2020-06-04T10:17:01-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 260806477 ASPIRUS ONTONAGON HOSPITAL INC ASPI 9068848000 601 SEVENTH STREET ONTONAGON MI 49953 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 9068848000 2020-06-01 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-06-01 71.13.38.61 2020-06-01 12:50:50 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2021-01-29 14:40:06Z MATT HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 14856722 0 X WWW.ASPIRUS.ORG X 2007 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 5 2 146 4 0 0 38757 27812 14156452 14813769 2843 4718 9535 10423 14207587 14856722 0 7362 0 0 7707855 7627151 0 0 0 7858628 7930337 15566483 15564850 -1358896 -708128 8024166 7486038 3751938 4279449 4272228 3206589 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 10195733 7362 14813769 ASPIRUS ONTONAGON HOSPITAL, INC. (AOH) OPERATES SEVERAL HEALTHCARE SERVICE LINES INCLUDING A 18-BED CRITICAL ACCESS HOSPITAL, THREE PHYSICIAN CLINICS, AND A 46-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, 2019, AOH SERVICED THE COMMUNITY THROUGH 450 INPATIENT DAYS, 48 SWING BED INPATIENT DAYS, 14,409 SKILLED NURSING FACILITY DAYS OF CARE, AND 13,431 OUTPATIENT VISITS. IN ADDITION, THE FAMILY PRACTICE CLINIC HAD 6,165 VISITS, THE UP CLINIC HAD 1,379 VISITS AND THE ONCOLOGY CLINIC HAD 255 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. 10195733 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 0 0 0 0 0 0 0 1 1 1 0 0 1 33 0 146 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 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 JOHN HEISLER CHAIRMAN / SVP AND CHIEF 2.00 50.00 X X 0 416068 40142 SARA LUSIGNAN TERMED 119 VICE CHAIRMAN/ VP OF FINAN 2.00 40.00 X X 0 273228 57186 JR RICHARDSON SECRETARY / TREASURER 1.00 0.00 X X 0 0 0 JENNIFER WEAVER BOARD TRUSTEE / NURSE PRACTITIONER 40.00 0.00 X 101118 0 36652 BILL WOOD BOARD TRUSTEE 1.00 0.00 X 0 0 0 KIRK SCHOTT BOARD TRUSTEE/ CONTRACTED PHYSICIAN 1.00 0.00 X 0 0 0 CHARLES NELSON TERMED 918 REGIONAL CEO- UP 1.00 50.00 X 0 321540 77137 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1156743 195564 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 654883 117668 CARI LOGEMANN SVP & GENERAL COUNSEL 2.00 50.00 X 0 452398 81636 RICK NEVERS SVP REG OPS SYSTEM INT OFF 2.00 50.00 X 0 456553 79281 JESSE TISCHER SVP & PRES. REGIONAL MARKETS 2.00 50.00 X 0 113121 16733 MICHAEL MCGRAIL SVP SYSTEM CMO 2.00 50.00 X 0 485524 80747 RUTH RISLEY-GRAY SVP NURSING, CNO 2.00 50.00 X 0 392122 77261 ERIC ANDERSON SVP SERVICE LINE & PATIENT 2.00 50.00 X 0 334002 80130 TODD RICHARDSON SVP CIO 2.00 50.00 X 0 395287 88380 GRACE TOUSIGNANT REGIONAL CNO 2.00 40.00 X 0 202497 27959 RENEE SMITH EXECUTIVE DIRECTOR ANI 2.00 50.00 X 0 455560 45608 F DEAN DANNER JR TERMED 618 SVP AMBULATORY SERVICES & PRES ACI 2.00 50.00 X 0 386225 27706 DEANNA WILSON TERMED 1218 VP PATIENT CARE SERVICES 40.00 0.00 X 161584 0 22518 TERRENCE ASPLUND PHYSICIAN 40.00 0.00 X 138073 0 19258 RICHARD CHALTRY PHYSICIAN 40.00 0.00 X 123932 0 17108 524707 6495751 1188674 4 0 1 0 ERX LLC 9724 KINGSTON PIKE STE 1300 KNOXVILLE TN 37922 CONTRACTED ER PHYSICIANS 1252824 NORTHERN X RAY COMPANYNXC IMAGING 2118 FOURTH AVENUE SOUTH MINNEAPOLIS MN 554042642 IMAGING EQUIPMENT 392602 2 6428 17400 3984 27812 NET PATIENT REVENUE 621110 13791078 13791078 340B REVENUE 900099 818286 818286 CONTRACT SERVICE REVENUE 621110 102995 102995 FOOD SERVICE REVENUE 722210 77878 77878 FITNESS CENTER REVENUE 621110 24137 24137 -605 -605 14813769 4718 4718 8320 0 8320 8320 8320 2103 6428 0 2103 2103 14856722 14813769 0 15141 X 7362 7362 5804560 4392037 1412523 258116 231904 26212 1134425 768388 366037 430050 324515 105535 80 80 4101973 1970130 2131843 25291 1753 23538 111686 89625 22061 54619 54619 213990 10487 203503 36285 20482 15803 -18130 -19321 1191 93887 93887 5000 5000 691175 311897 379278 54083 54083 MEDICAL SUPPLIES/EXP 1437135 1162029 275106 HOSPITAL ASSESSMENT PAY 647015 647015 EQUIPMENT RENTAL/MAINTE 401925 