTH STREET ONTONAGON MI 49953 CLINIC 3 - ASPIRUS UP CLINIC - BRUCE CROSSING 13833 US HWY 45 BRUCE CROSSING MI 49912 CLINIC 4 - ASPIRUS ONTONAGON FITNESS CENTER 400 RIVER STREET ONTONAGON MI 49953 OUTPATIENT PHYSICAL THERAPY AND FITNESS CENTER 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 EXPENSES DIVIDED BY GROSS PATIENT SERVICES REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THIS ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FROM THE FORM 990. PART I, LINE 7G: THE ORGANIZATION DID NOT INCLUDE ANY PHYSICIAN CLINICS IN CALCULATING SUBSIDIZED HEALTH SERVICE COSTS. THE SUBSIDIZED HEALTH SERVICES INCLUDED THE EMERGENCY DEPARTMENT WITH COSTS OF $870,390 AND DIRECT OFFSETTING REVENUE OF $853,933 THE INPATIENT UNIT WITH COSTS OF $323,361 AND DIRECT OFFSETTING REVENUE OF $293,193 AND THE NURSING HOME WITH COSTS OF $366,981 AND DIRECT OFFSETTING REVENUE OF $66,504. THE SUBSIDIZED HEALTH SERVICES COSTS WERE ESTIMATED USING AN OVERALL COST TO CHARGE RATIO. PART II, COMMUNITY BUILDING ACTIVITIES: AOH 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 BENEFIT WHICH IS NOT QUANTIFIED. AOH, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. THE BOARD ALSO CONTAINS THREE COMMUNITY REPRESENTATIVES. THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, NURSING HOME SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, ONCOLOGY, AND WOMEN'S SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 2: CURRENT YEAR BAD DEBT EXPENSE IS MULTIPLIED BY THE RATIO OF PATIENT CARE TO COST CHARGES. 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 HEALTH CARE 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. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ASPIRUS ONTONAGON HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD ABOVE FOR THE IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2020 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICES REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). PART III, LINE 9B: UPON A PATIENTS APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENTS ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORK QUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT. PART VI, LINE 2: ASPIRUS ONTONAGON HOSPITAL UTILIZES SEVERAL METHODS IN ASSESSING COMMUNITY HEALTH CARE NEEDS WHICH INCLUDE: WORKING CLOSELY WITH THE LOCAL HEALTH DEPARTMENT, SCHOOL DISTRICT, COUNTY AGING DEPARTMENT, AND OTHER ORGANIZATIONS IN THE COMMUNITY; DEMOGRAPHIC DATA FROM SURROUNDING COMMUNITIES; AND EXTERNAL REPORTS, PARTICULARLY THOSE PUBLISHED BY THE LOCAL DEPARTMENT OF HEALTH. ASPIRUS ONTONAGON HOSPITAL, AT THE END OF FISCAL YEAR 2019, COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND WILL USE THE DATA AND FINDINGS OF THIS REPORT TO GUIDE THE ORGANIZATION IN THE FUTURE TO BE ABLE TO RESPOND TO THOSE NEEDS. 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 ONTONAGON HOSPITAL'S COMMUNITY CARE PROGRAM DOES NOT HAVE ANY BOUNDARIES. THE MAJORITY OF AOH'S PATIENTS DO RESIDE IN ONTONAGON COUNTY AND ARE EITHER MEDICARE OR MEDICAID PROGRAM BENEFICIARIES. ONTONAGON COUNTY IS REMOTE AND AOH IS THE ONLY HOSPITAL IN THE COUNTY. THE MAIN INDUSTRIES IN THE COUNTY HAVE CLOSED, CAUSING MANY ECONOMIC HARDSHIPS OVER THE PAST FEW YEARS AND A POPULATION DECLINE. PART VI, LINE 5: ASPIRUS ONTONAGON HOSPITAL, INC. IS IN A PHYSICIAN SHORTAGE AREA AND WORKS HARD TO RECRUIT PROVIDERS TO OUR AREA AND FILL THE NEEDS OF OUR COMMUNITY. AOH ALSO HAS EMPLOYEES THAT REPRESENT ASPIRUS ONTONAGON HOSPITAL AND ARE ACTIVE IN OTHER GROUPS TO HELP IN BUILDING COMMUNITY EFFORTS TO IMPROVE HEALTHCARE IN OUR SERVICE AREA. PART VI, LINE 6: ASPIRUS ONTONAGON HOSPITAL IS PART OF THE ASPIRUS HEALTH SYSTEM. ASPIRUS, INC. IS A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. ASPIRUS ONTONAGON HOSPITAL WORKS WITH ASPIRUS TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES THEY SERVE. AS NOTED PREVIOUSLY IN THE FORM 990, A NUMBER OF REPRESENTATIVES FROM ASPIRUS HAVE ROLES ON THE BOARD OF DIRECTORS OF ASPIRUS ONTONAGON HOSPITAL AND TOGETHER PROMOTE THE MISSION OF ASPIRUS. