2021-05-13T06:12:55-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 383236977 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC ASPI 9062656121 1400 W ICE LAKE RD IRON RIVER MI 49935 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 9062656121 2021-05-03 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-05-03 2019 2022-09-23 18:48:47Z SIDNEY C SCZYGELSKI 1400 W ICE LAKE RD IRON RIVER MI 49935 39876602 0 X WWW.ASPIRUS.ORG X 1995 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 10 2 271 35 0 0 106499 2959952 37988202 36399290 167282 443948 2597106 73412 40859089 39876602 21325 2000 0 0 18848576 18074128 0 0 0 25009897 22202217 43879798 40278345 -3020709 -401743 31829580 38373665 24629962 34611857 7199618 3761808 WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 26898044 2000 36328745 ASPIRUS IRON RIVER HOSPITAL (AIR) PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL AND PHYSICIAN CLINIC SERVICES. IN 2020, AIR HAD 577 INPATIENT ADMISSIONS AND 1613 INPATIENT DAYS ALONG WITH 6,652 EMERGENCY DEPARTMENT VISITS WITH AN EMERGENCY PHYSICIAN STAFFED 24/7. AIR HAS 2 PROVIDER CLINICS, ONE ON THE HOSPITAL CAMPUS AND ONE LOCATED 15 MILES AWAY IN CRYSTAL FALLS, MI., BOTH PROVIDED 19,516 PATIENT VISITS FOR 2020. THE HOSPITAL ALSO PROVIDES ICU SERVICES ALONG WITH A SWING BED PROGRAM. THE HOSPITAL ALSO HAS A FULLY FUNCTIONING LAB AND RADIOLOGY DEPARTMENTS THAT ARE SUPPLEMENTED BY A MOBILE MRI UNIT THAT VISITS THE HOSPITAL CAMPUS WEEKLY. BECAUSE OF REGIONAL AFFILIATION, AIR IS ALSO ABLE TO PROVIDE ORTHOPEDIC, OB CLINIC VISITS AND ONCOLOGY SERVICES. 26898044 1 1 0 1 0 0 0 0 0 0 1 0 0 0 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 1 0 0 0 0 0 0 1 1 1 0 0 1 75 0 271 1 0 0 0 0 0 0 0 0 0 0 X 10 2 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 HAROLD CLINE PHYSICIAN 40.00 X 518093 0 48331 MEDHAT FANOUS PHYSICIAN 40.00 X 485711 0 42731 DONALD PATTON PHYSICIAN 40.00 X 451000 0 42635 SHARON HAYWARD PHYSICIAN 40.00 X 395799 0 48331 RONALD DALTON PHYSICIAN 40.00 X 283370 0 38111 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 2.00 50.00 X 0 527876 83274 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXPERIENCE 2.00 50.00 X 0 449876 93739 TODD RICHARDSON SVP SYSTEM CMOS 2.00 50.00 X 0 443960 90922 RENEE SMITH SVP OF SERVICE LINE & PATI 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 CHRISTOPHER POGLIANO PHYSICIAN 2.00 50.00 X 0 383201 44280 PATRICK TINCHER JR VP- FINANCE REGIONAL OPERATIONS 2.00 40.00 X 0 356677 54014 STEPHEN BREWER VP- HEART VASCULAR & TERTIARY ACI 2.00 40.00 X 0 279378 67262 JOHN MONKS VP- OPERATIONS 2.00 40.00 X 0 250602 45380 JAMISON GOULD CHIEF CRNA 2.00 40.00 X 266257 0 27287 GRACE TOUSIGNANT SVP AND CIO 2.00 30.00 X 0 249273 34605 CHRISTINE HARFF PRESIDENT- REGIONAL UP 2.00 40.00 X 0 196756 18363 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1351919 222225 SIDNEY SCYZGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 742406 126380 CONNIE KOUTOUZOS CEO - AIR (FORMER) 40.00 0.00 X 117576 0 17834 PAULA CHERMSIDE CEO - AIR (THRU JULY) 2.00 50.00 X 0 338658 29071 GLENN E DOBSON CFO, SENIOR FINANCIAL ANALYST 