252763 149162 DUES AND SUBSCRIPTIONS 33705 5496 28209 40618 19171 21447 15564850 10195733 5369117 0 1179914 657205 303790 237490 1943431 2170879 192164 136868 113096 68940 8800603 4773179 4215241 4027424 76530 187232 8024166 7486038 1182230 1855029 1973915 1970695 437111 364960 158682 88765 3751938 4279449 X 4272228 3206589 4272228 3206589 8024166 7486038 X -708128 -357511 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 1617 1617 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 $1,617.26 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 59006 59006 3652125 904633 2747492 211224 90512 120712 4838278 3778034 1060244 39970 39970 4027424 ASBESTOS LIABILITY 56765 LONG-TERM INSURANCE LIABILITY 32000 88765 1 1 X 1 X 1 X 1 1 1 0 1 1 111782 111782 0.00720 4335802 4001592 334210 0.02150 4447584 4001592 445992 0.02870 4220 4220 0.00030 2528120 2020176 507944 0.03260 5728 5728 0.00040 2538068 2020176 517892 0.03330 6985652 6021768 963884 0.06200 8500 8500 0.00050 8500 8500 0.00050 1 133804 5333826 5062511 271315 X 1 0 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: THE FOUR MAJOR PRIORITY AREAS FOR ONTONAGON COUNTY WERE IDENTIFIED AS THE IMPORTANCE OF PREVENTION (OVERARCHING THEME), THE IMPACT ON AN AGING COMMUNITY, EXPANDED ACCESS TO CARE VIA THE EVOLVING AFFORDABLE CARE ACT, AND THE POWERFUL CORRELATION BETWEEN SOCIO-ECONOMIC STATUS AND POOR HEALTH. TO ADDRESS THE OVERARCHING THEME WHICH INVOLVES ALL FOUR OF THE PRIORITY AREAS, AOH PROVIDES EDUCATION AND INFORMATION ON HEALTH LIVING FOR PREVENTION AND AWARENESS OF CHRONIC DISEASES. THEY ALSO SUPPORT AND PROVIDE THE COMMUNITY WITH A FITNESS LOCATION AND PROGRAMS THAT WORK TOWARDS PREVENTING CHRONIC DISEASE AND OTHER HEALTH CONCERNS IN OUR LOCAL POPULATION AND MAINTAIN CURRENT VOLUME. THEY ALSO CONTINUE TO SUPPORT THE DIABETES EDUCATION PROGRAM THROUGH OFFERING A VARIETY OF AVENUES FOR EDUCATION TO THE COMMUNITY AND FOCUS ON SUBSTANCE ABUSE EPIDEMIC RELATED ISSUES AND PROVIDE EDUCATION AND TREATMENT OPTIONS FOR THE COMMUNITY LOCALLY. FINALLY, THEY SEEK TO REACH 50 PERCENT OF ONTONAGON POPULATION ANNUALLY WITH "HOW-TO" INFORMATION REGARDING THE LONG-TERM CARE AND SWING BED PROCESSES AS WELL AS FREE EDUCATIONAL SERVICES TO SENIORS.TO ADDRESS THE IMPACT OF AN AGING POPULATION, WE AIM TO INCREASE SUPPORT FOR SERVICES TO MANAGE CHRONIC DISEASE AND CARE FOR THOSE IN NEED. 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 - 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 $855,009 AND DIRECT OFFSETTING REVENUE OF $730,256 THE INPATIENT UNIT WITH COSTS OF $347,561 AND DIRECT OFFSETTING REVENUE OF $294,283 THE NURSING HOME WITH COSTS OF $558,198 AND DIRECT OFFSETTING REVENUE OF $266,353 AND THE RHC WITH COSTS OF $767,352 AND DIRECT OFFSETTING REVENUE OF $729,284. THE SUBSIDIZED HEALTH SERVICES COSTS WERE ESTIMATED USING AN OVERALL COST TO CHARGE RATIO. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. 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 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, 2019 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 X 1 1 X X X X 1 1 0 0 0 0 0 0 0 JOHN HEISLER CHAIRMAN / SVP AND CHIEF 0 304853 0 56609 0 54606 0 16506 0 23636 0 456210 0 40214 SARA LUSIGNAN TERMED 119 VICE CHAIRMAN/ VP OF FINAN 0 221639 0 27914 0 23675 0 10593 0 46593 0 330414 0 22547 CHARLES NELSON TERMED 918 REGIONAL CEO- UP 0 228200 0 52435 0 40905 0 15209 0 61928 0 398677 0 34297 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 0 869672 0 267317 0 19754 0 16506 0 179058 0 1352307 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 514118 0 87791 0 52974 0 16506 0 101162 0 772551 0 49137 CARI LOGEMANN SVP & GENERAL COUNSEL 0 372200 0 58440 0 21758 0 16506 0 65130 0 534034 0 19856 RICK NEVERS SVP REG OPS SYSTEM INT OFF 0 356162 0 55425 0 44966 0 16506 0 62775 0 535834 0 38383 MICHAEL MCGRAIL SVP SYSTEM CMO 0 400085 0 73833 0 11606 0 14262 0 66485 0 566271 0 0 RUTH RISLEY-GRAY SVP NURSING, CNO 0 286934 0 52327 0 52861 0 16506 0 60755 0 469383 0 45015 ERIC