2020-06-04T10:15:58-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 381443361 ASPIRUS KEWEENAW HOSPITAL ASPI 9063376500 205 OSCEOLA LAURIUM MI 49913 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 7158472250 2020-06-01 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-06-01 71.13.38.61 2020-06-01 12:16:18 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2021-01-29 14:40:06Z MATT HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 56181901 0 X WWW.ASPIRUS.ORG X 1939 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 10 6 415 37 0 -23571 19044 302660 54158750 54240312 238057 323823 898483 1242035 55314334 56108830 18094 38899 0 0 24952186 26170729 0 0 0 30052778 30466451 55023058 56676079 291276 -567249 51295751 50359940 26421344 28523999 24874407 21835941 WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 44006751 38899 55280720 ASPIRUS KEWEENAW HOSPITAL PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, PHYSICIAN CLINIC SERVICES, AND EYE CLINIC SERVICES. 44006751 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 90 0 415 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 6 1 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 DANIEL L DALQUIST CHAIRMAN 1.00 0.00 X X 0 0 0 EDWARD D JENICH VICE-CHAIRMAN 1.00 0.00 X X 0 0 0 DARRYL A PIERCE SECRETARY / TREASURER 1.00 0.00 X X 0 0 0 JOHN F HEISLER DIRECTOR / SVP CHIEF HR OF 1.00 50.00 X 0 416068 40142 JERRY W LUOMA MD DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL W LUOMA MD DIRECTOR/MEDICAL DIRECTOR 40.00 0.00 X 269885 0 33875 ADNAN MALIK MD DIRECTOR / PHYSICIAN 40.00 0.00 X 316106 0 35409 DALE R TAHTINEN DIRECTOR 1.00 0.00 X 0 0 0 JOEL C TUORINIEMI DIRECTOR 1.00 0.00 X 0 0 0 CHRISTINE K HARFF CEO 10.00 30.00 X X 0 0 0 SARA LUSIGNAN TERMED 119 VP FINANCE 1.00 40.00 X X 0 273228 57185 CHARLES NELSON REGIONAL CEO (TERMED 9/18) 20.00 30.00 X 0 321540 77137 MATTHEW HEYWOOD PRESIDENT & CEO AI 1.00 50.00 X 0 1156743 195564 SIDNEY C SCZYGELSKI SVP FINANCE & CFO OF ASPIRUS, INC. 1.00 50.00 X 0 654883 117668 JESSE TISCHER INTERIM REGIONAL CEO/SVP & PRES REG MARKETS 1.00 50.00 X 0 113121 16733 CARI LOGEMANN SVP & GEN COUNSEL 1.00 50.00 X 0 452398 81636 RICK NEVERS SVP & CFO 1.00 50.00 X 0 456553 79281 GRACE TOUSIGNANT REGIONAL CNO/VP- REGIONAL PATIENT CARE 20.00 20.00 X 0 202497 27959 F DEAN DANNER TERMED 618 SVP AMBULATORY SER & PRES ACI 1.00 50.00 X 0 386225 27706 RUTH RISLEY-GRAY SVP NURSING CNO 1.00 50.00 X 0 392122 77261 TODD RICHARDSON SVP & CIO 1.00 50.00 X 0 395287 88380 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXP 1.00 50.00 X 0 334002 80130 MICHAEL MCGRAIL SVP & CMO 1.00 50.00 X 0 485524 80747 RENEE SMITH EXEC DIRECTOR ANI 1.00 50.00 X 0 455560 45608 ZUHAIR GHANEM PHYSICIAN 30.00 10.00 X 658859 0 32861 FREDERICK RAU PHYSICIAN 40.00 0.00 X 558377 0 35119 MARK KELLEY PHYSICIAN 40.00 0.00 X 529576 0 35305 SHAHAR MADJAR PHYSICIAN 30.00 10.00 X 458888 0 36592 JAMES BLACK PHYSICIAN 40.00 0.00 X 485894 0 39259 MICHAEL HAUSWIRTH TERMED 618 CEO AKH 28.00 12.00 X 158996 0 13895 3436581 6495751 1355452 40 1 1 0 DOUGLAS A CROSBY MD PLLC 3219 CONGER ST PORT HURON MI 48060 CONTRACT PROVIDER 466385 ERX LLC 9724 KINGSTON PIKE STE 1300 KNOXVILLE TN 37922 CONTRACT PROVIDERS 419500 UP PATHOLOGY SERVICES PC 205 OSCEOLA ST LAURIUM