2.00 40.00 X 165058 0 34740 RAE KAARE CHIEF OPERATING OFFICER 2.00 40.00 X 0 0 0 CARI LOGEMANN SVP GENERAL COUNSEL, ASST. SECRETARY 2.00 50.00 X X 0 527198 91251 RICK L NEVERS VICE-CHRM/SVP REG MKTS (THRU JUNE) 2.00 50.00 X X 0 468168 87163 JENNY REDMAN-SCHELL VICE-CHRM/SVP & PRES ASPIRUS CLINICS 2.00 50.00 X X 0 450779 79716 LORI PECK TREASURER/SVP OF REV (THRU SEPT) 2.00 50.00 X X 0 261660 32868 JAMES LORENSON CHAIRMAN 2.00 X X 0 0 0 MARK D TOUSIGNANT CHAIRMAN (THRU SEPT) 2.00 1.00 X X 0 0 0 STEVEN TINTI TREASURER 2.00 1.00 X X 0 0 0 KATIE CLARK SECRETARY 2.00 X X 0 0 0 DONALD BASTIANELLO SECRETARY (THRU SEPT) 2.00 X X 0 0 0 JESSE TISCHER DIRECTOR/SVP REGIONAL MKTS 2.00 50.00 X 0 455557 71884 MARCUS SANTINI DIRECTOR/PHYSICIAN 2.00 50.00 X 0 330058 44708 JONATHAN N BRUEGGEMAN DIRECTOR/CMO-UP REGION 2.00 50.00 X 0 312591 48155 JENNIFER E WEAVER DIRECTOR/FNP 2.00 50.00 X 0 97404 38135 RAY KOIVUNEN DIRECTOR/VPMA (THRU SEPT) 2.00 X 0 0 0 JOHN D MATONICH DIRECTOR 2.00 X 0 0 0 GARY SCALCUCCI DIRECTOR (THRU SEPT) 2.00 X 0 0 0 KIRK R SCHOTT DIRECTOR/PHYSICIAN 2.00 X 0 0 0 JOEL TUORINIEMI DIRECTOR (THRU JUNE) 2.00 X 0 0 0 WILLIAM W WOOD DIRECTOR 2.00 X 0 0 0 2682864 9844759 1836244 22 1 1 0 INNOVA EMERGENCY SERVICES 700 N COLORADO BLVD SUITE 109 DENVER CO 80206 EMERGENCY DEPT PROVIDERS 1717621 ORTHOPEDIC SOLUTIONS N10565 GRANDVIEW LN IRONWOOD MI 49938 LOCUM DOCTOR 392500 JOHN MAESAKE MD 15730 CTY RD 28 GOSHEN IN 46528 LOCUM DOCTOR 387000 UPPER PENINSULA HEALTH CARE SOLUTIONS 853 WEST WASHINGTON ST MARQUETTE WI 49855 MOBILE MRI SERVICES 293941 ARAMARK UNIFORM SERVICES INC 5330 INDUSTRIAL BLVD SUITE 616 FRIDLEY MN 55412 LAUNDRY SERVICES 282455 16 2944152 15800 5000 2959952 PATIENT SERVICE REVENUE 621110 33784769 33784769 PHARMACY REVENUE 446110 2416029 2416029 CAFETERIA 621990 70545 70545 CONTRACT SERVICE REVENUE 621110 49718 49718 78229 78229 36399290 443948 443948 73412 0 73412 73412 73412 39876602 36328745 0 587905 X 2000 2000 2435835 2122122 313713 11180854 8416017 2764837 1320920 1022682 298238 2239116 1523203 715913 897403 671792 225611 4351 4351 11111 11111 5090246 4996214 94032 138689 138689 609947 266052 343895 1608124 1181629 426495 74080 35442 38638 341144 341144 2026909 1057536 969373 160285 21426 138859 CORPORATE ALLOCATIONS 5685961 5685961 MEDICAL SUPPLIES 4706134 4706134 HOSPITAL TAX 835594 835594 PROVISION FOR BAD DEBTS 820122 820122 89520 55673 33847 40278345 26898044 13380301 0 948510 906229 141866 6143471 2990850 831231 690350 123743 11162827 47218698 25299024 23147351 21919674 126601 508673 561869 31829580 38373665 1051695 15659924 18081107 17548405 5497160 1403528 24629962 34611857 X 7199618 3761808 7199618 3761808 31829580 38373665 X -401743 13704 -3049771 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4351 4351 0 PART II-B, LINE 1: MEMBERSHIP DUES ARE PAID TO THE MICHIGAN HOSPITAL ASSOCIATION (MHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). A PORTION OF THOSE DUES ARE COMMITTED TO LOBBYING PURPOSES. MHA INVOICE STATES 14.2% OF $1,568 GOES FOR LOBBYING ON INVOICE COVERING THE PERIOD OF 7/1/19-6/30/20. SIMILARLY, AHA DUES COMMITTED TO LOBBYING WAS 22.12% OF $12,583. 