ANDERSON SVP SERVICE LINE & PATIENT 0 274871 0 45840 0 13291 0 15344 0 64786 0 414132 0 11262 TODD RICHARDSON SVP CIO 0 297875 0 56000 0 41412 0 16506 0 71874 0 483667 0 38563 GRACE TOUSIGNANT REGIONAL CNO 0 178847 0 21055 0 2595 0 4639 0 23320 0 230456 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 348984 0 64382 0 42194 0 16506 0 29102 0 501168 0 33431 F DEAN DANNER JR TERMED 618 SVP AMBULATORY SERVICES & PRES ACI 0 161114 0 111152 0 113959 0 14416 0 13290 0 413931 0 66173 DEANNA WILSON TERMED 1218 VP PATIENT CARE SERVICES 140109 0 17588 0 3887 0 8124 0 14394 0 184102 0 0 0 TERRENCE ASPLUND PHYSICIAN 134280 0 0 0 3793 0 6906 0 12352 0 157331 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 - J. TISCHER $3,889 - INCLUDED IN INCOME. TRAVEL FOR COMPANIONS - INCLUDED IN INCOME M. HEYWOOD - $177 S. SCZYGELSKI - $273 R. NEVERS - $273 J. HEISLER - $177 J. TISCHER - $267 S. LUSIGNAN - $177 E. ANDERSON - $237 R. RISLEY-GRAY - $199 R. SMITH - $135 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(B) DISTRIBUTION: S. SCZYGELSKI $49,137 R. NEVERS $38,383 J. HEISLER $40,214 R. RISLEY-GRAY $45,015 T. RICHARDSON $38,563 E. ANDERSON $11,262 C. NELSON $34,297 S. LUSIGNAN $22,547 C. LOGEMANN $19,856 R. SMITH $33,431 D. DANNER $66,173 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 CONSTRUTION 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 RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS WAUSAU HOSPITAL (EIN 39-1138241); AND ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC (EIN 38-2908586); ASPIRUS ONTONAGON HOSPITAL, INC. (EIN 26-0806477). INFORMATION REGARDING THE SERIES 2017 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2017 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2017 BONDS. FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS, INC. IS THE SOLE 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, INCLUDING THE UBI CALCULATIONS. 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 363,503. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 363,503. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 153,594. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,594. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,590,522. MANAGEMENT AND GENERAL EXPENSES 120,717. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,711,239. CORPORATE ALLOCATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,857,532. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,857,532. BAD DEBT EXPENSE: PROGRAM SERVICE EXPENSES 8,905. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,905. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS -357,511. 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 INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE SYSTEM MANAGEMENT WI 501(C)(3) LINE 12B, II N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501(C)(3) LINE 10 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501(C)(3) LINE 10 ASPIRUS INC 0 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501(C)(3) LINE 10 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 N10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 GRAND VIEW HOSPITAL AUXILLIARY N10561 GRAND VIEW LANE IRONWOOD MI 49938 237178363 SUPPORTING ORGANIZATION TO HOSPITAL AND LIFELINE EMERGENCY SYSTEM MI 501(C)(3) LINE 10 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS KEWEENAW HOSPTIAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI N/A ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 ASPIRUS HEALTH VENTURES 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 1 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 ASPIRUS WAUSAU HOSPITAL INC L 55523 COST ASPIRUS WAUSAU HOSPITAL INC M 93313 COST ASPIRUS WAUSAU HOSPITAL INC O 1252626 COST ASPIRUS KEWEENAW HOSPITAL M 200072 COST ASPIRUS KEWEENAW HOSPITAL O 262831 COST ASPIRUS KEWEENAW HOSPITAL P 577856 COST ASPIRUS INC E 312907 COST ASPIRUS INC M 1857532 COST ASPIRUS INC O 2809138 COST ASPIRUS INC P 182259 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.