2020-06-04T10:31:24-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 390964813 ASPIRUS MEDFORD HOSPITAL & CLINICS INC ASPI 7157488100 135 SOUTH GIBSON MEDFORD WI 54451 GREG SHAW CFO 7157488100 2020-06-01 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-06-01 71.13.38.61 2020-06-01 12:42:28 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2020-09-23 17:36:50Z DALE HUSTEDT 135 SOUTH GIBSON STREET MEDFORD WI 54451 95852472 0 X WWW.ASPIRUS.ORG/ASPIRUSMEDFORDHOSPITAL X 1958 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 10 4 711 0 1773378 0 455392 76364 83093250 88955793 2826301 4450024 128688 126761 86503631 93608942 49765 205603 0 0 38042545 40511398 0 0 0 39954312 41281959 78046622 81998960 8457009 11609982 133752399 143860673 26196259 25315645 107556140 118545028 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 43202050 205603 59475883 HOSPITAL SERVICES - ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN MEDFORD, WISCONSIN. DURING THE YEAR ENDED JUNE 30, 2019, THE HOSPITAL HAD 2,223 INPATIENT DAYS AND 77,768 OUTPATIENT VISITS. SURGERY, EMERGENCY CARE, RADIOLOGY, LABORATORY, CHEMOTHERAPY/INFUSION, DIALYSIS, AND THERAPIES ARE JUST SOME OF THE OTHER SERVICES THAT AMHC PROVIDES WITHIN THE HOSPITAL. AS A CRITICAL ACCESS HOSPITAL, AMHC PROVIDES ACCESS TO LOCAL HEALTH CARE FOR THE COMMUNITIES OF WHICH THEY SERVE.AMHC ALSO PROMISES TO THE COMMUNITY TO PROVIDE HEALTH CARE SERVICES TO THOSE IN NEED REGARDLESS OF THEIR ABILITY TO PAY AS DEFINED IN AMHC'S CHARITY AND COMMUNITY CARE POLICIES AND PROGRAMS. DURING FISCAL YEAR 2019, AMHC'S CHARITY CARE PROGRAM AWARDED APPROXIMATELY $1,720,195 IN FINANCIAL ASSISTANCE THROUGH CHARGE REDUCTIONS TO PATIENTS WHO COULD NOT OTHERWISE AFFORD CARE. ADDITIONAL INFORMATION ON THE COST OF PROVIDING CHARITY CARE TO PATIENTS CAN BE FOUND IN SCHEDULE H OF THE FORM 990. IN ADDITION TO PROVIDING CHARITY CARE SERVICES, AMHC ALSO PROVIDES A SIGNIFICANT AMOUNT OF SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS. DURING FISCAL YEAR 2019, APPROXIMATELY 58 PERCENT OF THE PATIENT SERVICES PROVIDED BY AMHC WERE PROVIDED TO MEDICARE AND MEDICAID PROGRAM BENEFICIARIES. THESE SERVICES ARE CONSIDERED A LARGE NEED IN THE COMMUNITY AND AMHC IS OFTEN REIMBURSED AT RATES BELOW THE COST OF PROVIDING THE CARE FOR THESE PATIENTS. 15083164 20764858 CLINIC SERVICES - AMHC OPERATES SEVEN OUTPATIENT CLINICS IN THE COMMUNITIES OF ABBOTSFORD, ATHENS, GILMAN, MEDFORD, PHILLIPS, PRENTICE AND RIB LAKE (ALL LOCATED WITHIN THE STATE OF WISCONSIN). DURING THE YEAR ENDED JUNE 30, 2019, THE CLINICS HAD 61,147 VISITS. AMHC PROVIDES ACCESS TO PRIMARY CARE PHYSICIANS IN THESE RURAL AND MEDICALLY UNDERSERVED AREAS.THE CLINICS ALSO SERVES A LARGE PORTION OF ELDERLY, DISABLED, AND LOW INCOME PATIENTS WHO ARE COVERED UNDER THE MEDICARE AND WISCONSIN MEDICAID PROGRAMS. PATIENTS OF THE AMHC CLINICS ARE ALSO ELIGIBLE FOR CHARITY CARE AS DEFINED BY AMHC'S CHARITY CARE POLICY. CHARITY CARE AMOUNTS FOR THE CLINICS ARE INCLUDED IN THE TOTAL NOTED UNDER 4A ABOVE. 