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTHCARE 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 ASPIRUS ONTONAGON HOSPITAL WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE 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 MI X 1 1 X X X X 1 1 0 0 0 0 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 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 CHIEF NURSING OFFICER 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 GRACE TOUSIGNANT VP- REGIONAL PATIENT CARE & CNO 0 182057 0 64594 0 2622 0 10343 0 24558 0 284174 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 920866 0 410719 0 20334 0 16832 0 205393 0 1574144 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 536087 0 132967 0 73352 0 19582 0 106798 0 868786 0 60259 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-ASPIRUS CLINICS 0 384617 0 62473 0 3689 0 8400 0 71316 0 530495 0 0 CHRISTINE HARFF PRESIDENT-REGIONAL UP 0 143509 0 40000 0 13247 0 5354 0 13009 0 215119 0 0 JESSE TISCHER SVP & PRESIDENT- REGIONAL MARKETS 0 374250 0 80770 0 537 0 1971 0 69913 0 527441 0 0 PATRICK TINCHER JR VP- FINANCE REGIONAL OPERATIONS 0 274699 0 42396 0 39582 0 15181 0 38833 0 410691 0 32761 MARCUS SANTINI PHYSICIAN 0 304375 0 9817 0 15866 0 16832 0 27876 0 374766 0 0 JONATHAN BRUEGGEMAN PHYSICIAN 0 255375 0 50000 0 7216 0 14627 0 33528 0 360746 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 C. HARFF $3,257 J. BRUEGGEMAN $1,679 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS ONTONAGON HOSPITAL, INC. RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICES, 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, LINES 4A-B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $60,259 S. BREWER $19,731 J. HEISLER $41,623 P. TINCHER JR. $32,761 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 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 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DC53 2017-11-02 2000000 NEW CONSTRUCTION 0 0 0 A 2000000 2000000 2017 0 0 1 1 A 0 0 1 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 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 III, LINE 3 ASPIRUS ONTONAGON HOSPITAL, INC. CLOSED ITS OPERATING ROOM AND RELATED DEPARTMENTS. FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A SEE EXPLANATION FOR FORM 990, PART VI, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE SOLE MEMBER OF THE ORGANIZATION, ASPIRUS, INC.: 1) CHANGE OR AMEND THE ARTICLES OF INCORPORATION OR BYLAWS; 2) CHANGE THE MISSION, PURPOSE, OR SCOPE OF THE CORPORATION; 3) RATIFICATION OR REMOVAL OF DIRECTORS OR OFFICERS; 4) CHANGE THE FORMULA OR METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION; 5) APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS, STRATEGIC AND LONG-RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 INFORMATION. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND IS 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 DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS ONTONAGON HOSPITAL, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, NOR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, LINE 1A, EXPLANATION FOR HOURS WORKED: SOME OFFICERS AND DIRECTORS ALSO PROVIDED SERVICE TO OTHER RELATED ORGANIZATIONS OTHER THAN ASPIRUS ONTONAGON HOSPITAL, INC. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. FORM 990, PART IX, LINE 11G MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 7,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,200. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 288,934. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 288,934. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 60,167. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 60,167. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,505,599. MANAGEMENT AND GENERAL EXPENSES 124,947. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,630,546. FORM 990, PART XI, LINE 9: UNRESTRICTED NET ASSET TRANSFERS - AWH -2,480,077. UNRESTRICTED NET ASSET TRANSFERS - AI -3,620,344. UNRESTRICTED NET ASSET TRANSFERS - AI COVID 5,210,328. UNRESTRICTED NET ASSET TRANSFERS - ACI -379,003. UNRESTRICTED NET ASSET TRANSFERS - VNA -1,528. UNRESTRICTED NET ASSET TRANSFERS - AIW -7,768. UNRESTRICTED NET ASSET TRANSFERS - AIR -20,030. UNRESTRICTED NET ASSET TRANSFERS - AKH 609,321. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF ASPIRUS, INC., THE PARENT ORGANIZATION, ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE CONSOLIDATED AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE IN THIS PROCESS IN THE PAST YEAR. 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