MI 49913 CONTRACT PROVIDER 368318 HAYES HEALTHCARE LLC 6700 N ANDREWS AVE STE 600 LAUDERDALE FL 33309 CONTRACT PROVIDER 286087 UPPER PENINSULA HEALTH CARE SOLUTIONS IN 853 W WASHINGTON ST MARQUETTE MI 49855 CONTRACT SERVICES 281633 11 17400 285260 302660 NET PATIENT SERVICE REVENUE 621990 51128321 51128321 340B REVENUE DRUG PROGRAM 900099 2983465 2983465 CAFETERIA REVENUE 624200 123010 123010 VENDING REVENUE 624200 5516 5516 54240312 323823 323823 146172 73071 73101 73101 73101 E.H.R INCENTIVE 900099 521501 521501 CONTRACT SERVICE REVENUE 900099 307546 307546 339887 339887 1168934 56108830 55280720 0 525450 38899 38899 792083 585495 206588 20238650 19512932 725718 1112532 1063532 49000 2741871 2596832 145039 1285593 1224438 61155 1671 1671 32000 32000 4741385 4082435 658950 163166 286 162880 9459574 9404750 54824 31476 30123 1353 434187 433829 358 262316 209102 53214 737932 737932 3072704 3036710 35994 228681 80975 147706 CORPORATE ALLOCATIONS 7462507 7462507 DUES AND SUBSCRIPTIONS/ 1474341 18706 1455635 PROVISION FOR BAD DEBTS 1284429 1284429 EQUIPMENT RENTAL AND MA 1077729 949775 127954 2353 2353 56676079 44006751 12669328 0 2557038 4334538 3521394 3591556 6226155 6306805 1088650 953858 3628029 3491841 48463099 25559684 25159338 22903415 3276897 3960342 1135979 1083943 4702271 3733642 51295751 50359940 6116549 5948944 550836 130148 16892523 16936361 2861436 5508546 26421344 28523999 X 24874407 21835941 24874407 21835941 51295751 50359940 X -567249 -97436 287946 -2661727 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 4963 4963 0 PART II-B, LINE 1: ASPIRUS KEWEENAW HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND MHA HAVE NOTIFIED ASPIRUS KEWEENAW THAT APPROXIMATELY $4,963 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 898763 898763 33213569 15440751 17772818 1917398 1145968 771430 12162399 8972965 3189434 270970 270970 22903415 DUE FROM ASPIRUS KEWEENAW ENTERPRISES 2749513 DUE FROM OTHER ENTITIES 331861 OTHER RECEIVABLES 413481 DEFFERED COMP 238787 3733642 LONG TERM INSURANCE PAYABLE 2791898 ASBESTOS LIABILITY 21448 THIRD PARTY PAYABLES 2456413 DEFFERED COMP 238787 5508546 1 1 X 1 X 1 X 1 1 0 1 1 388921 388921 0.00700 10402254 5388529 5013725 0.09050 10791175 5388529 5402646 0.09750 86567 86567 0.00160 18409154 13279468 5129686 0.09260 18899 18899 0.00030 18514620 13279468 5235152 0.09450 29305795 18667997 10637798 0.19200 1 550159 13199241 15580628 -2381387 X 1 0 1 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 WWW.ASPIRUS.ORG 1060000151 X X X X PHYSICIAN CLINIC & PHARMACY ASPIRUS KEWEENAW HOSPITAL 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 KEWEENAW HOSPITAL PART V, SECTION B, LINE 5: A SURVEY WAS MAILED TO 23,800 HOUSEHOLDS ACROSS THE WESTERN U.P. IN AUGUST 2017. A TOTAL OF 1,700 RANDOMLY SELECTED HOUSEHOLDS IN HOUGHTON AND KEWEENAW COUNTIES RECEIVED A SURVEY. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 6A: ASPIRUS GRAND VIEW, ASPIRUS ONTONAGON, BARAGA COUNTY MEMORIAL HOSPITAL, U.P. HEALTH SYSTEM - PORTAGE. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 6B: WESTERN UPPER PENINSULA HEALTH DEPARTMENT AND COPPER COUNTY MEMORIAL HEALTH SERVICES ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 11: FOR THE PURPOSES OF DEVELOPING ASPIRUS KEWEENAW'S CHNA AND TO FULFILL THE PPACA REQUIREMENTS, ASPIRUS KEWEENAW IS USING THE FOUR OVERALL U.P. PRIORITIES AS THE STRATEGIC DRIVERS TO ENACT EFFORTS TO PROVIDE PROACTIVE HEALTHCARE SERVICES THAT ALIGN TO THE NEEDS OF THE COMMUNITIES ASPIRUS KEWEENAW SERVES. WITHIN THOSE 4 STRATEGIC DRIVERS ARE FIVE MAIN GOALS. THE FISCAL YEAR 2019 PROGRESS TOWARD THOSE GOALS ARE AS FOLLOWS: 1. PROVIDE EDUCATION AND INFORMATION ON HEALTH LIVING FOR PREVENTION AND AWARENESS OF CHRONIC DISEASES. A. WE'VE HELD MULTIPLE ASPIRING WOMEN EVENTS ON VARIOUS TOPICS INCLUDING HEALTHY EATING, HEART DISEASE, MINDFULNESS, ADDICTION AND OVERALL WELLNESS. B. WE CONTINUE TO PROVIDE OUR MONTHLY DIABETES SUPPORT GROUP. C. ALL EVENTS WE HOLD OR ATTEND WE PROVIDE INFORMATION ON FITNESS, NUTRITION, GENERAL AWARENESS AND INFORMATION ON SERVICES WE PROVIDE. D. WE ALSO HOLD SPORTS PHYSICALS. 2. SUPPORT AND PROVIDE THE COMMUNITY WITH A FITNESS LOCATION AND PROGRAMS THAT WORK TOWARD PREVENTING CHRONIC DISEASE AND OTHER HEALTH CONCERNS IN OUR LOCAL POPULATION. A. WE CURRENTLY ACCEPT SILVER SNEAKERS THROUGH MEDICARE. B. THE STAFF AT THE FITNESS CENTER ATTEND 100% OF OUR OUTREACH EVENTS. C. FITNESS CHALLENGES ARE CREATED MONTHLY TO EDUCATE THE GENERAL COMMUNITY AS WELL AS MEMBERS. D. THE FITNESS STAFF ARE COLLABORATING WITH ASPIRUS AND OTHER AREA PROVIDERS TO CREATE FITNESS PLANS FOR INDIVIDUALS WHO ARE STRUGGLING WITH ADDICTION ISSUES. 3. CONTINUE TO SUPPORT THE DIABETES EDUCATION PROGRAM THROUGH EDUCATION TO THE COMMUNITY. A. WE OFFER ONE-ON-ONE SESSIONS WITH OUR DIABETES CLINIC FOR GENERAL EDUCATION AND SPECIFIC NEEDS. B. DIABETES SUPPORT GROUPS CONTINUE MONTHLY. 4. FOCUS ON SUBSTANCE ABUSE EPIDEMIC RELATED ISSUES AND PROVIDE EDUCATION AND TREATMENT OPTIONS FOR LOCAL COMMUNITY. A. OFFERING SELF-REFERRAL TO LOCAL ADDITIONAL SPECIALIST PROVIDER. B. HIRED A SOCIAL WORKER TO DIRECTLY WORK WITH LOCAL ADDICTION PROVIDER TO HELP MAKE THE CONNECTION FOR ALL ASPECTS OF RECOVERY INCLUDING LOCAL RESOURCES. C. PROVIDE SUBSTANCE ABUSE PREVENTION INFORMATION AT ALL OUTREACH EVENTS. 5. REACH 50% OF HOUGHTON AND KEWEENAW COUNTY POPULATION WITH ANNUAL "HOW-TO" INFORMATION. A. CREATING FEATURES FOR LOCAL PUBLICATIONS REGARDING SCREENINGS, PREVENTION AND USEFUL INFORMATION ON LOCAL AND SYSTEM SERVICES. B. CONTINUE TO HOLD ASPIRING WOMEN EVENTS C. CROSS COMMUNICATION INCLUDING INFORMATION ON SUBSTANCE ABUSE AT NUTRITIONAL COMMUNITY EVENT. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 13H: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 5 1 - ASPIRUS HOUGHTON CLINIC 1000 CEDAR STREET HOUGHTON MI 49931 CLINIC & OUTPATIENT THERAPY 2 - ASPIRUS KEWEENAW OUTPATIENT THERAPIES 342 HECLA STREET LAURIUM MI 49913 OUTPATIENT THERAPY 3 - ASPIRUS KEWEENAW LAURIUM WELLNESS 300 HECLA STREET LAURIUM MI 49913 CLINIC 4 - ASPIRUS EYE CLINIC 404 EAST SHARON AVENUE HOUGHTON MI 49931 CLINIC 5 - ASPIRUS KEWEENAW LAKE LINDEN CLINIC 110 CALUMET STREET LAKE LINDEN MI 49945 CLINIC PART I, LINE 7: THE COST METHOD THAT IS USED ON THE FORM 990 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. THIS IS THEN DIVIDED BY GROSS PATIENT SERVICES REVENUE. PART I, LINE 7G: THE COST OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE ASPIRUS KEWEENAW CLINICS. ASPIRUS KEWEENAW HOSPITAL UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. 