4340334 5975299 SENIOR CARE SERVICES - AMHC OPERATES A 99-BED SKILLED NURSING FACILITY (SNF), 10 CBRF APARTMENTS, AND A 28-UNIT RCAC. DURING THE YEAR ENDED JUNE 30, 2019, THE SNF HAD A DAILY CENSUS OF 52.26 AND THE RCAC HAD A DAILY CENSUS OF 24.73. THROUGH THESE SENIOR CARE SERVICES, AMHC PROVIDES CARE AND ASSISTANCE TO THE ELDERLY IN OUR COMMUNITY. A MAJORITY OF THE RESIDENTS RECEIVING SENIOR CARE SERVICES AT AMHC RECEIVE CARE UNDER THE WISCONSIN MEDICAID OR FAMILY CARE PROGRAMS. AMHC RECOGNIZES THAT THE COST OF CARING FOR THESE INDIVIDUALS OFTEN EXTENDS BEYOND THE AMOUNT THAT IS PAID TO AMHC BY THE MEDICAID PROGRAM. ADDITIONAL INFORMATION ON THE COST OF PROVIDING SERVICES TO MEDICAID PROGRAM BENEFICIARIES CAN BE FOUND IN SCHEDULE H OF THE FORM 990. 62625548 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 84 0 711 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X GREG SHAW CFO 7157488100 135 SOUTH GIBSON STREET MEDFORD WI 54451 X MICHAEL RIGGLE CHAIRPERSON 1.00 2.00 X X 0 0 0 RUTH RISLEY-GRAY VICE CHAIRPERSON / SVP NURSING SYSTEM CNO AI 2.00 50.00 X X 0 392122 77261 DEBBIE WOODS TREASURER 1.00 2.00 X X 0 0 0 LEONARD HAMMAN SECRETARY 1.00 2.00 X X 0 0 0 MATTHEW HEYWOOD BOARD MEMBER 2.00 0.00 X 0 1156743 195564 SUSAN FRAZIER PHYSICIAN / BOARD MEMBER 32.00 2.00 X 288495 0 22343 RACHEL DIXON PHYSICIAN / BOARD MEMBER 40.00 0.00 X 75598 0 30609 MICHAEL PLOOY BOARD MEMBER 1.00 1.00 X 0 0 0 MATT BREWER BOARD MEMBER / VP OF OPERATIONS AI 2.00 40.00 X 0 241525 55983 RICK NEVERS TERM 718 INTERIM CEO/BOARD MEMBER 2.00 50.00 X 0 456553 79281 DALE HUSTEDT CEO/BOARD MEMBER 40.00 0.00 X 120423 0 15345 GREG SHAW CFO 40.00 0.00 X 176887 0 35703 SID SCZYGELSKI SVP OF FINANCE AND CFO OF 2.00 50.00 X 0 654883 117668 CARI LOGAMAN SVP & GENERAL COUNSEL 1.00 50.00 X 0 452398 81636 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXPERIENCE 1.00 50.00 X 0 334002 80130 RENEE SMITH EXECUTIVE DIRECTOR ANI 1.00 50.00 X 0 455560 45608 TODD RICHARDSON SVP & CIO OF AI 1.00 50.00 X 0 395288 88380 MICHAEL MCGRAIL SVP SYSTEM CMO OF AI 1.00 50.00 X 0 485524 80747 JOHN HEISLER SVP & CHIEF HR OFFICER OF 1.00 50.00 X 0 416068 40142 F DEAN DANNER JR SVP AMBULATORY SERVICES, PRES ACI (TERMED 6/29/18) 1.00 50.00 X 0 386225 27706 ERICK T BRANSTETTER PHYSICIAN 40.00 0.00 X 388043 0 20193 SUJATHA ROBERTS PHYSICIAN 40.00 0.00 X 697689 0 36676 TROY SENNHOLZ PHYSICIAN 40.00 0.00 X 443425 0 39294 CARY TAUCHMAN PHYSICIAN 40.00 0.00 X 376986 0 34012 DAVID VANDERKIN PHYSICIAN 40.00 0.00 X 459135 0 29063 3026681 5826891 1233344 48 0 1 0 MIRON CONSTRUCTION CO INC PO BOX 1372 GREENBAY WI 54305 CONTRACTED CONSTRUCTION COMPANY 2317317 FOCUSONE SOLUTIONS LLC 13609 CALIFORNIA STREET OMAHA NE 68154 CONTRACTED SERVICES 611487 AMERICAN RADIOLOGY SC 372 E16TH PL LOMBARD IL 60148 CONTRACTED EMPLOYMENT 393985 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY SUITE 7 FORT LAUDERDALE FL 33308 CONTRACT LABOR 379725 ASSOCIATES IN PATHOLOGY SC 2800 WESTHILL DRIVE 208 WAUSAU WI 54401 CONTRACTED LAB SERVICES 308840 19 76364 76364 PATIENT SERVICE REVENUE 621110 80422230 80421179 1051 PHARMACY REVENUE 446110 7567188 5794861 1772327 CONTRACT SERVICE REVENUE 621110 552567 552567 CAFETERIA 621990 222461 222461 OTHER OPERATING REVENUE 621110 191347 191347 