210026 210026 34793250 16038984 18754266 11700317 9246792 2453525 515105 13248 501857 21919674 PENSION/ INSURANCE LIABILITY 930614 DEFFERED POSTREIREMENT BENEFITS 21447 DEFFERED COMP 145619 FINANCE LEASE LIABLILITY 131382 OPERATING LEASE LIABILITY 15837 INSURANCE LIABILITY 32000 DEFERRED FICA TAX LIABILITY 126629 1403528 1 1 X 1 X 1 X 1 1 0 1 1 481663 481663 0.01220 6073290 2657914 3415376 0.08660 6554953 2657914 3897039 0.09880 9410 9410 0.00020 3000 3000 0.00010 5000 5000 0.00010 17410 17410 0.00040 6572363 2657914 3914449 0.09920 1 336250 11913591 12027121 -113530 X 1 0 1 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 WWW.ASPIRUS.ORG 732-410 X X X X ASPIRUS IRON RIVER HOSPITAL & CLINICS I 1 0 0 1 X X X X X X X X X X 19 1 1 0 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X X 1 19 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 3J: IMPLEMENTATION STRATEGY AND BUDGET PROJECTIONS. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: DATA FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT WERE GATHERED FROM A WIDE ARRAY OF PUBLISHED SOURCES, FROM A SURVEY OF 4,820 RESIDENTS OF THE 15 COUNTIES, AND FROM HEALTH CARE PROVIDERS. EXTERNAL, OR SECONDARY, DATA SOURCES INCLUDE THE US CENSUS BUREAU AND ITS AMERICAN COMMUNITY SURVEY, AS WELL AS STATISTICS COMPILED BY THE MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION, AND OTHER GOVERNMENT AND PRIVATE AGENCIES. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: ASPIRUS KEWEENAW HOSPITAL AND ASPIRUS IRONWOOD HOSPITAL ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 7D: WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: USING A SET OF CATEGORIES AND THE DATA WITHIN, ASPIRUS IRON RIVER IDENTIFIED FOUR MAJOR PRIORITY AREAS THAT IMPACT EACH OF THE UPPER PENINSULA COUNTIES AND IRON COUNTY, WI. FOR THE PURPOSES OF THE ASPIRUS IRON RIVER CHNA, AND TO FULFILL THE REQUIREMENTS SET FORTH BY THE PPACA, ASPIRUS IRON RIVER HAS TAKEN THE FOUR OVERALL PRIORITIES AND WILL BE ADDRESSING THESE NEEDS AND LOOKING TO MAKE AN IMPACT ON THE FUTURE OF OUR COMMUNITIES. THE FOUR MAJOR PRIORITY AREAS THAT WILL BE THE FOCUS ARE: 1. HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES, 2. DRUG ABUSE, 3. LACK OF HEALTH INSURANCE, 4. UNEMPLOYMENT, WAGES AND ECONOMIC CONDITIONS. BASED ON THE INDIVIDUAL DATA FOR IRON COUNTY, ASPIRUS IRON RIVER HOSPITAL WILL CONTINUE TO FOCUS ON THE FOLLOWING IN ORDER TO MAKE THE GREATEST COMMUNITY IMPACT: 1. THE IMPACT ON AN AGING POPULATION, 2. THE IMPORTANCE OF PREVENTION, 3. THE POWERFUL CORRELATION BETWEEN SOCIO-ECONOMIC STATUS AND POOR HEALTH, 4. EXPANDED ACCESS TO CARE VIA THE EVOLVING AFFORDABLE CARE ACT. ASPIRUS IRON RIVER ALSO HAD THE FOLLOWING IMPLEMENTATION STRATEGIES: 1. FOCUS HUMAN RESOURCE AND LOCAL PUBLIC RELATIONS RESOURCES ON HEALTHY EATING, NUTRITION COMMUNITY OUTREACH AND WELLNESS, 2. SUPPORT THE DIABETES EDUCATION PROGRAM TO GROW PATIENT ENCOUNTERS BY 5% ANNUALLY OVER 3 YEARS ALONG WITH A FOCUS ON STROKE AWARENESS AND PREVENTION, 3. REACH 50% OF IRON COUNTY POPULATION ANNUALLY WITH "HOW TO" INFORMATION REGARDING POSITIVE DISEASE PREVENTION BEHAVIORS AND ACCESS TO SERVICES, 4. CONTINUE TO SUPPORT SMOKING AND RUN CESSATION EDUCATION WITH A DIRECTED EFFORT TOWARDS ADOLESCENTS AND FAMILIES. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 13H: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. SCHEDULE H, PART V, LINE 10: WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 3 1 - ASPIRUS IRON RIVER CLINIC 814 S ICE LAKE ROAD IRON RIVER MI 49935 PHYSICIAN PRACTICES, REHAB AND OUTPATIENT CLINIC 2 - CRYSTAL FALLS CLINIC 1328 US HWY 2 CRYSTAL FALLS MI 49920 FAMILY PRACTICE 3 - ASPIRUS HOME CARE & HOSPICE 229 GENESEE STREET IRON RIVER MI 49935 HOSPICE PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF THE FOLLOWING (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY): PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200% EQUITY ALLOWANCE IS $75,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G., DAIRY FARM) IS EVALUATED INDIVIDUALLY ON A CASE-BY-CASE BASIS. CASH ASSETS IN EXCESS OF $4,000 AT THE TIME OF APPLICATION. SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS AND IRREVOCABLE BURIAL TRUST FUNDS. TOTAL NET ASSETS CANNOT EXCEED 800% OF FEDERAL POVERTY GUIDELINES. THIS INCLUDES ALL ASSETS INCLUDING CASH ASSETS ABOVE. PART I, LINE 7: THE COSTING METHODOLOGY USED WAS A COST-TO-CHARGE RATIO. PART I, LN 7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $820,122 WAS EXCLUDED FROM THE DENOMINATOR. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES. THE COSTING METHODOLOGY USED WAS THE PATIENT CARE COST TO CHARGE RATIO WHICH WAS DERIVED FROM THE CALCULATION ON IRS WORKSHEET 2. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE ALLOWABLE COSTS REPORTED ABOVE IS THE COST TO CHARGE RATIO. PART III, LINE 9B: UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENT'S ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORK QUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATION AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: THE CHNA GIVES A DETAILED BREAKDOWN OF THE COMMUNITY THAT ASPIRUS IRON RIVER SERVES ALONG WITH THE DETAILS ABOUT THE SEVERE CHALLENGES TO A RURAL COMMUNITY WITH A SIGNIFICANT AGING POPULATION. PART VI, LINE 5: ASPIRUS IRON RIVER HAS A REGIONAL BOARD OF DIRECTORS THAT INCLUDES SEVERAL INDIVIDUALS FROM THE COMMUNITY WITH A FOCUS ON HAVING THEM BE INDEPENDENT (IE, HAVING NO DIRECT TIES TO THE HOSPITAL SYSTEM). MEDICAL PRIVILEGES ARE EXTENDED TO ALL LOCAL, QUALIFIED PROVIDERS. THROUGH MANY OPPORTUNITIES IN THE COMMUNITIES THAT WE SERVE, INVESTMENTS ARE MADE BACK INTO THE COMMUNITY INCLUDING DONATIONS TO SUPPORT LOCAL, HEALTH INSPIRED ACTIVITIES ANNUALLY. THESE OPPORTUNITIES RELATE TO THE SCHOOLS, ELDERLY CARE SERVICES, AMERICAN CANCER SOCIETY, HEALTH SCREENING, AND OTHERS. PART VI, LINE 6: ASPIRUS IRON RIVER IS A PART OF THE ASPIRUS, INC. SYSTEM WITH THE MAIN BASE IN WAUSAU WI. TOGETHER WE PROMOTE THE MISSION AND WORK COLLABORATIVELY TO SHARE THE PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. THE COMBINED EFFORTS ARE ABLE TO PROVIDE THE SMALLER COMMUNITIES WITH THE ACCESS TO CARE THAT THEY MAY NOT OTHERWISE BE ABLE TO HAVE. ALSO AS PART OF THIS