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 $1,284,429. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFITS HOSPITAL'S COMMUNITY BENEFIT AND CHARITY CARE, THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. ASPIRUS KEWEENAW HOSPITAL, INC., IN ADDITION TO PROVIDING SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. ASPIRUS KEWEENAW 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. IN ADDITION TO INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: EMERGENCY SERVICES, RESPIRATORY THERAPY, OCCUPATIONAL THERAPY, PHYSICAL THERAPY, FAMILY PRACTICE CLINICS, AND LABORATORY AND PATHOLOGY SERVICES. PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE 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 RELATING TO SERVICES PROVIDED TO PATIENTS HAVING THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS 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), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS 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 OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: ALLOWABLE MEDICARE COSTS WERE OBTAINED FROM THE ORGANIZATION'S FILED MEDICARE COST REPORT. AS SUCH THEY ONLY INCLUDE THE AMOUNTS ALLOWED IN THE FORM 990 INSTRUCTIONS. THEREFORE, THEY ONLY INCLUDE A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DO NOT CONSIDER ALL OF THE CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. THE MEDICARE REVENUES AMOUNTS LISTED DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS, PHYSICAL THERAPY SERVICES PROVIDED TO NURSING HOME RESIDENTS, AND A SIGNIFICANT PORTION OF LAB SERVICES PROVIDED TO AREA CLINIC PATIENTS. 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: THE ORGANIZATION MEETS WITH A LOCAL FEDERALLY QUALIFIED HEALTH CENTER TO CONSULT AND DETERMINE HOW TO MEET THE HEALTH CARE NEEDS IN THE ORGANIZATION'S GEOGRAPHICAL AREA. IN ADDITION, THE ORGANIZATION ITSELF EVALUATES ITS' OWN SERVICES OFFERED IN THEIR SERVICE AREA AND EVALUATES OTHER SERVICES THAT COULD BE PROVIDED TO BENEFIT THE COMMUNITY SERVED. 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 ORGANIZATION PROVIDES SERVICES PRIMARILY TO THE ELDERLY AND FRAIL OF NORTHERN HOUGHTON AND KEWEENAW COUNTIES. THE LARGEST CITIES IN THESE REGIONS INCLUDE HOUGHTON, HANCOCK, LAURIUM AND CALUMET. AS A PERCENTAGE OF TOTAL REVENUE, MEDICARE AND MEDICAID COMPRISE OF 49% AND 18%, RESPECTIVELY FOR THE ORGANIZATION. PART VI, LINE 5: THE BOARD OF DIRECTOR'S IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION PROVIDES, FREE OF CHARGE TO THE LOCAL SCHOOL, AN ATHLETIC TRAINER. PART VI, LINE 6: ASPIRUS KEWEENAW IS AN AFFILIATED HEALTH SYSTEM WHICH SERVES THE COMMUNITY SURROUNDING LAURIUM, MICHIGAN. AFFILIATES OF ASPIRUS KEWEENAW PROMOTE THE HEALTH OF THE COMMUNITY BY FULFILLING THEIR INDIVIDUAL MISSIONS. ASPIRUS KEWEENAW PROVIDES PHYSICIAN SERVICES IN OUTPATIENT CLINICS. PART VI, LINE 7, REPORTS FILED WITH STATES MI X X 0 1 X X X X X 0 1 0 0 0 0 0 0 0 JOHN F HEISLER DIRECTOR / SVP CHIEF HR OF 0 304853 0 56609 0 54606 0 16506 0 23636 0 456210 0 40214 MICHAEL W LUOMA MD DIRECTOR/MEDICAL DIRECTOR 255746 0 9210 0 4929 0 4650 0 29225 0 303760 0 0 0 ADNAN MALIK MD DIRECTOR / PHYSICIAN 300633 0 10000 0 5473 0 5062 0 30347 0 351515 0 0 0 SARA LUSIGNAN TERMED 119 VP