88955793 3673572 3673572 142933 16371 126562 126562 126562 3000221 3390 2131006 96153 869215 -92763 776452 776452 ADMIN OTHER INCOME 900099 199 199 199 93608942 86216040 1773378 5543160 205603 205603 772791 358437 414354 30313094 25444336 4868758 1515283 1291950 223333 5899245 4621097 1278148 2010985 1647003 363982 12602 12602 5556857 5366279 190578 162381 21768 140613 514923 342761 172162 141355 113000 28355 2480289 1054585 1425704 156252 112398 43854 93148 64481 28667 638245 21481 616764 4376566 3082437 1294129 192871 58184 134687 MEDICAL SUPPLIES 12432556 12036303 396253 ALLOCATIONS 10181385 4391085 5790300 BAD DEBT EXPENSE 1962712 1962712 MGNT FEE 1729000 1729000 650817 429648 221169 81998960 62625548 19373412 0 21155866 23069954 10344103 11875104 998487 1283393 974306 1392673 72421434 42094124 30520856 30327310 58830246 65359407 1993479 1833003 8935056 8719829 133752399 143860673 7948011 8021468 15000174 14671481 3248074 2622696 26196259 25315645 X 105562661 116712026 1873479 1833002 120000 0 107556140 118545028 133752399 143860673 11609982 -621094 0 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 9561 9561 0 PART II-B, LINE 1(I), OTHER LOBBYING ACTIVITIES: ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE AHA AND WHA HAVE NOTIFIED AMHC THAT A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE PERCENTAGES OF DUES ATTRIBUTED TO LOBBYING ARE 22.73% FOR THE AHA AND 13.6% FOR WHA FOR DOLLAR AMOUNTS OF $3,178 AND $2,315, RESPECTIVELY. AMHC IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS INCLUDES SOME LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. $4,068 OR 19.1% OF THESE DUES WERE RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 131984 11335 143319 124340 7644 131984 121904 2436 124340 131113 -9209 121904 129531 1582 131113 0.83730 0.16270 0 1 1 227478 227478 46355391 23948230 22407161 21975597 16138993 5836604 3862968 2006901 1856067 30327310 DEFERRED COMPENSATION 2585899 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 5611600 ACCOUNTS RECEIVABLE OTHER 517533 CASH SURRENDER VALUE OF LIFE INSURANCE 4797 8719829 DEFERRED COMPENSATION 2585899 LONG-TERM INSURANCE LIABILITY 36797 2622696 X 91130143 -621094 -621094 91751237 1857705 1857705 93608942 80217618 109133 109133 80108485 1890475 1890475 81998960 PART V, LINE 4: TERM-ENDOWMENT FUNDS HELD BY ASPIRUS MEDFORD FOUNDATION, INC.; ANY AMOUNT ABOVE $120,000 MAY BE USED TO PURCHASE ITEMS FOR THE COUNTRY GARDENS ASSISTED LIVING FACILITY AT ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. PART X, LINE 2: AMHC IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AMHC IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). INCOME TAXES ON UBI ARE NOT SIGNIFICANT. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF AMHC FOUNDATION, INC. 76,364. LOSS ON SALE OF FIXED ASSETS -92,763. PROVISION FOR BAD DEBTS 1,890,475. RENTAL EXPENSES -16,371. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS 92,763. RENT EXPENSE 16,370. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,890,475. 