SYSTEM ARE 3 OTHER UPPER PENINSULA OF MI HOSPITALS AND 4 OTHER HOSPITAL SYSTEMS IN WI ALONG WITH POST-ACUTE CARE PROGRAMS, MANY PROVIDER CLINICS, AMBULANCE SERVICE AND LONG-TERM CARE. PART VI, LINE 7, REPORTS FILED WITH STATES MI X 1 1 X X X X 1 1 0 0 0 0 0 0 0 HAROLD CLINE PHYSICIAN 494117 0 2143 0 21833 0 16832 0 31499 0 566424 0 0 0 MEDHAT FANOUS PHYSICIAN 427870 0 44123 0 13718 0 11148 0 31583 0 528442 0 0 0 DONALD PATTON PHYSICIAN 409642 0 26429 0 14929 0 16832 0 25803 0 493635 0 0 0 SHARON HAYWARD PHYSICIAN 369129 0 18214 0 8456 0 16832 0 31499 0 444130 0 0 0 RONALD DALTON PHYSICIAN 258775 0 17500 0 7095 0 13487 0 24624 0 321481 0 0 0 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 0 406549 0 109773 0 11554 0 14438 0 68836 0 611150 0 0 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXPERIEN 0 360168 0 88372 0 1336 0 16832 0 76907 0 543615 0 0 TODD RICHARDSON SVP SYSTEM CMOS 0 313273 0 88199 0 42488 0 16832 0 74090 0 534882 0 39566 RENEE SMITH SVP OF SERVICE LINE & PATI 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 CHRISTOPHER POGLIANO PHYSICIAN 0 358203 0 17932 0 7066 0 13504 0 30776 0 427481 0 0 PATRICK TINCHER JR VP- FINANCE REGIONAL OPERATIONS 0 274699 0 42396 0 39582 0 15181 0 38833 0 410691 0 32761 STEPHEN BREWER VP- HEART VASCULAR & TERTIARY ACI 0 216847 0 41275 0 21256 0 14216 0 53046 0 346640 0 19731 JOHN MONKS VP- OPERATIONS 0 191583 0 36077 0 22942 0 12836 0 32544 0 295982 0 17632 JAMISON GOULD CHIEF CRNA 245324 0 12500 0 8433 0 5271 0 22016 0 293544 0 0 0 GRACE TOUSIGNANT SVP AND CIO 0 182057 0 64594 0 2622 0 10343 0 24262 0 283878 0 0 CHRISTINE HARFF PRESIDENT- REGIONAL UP 0 143509 0 40000 0 13247 0 5354 0 13009 0 215119 0 0 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 0 920866 0 410719 0 20334 0 16832 0 205393 0 1574144 0 0 SIDNEY SCYZGELSKI SR. VP OF FINANCE/CFO 0 536087 0 132967 0 73352 0 19582 0 106798 0 868786 0 60259 CONNIE KOUTOUZOS CEO - AIR (FORMER) 76921 0 0 0 40655 0 9063 0 8771 0 135410 0 40000 0 PAULA CHERMSIDE CEO - AIR (THRU JULY) 0 225764 0 102461 0 10433 0 14627 0 14444 0 367729 0 0 GLENN E DOBSON CFO, SENIOR FINANCIAL ANALYST 143586 0 17386 0 4086 0 9278 0 25462 0 199798 0 0 0 CARI LOGEMANN SVP GENERAL COUNSEL, ASST. SECRETARY 0 381456 0 102648 0 43094 0 16832 0 74419 0 618449 0 41199 RICK L NEVERS VICE-CHRM/SVP REG MKTS (THRU JUNE) 0 339937 0 83542 0 44689 0 19582 0 67581 0 555331 0 38399 JENNY REDMAN-SCHELL VICE-CHRM/SVP & PRES ASPIRUS CLINICS 0 384617 0 62473 0 3689 0 8400 0 71316 0 530495 0 0 LORI PECK TREASURER/SVP OF REV (THRU SEPT) 0 219881 0 40703 0 1076 0 12349 0 20519 0 294528 0 0 JESSE TISCHER DIRECTOR/SVP REGIONAL MKTS 0 374250 0 80770 0 537 0 1971 0 69913 0 527441 0 0 MARCUS SANTINI DIRECTOR/PHYSICIAN 0 304375 0 9817 0 15866 0 16832 0 27876 0 374766 0 0 JONATHAN N BRUEGGEMAN DIRECTOR/CMO-UP REGION 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 J. BRUEGGEMAN - $1,679 C. HARFF - $3,257 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRON RIVER HOSPITAL & CLINIC, INC. RELIED ON 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 INDIVIDUAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(7) DISTRIBUTION: S. SCZYGELSKI $60,259 P. TINCHER JR. $32,761 S. BREWER $19,731 C. LOGEMANN $41,199 J. HEISLER $41,623 J. MONKS $17,632 R. NEVERS $38,399 T. RICHARDSON $39,566 R. RISLEY-GRAY $76,355 R. SMITH $32,734 C. KOUTOUZOS $40,000 KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31. EMPLOYER CONTRIBUTIONS: THE CONTRIBUTION MADE BY THE EMPLOYER IS A THREE-TIERED STRUCTURE DEPENDING UPON THE EXECUTIVE'S POSITION, WHICH ARE AS FOLLOWS: 9% FOR VICE PRESIDENT, 13% FOR SENIOR LEADERSHIP COUNCIL, AND 15% FOR THE CEO. IF A PARTICIPANT TERMINATES DURING THE YEAR, THE PARTICIPANT'S EXECUTIVE ALLOWANCE IS PRORATED BASED ON THE NUMBER OF FULL CALENDAR MONTHS FROM THE BEGINNING OF THE PLAN YEAR TO THE BEGINNING OF THE CALENDAR YEAR MONTH CLOSEST TO THE CHANGE OR TERMINATION OF EMPLOYMENT. DISTRIBUTIONS: CONTINUATION OF EMPLOYMENT THROUGH THE DEFERRED VESTING DATE; THE DATE ON WHICH THE PARTICIPANT'S EMPLOYMENT IS TERMINATED AS A RESULT OF DEATH OR DISABILITY; THE DATE ON WHICH THE PARTICIPANT INCURS AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; OR THE DATE THAT IS 24 MONTHS FOLLOWING THE PARTICIPANT'S SEPARATION FROM SERVICE, BUT ONLY IF THE PARTICIPANT'S INTEREST HAS NOT BEEN FORFEITED FOR COMPETITION DURING SUCH 24 MONTH PERIOD AND THE PARTICIPANT HAS NOT ENGAGED IN COMPETITION AFTER HIS OR HER SEPARATION FROM SERVICE AND PRIOR TO HIS OR HER DEATH, THE PARTICIPANT SHALL BE VESTED AT HIS OR HER DATE OF DEATH. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 463003AA1 2015-05-07 19765185 REFUND 2008 ISSUE 0 0 0 A 210000 19765185 2010 1 0 1 1 A 0 0 1 0 0 0 0 1 A 0 1 0 0 0 0 1 0 1 A 1 PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2015 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. (EIN 38-3236977); AND ASPIRUS KEWEENAW HOSPITAL (EIN 38-1443361). INFORMATION REGARDING THE SERIES 2015 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2015 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2015 BONDS.] PART III, LINES 3A AND 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. CAROL BASTIANELLO EMPLOYED SPOUSE OF BOARD MEMBER 56088 PAYROLL 0 FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 INFORMATION, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS THEN REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND ARE MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH DIRECTOR'S DESK OR OTHER MEANS OF ELECTRONIC RETRIEVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL MANAGERS ARE REQUIRED TO SIGN BIANNUAL CONFLICT OF INTEREST STATEMENTS. THE HOSPITAL'S CEO AND BOARD CHAIR REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTION WHERE A CONFLICT HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CHIEF ADMINISTRATIVE OFFICER, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE FILE FORM 990 IS AVAILABLE TO THE PUBLIC THROUGH REQUEST FROM ANY MEMBER OF THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,996,214. MANAGEMENT AND GENERAL EXPENSES 94,032. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,090,246. FORM 990, PART XI, LINE 9: TRANSFERS -3,049,771. 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