FINANCE 0 221639 0 27914 0 23675 0 10593 0 46592 0 330413 0 22547 CHARLES NELSON REGIONAL CEO (TERMED 9/18) 0 228200 0 52435 0 40905 0 15209 0 61928 0 398677 0 34297 MATTHEW HEYWOOD PRESIDENT & CEO AI 0 869672 0 267317 0 19754 0 16506 0 179058 0 1352307 0 0 SIDNEY C SCZYGELSKI SVP FINANCE & CFO OF ASPIRUS, INC. 0 514118 0 87791 0 52974 0 16506 0 101162 0 772551 0 49137 CARI LOGEMANN SVP & GEN COUNSEL 0 372200 0 58440 0 21758 0 16506 0 65130 0 534034 0 19856 RICK NEVERS SVP & CFO 0 356162 0 55425 0 44966 0 16506 0 62775 0 535834 0 38383 GRACE TOUSIGNANT REGIONAL CNO/VP- REGIONAL PATIENT CA 0 178847 0 21055 0 2595 0 4639 0 23320 0 230456 0 0 F DEAN DANNER TERMED 618 SVP AMBULATORY SER & PRES ACI 0 161114 0 111152 0 113959 0 14416 0 13290 0 413931 0 66173 RUTH RISLEY-GRAY SVP NURSING CNO 0 286934 0 52327 0 52861 0 16506 0 60755 0 469383 0 45015 TODD RICHARDSON SVP & CIO 0 297875 0 56000 0 41412 0 16506 0 71874 0 483667 0 38563 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXP 0 274871 0 45840 0 13291 0 15344 0 64786 0 414132 0 11262 MICHAEL MCGRAIL SVP & CMO 0 400085 0 73833 0 11606 0 14262 0 66485 0 566271 0 0 RENEE SMITH EXEC DIRECTOR ANI 0 348984 0 64382 0 42194 0 16506 0 29102 0 501168 0 33431 ZUHAIR GHANEM PHYSICIAN 653319 0 0 0 5540 0 2500 0 30361 0 691720 0 0 0 FREDERICK RAU PHYSICIAN 542085 0 0 0 16292 0 8250 0 26869 0 593496 0 0 0 MARK KELLEY PHYSICIAN 497254 0 25000 0 7322 0 8250 0 27055 0 564881 0 0 0 SHAHAR MADJAR PHYSICIAN 453213 0 0 0 5675 0 6231 0 30361 0 495480 0 0 0 JAMES BLACK PHYSICIAN 474029 0 0 0 11865 0 8250 0 31009 0 525153 0 0 0 MICHAEL HAUSWIRTH TERMED 618 CEO AKH 155055 0 0 0 3941 0 4520 0 9375 0 172891 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE AND TRAVEL FOR COMPANIONS, WHEN APPLICABLE, WAS ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE - INCLUDED IN INCOME. J. TISCHER - $3,889 TRAVEL FOR COMPANIONS - INCLUDED IN INCOME M. HEYWOOD - $177 S. SCZYGELSKI - $273 R. NEVERS - $273 J. HEISLER - $177 J. TISCHER - $267 S. LUSIGNAN - $177 M. LUOMA - $267 E. ANDERSON - $237 R. RISLEY-GRAY - $199 R. SMITH - $135 PART I, LINE 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, ASPIRUS KEWEENAW HOSPITAL RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICIES 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, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457 (F) DISTRIBUTION: 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 A 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 FROM 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. S. SCZYGELSKI $49,137 D. DANNER $66,173 R. NEVERS $38,383 C. NELSON $34,297 R. RISLEY-GRAY $45,015 T. RICHARDSON $38,563 C. LOGEMANN $19,856 R. SMITH $33,431 E. ANDERSON $11,262 S. LUSIGNAN $22,547 J. HEISLER $40,214 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG9 2015-05-07 16997543 NEW CONSTRUCTION 0 0 0 A 17005943 17005943 2017 0 0 1 1 A 0 1 1 0 0 0.00500 0.00500 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K, 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.] FORM 990, PART VI, SECTION A, LINE 2 JERRY LUOMA AND MICHAEL LUOMA HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 ASPIRUS, INC. IS THE SOLE CORPORATE AND VOTING MEMBER OF ASPIRUS KEWEENAW HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS IS COMPRISED OF 7 DIRECTORS FROM ASPIRUS, INC. AND 3 DIRECTORS FROM KEWEENAW HEALTH FOUNDATION. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS, CONSISTING OF THREE NOMINATED BY THE FOUNDATION BOARD OF TRUSTEES AND THREE NOMINATED BY ASPIRUS, INC. WITH CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD, AND ELECTED BY ASPIRUS, INC., TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTORS CONSISTING OF PHYSICIANS IN THE ACTIVE CATEGORY OF THE MEDICAL STAFF AT THE HOSPITAL, NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE DIRECTORS OF THE ORGANIZATION: 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 OFFICER; 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 ACCUMULATED 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 ANNUALLY, BOARD MEMBERS ARE REQUIRED TO DISCLOSE CONFLICTS TO THE BOARD. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS. AN INTERESTED PERSON IS AN DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST. AFTER DISCLOSURE, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING MEMBERS SHALL DECIDE IF A CONFLICT EXISTS. THE MEMBER WILL ABSTAIN FROM VOTING ON THIS ISSUE IF A CONFLICT OF INTEREST IS DISCOVERED. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS KEEWENAW 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 HAS DEEMED THAT ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART XI, LINE 9: EQUITY TRANSFER ASPIRUS, INC. -2,661,727. 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. 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 0 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 260806447 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTHCARE 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 IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 GRAND VIEW HOSPITAL AUXILIARY N 10561 GRAND VIEW LANE IRONWOOD MI 49938 237178363 SUPPORTING ORGANIZATION TO HOSPITAL AND LIFELINE EMERGENCY CENTER MI 501(C)(3) LINE 10 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC 1 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE MANAGEMENT SYSTEM WI 501(C)(3) LINE 12B, II N/A 0 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 RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501(C)(3) LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 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 ASPIRUS KEWEENAW HOSPITAL C -511417 1725985 1.00000 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 1 0 0 1 1 0 0 0 0 1 1 1 1 0 1 1 1 0 0 ASPIRUS WAUSAU HOSPITAL INC M 103580 COST ASPIRUS WAUSAU HOSPITAL INC O 3982662 COST ASPIRUS WAUSAU HOSPITAL INC P 113680 COST ASPIRUS INC M 7462507 COST ASPIRUS INC O 10311562 COST ASPIRUS INC P 933570 COST ASPIRUS CLINIC INC O 81205 COST ASPIRUS ONTONAGON HOSPITAL INC L 200072 COST ASPIRUS ONTONAGON HOSPITAL INC O 262831 COST ASPIRUS ONTONAGON HOSPITAL INC Q 577856 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC O 445262 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC Q 743186 COST ASPIRUS IRON RIVER HOSPITAL & CLINICS INC O 298199 COST ASPIRUS IRON RIVER HOSPITAL & CLINICS INC P 65808 COST ASPIRUS IRON RIVER HOSPITAL & CLINICS INC Q 548837 COST ASPIRUS RIVERVIEW HOSPITAL O 102039 COST ASPIRUS KEWEENAW ENTERPRISES A 95172 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.