1 1 X 1 X 1 X 1 1 0 1 1 856479 856479 0.01070 11954413 9222499 2731914 0.03410 1301649 849291 452358 0.00570 14112541 10071790 4040751 0.05050 257362 257362 0.00320 19720 19720 0.00020 1027248 770496 256752 0.00320 70773 70773 0.00090 1375103 770496 604607 0.00750 15487644 10842286 4645358 0.05800 58856 58856 0.00070 58856 58856 0.00070 1 977234 13723302 13652272 71030 X 1 0 1 1 ASPIRUS MEDFORD HOSPITAL 135 SOUTH GIBSON STREET MEDFORD WI 54451 1027 X X X X ASPIRUS MEDFORD HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 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 MEDFORD HOSPITAL PART V, SECTION B, LINE 5: YES, DURING THE COURSE OF 2018, THE TAYLOR COUNTY HEALTH DEPARTMENT, PRICE COUNTY HEALTH DEPARTMENT AND ASPIRUS MEDFORD HOSPITAL & CLINICS EMBARKED ON A COLLABORATIVE EFFORT TO ASSESS AND PRIORITIZE THE HEALTH NEEDS OF THE REGION AND, IN TURN, CREATE AN ACTION PLAN TO CREATE REAL AND SUSTAINED CHANGE WITHIN THE COMMUNITIES WE SERVE.WE TURNED TO RESIDENTS WITHIN THE THREE COUNTIES TO UNDERSTAND THE IMPACT THESE ISSUES HAD WITHIN OUR LOCAL COMMUNITIES. THIS INCLUDED FEEDBACK COLLECTED DURING OUR COMMUNITY HEALTH IMPROVEMENT PLANNING SESSION HELD ON JANUARY 25, 2019. WE COMPILED THIS DATA AND PARTNERED WITH STATE EXPERTS FOR ADDITIONAL QUANTIFIABLE DATA ON THESE ISSUES. THIS INFORMATION WAS SHARED WITH LOCAL STAKEHOLDERS DURING A HALF-DAY SESSION THAT INCLUDED ANALYZING WHAT SERVICES ARE CURRENTLY AVAILABLE AND GAPS IN SERVICES, AND PRIORITIZING KEY HEALTH CONCERNS WITHIN TAYLOR AND PRICE COUNTIES. THE COLLABORATIVE ALSO CONSIDERED THE LOCAL ASSETS AND RESOURCES CURRENTLY AVAILABLE IN THE COUNTIES THAT CAN BE MOBILIZED TO ADDRESS HEALTH. THESE INCLUDED BOTH PHYSICAL AND NON-PHYSICAL ASSETS AND RESOURCES. PHYSICAL ASSETS INCLUDE PARKS, OPEN SPACE, MARKETS, CLINICS AND OTHER ASPECTS OF A COMMUNITY THAT CAN AFFECT A PERSON'S OPPORTUNITY TO ACHIEVE HEALTH. NON-PHYSICAL ASSETS INCLUDE THE SKILLS OF RESIDENTS; THE POWER OF LOCAL ASSOCIATIONS LIKE SERVICE OR PROFESSIONAL GROUPS; LOCAL INSTITUTIONS LIKE FAITH-BASED GROUPS, LOCAL FOUNDATIONS, GOVERNMENT INSTITUTIONS AND INSTITUTIONS OF HIGHER LEARNING; SOCIAL CAPITAL; COMMUNITY RESILIENCE; AND A STRONG BUSINESS COMMUNITY.COMMUNITY STAKEHOLDERS INCLUDED (TAYLOR COUNTY): NAME TITLE ORGANIZATIONALLEN LANG PHARMACIST HEALTHMART PHARMACYJUDY LANG EMPLOYEE HEALTHMART PHARMACYRACHEL DIXON PHYSICIAN ASSISTANT ASPIRUS MEDFORD HOSPITAL & CLINICSDIANE ALBRECHT BOARD MEMBER TAYLOR COUNTY PUBLIC HEALTHCATHERINE LEMKE BOARD MEMBER TAYLOR COUNTYJUDY LEMASTER DISTRICT SCHOOL NURSE RIB LAKE SCHOOL DISTRICTTAMMY TOM-STEINMETZ DIRECTOR OF HUMAN SERVICES TAYLOR COUNTY HUMAN SERVICES DEPT.ANDRIA FARRAND COUNTY CLERK TAYLOR COUNTYCOLLEEN HANDRICK TAYLOR COUNTY EMERGENCY MANAGEMENT DIRECTOR TAYLOR COUNTYMIKE WELLNER MAYOR CITY OF MEDFORDMICHELE ARMBRUST PUBLIC HEALTH COORDINATOR TAYLOR COUNTY HEALTH DEPARTMENTINGRID PURVIS PUBLIC HEALTH NURSE TAYLOR COUNTY HEALTH DEPARTMENTDERRICK FRITZ TAYLOR COUNTY DRUG OPPOSITION PARTNERS PROJECT DIRECTOR TAYLOR COUNTY HUMAN SERVICESKRISTA BLOMBERG ASSISTANT DIRECTOR RIB LAKE PUBLIC LIBRARYNATHANAEL BROWN DIRECTOR TAYLOR COUNTY COMMISSION ON AGINGJOSEPH GREGET DIRECTOR OF SPECIAL EDUCATION AND STUDENT SERVICES MEDFORD PUBLIC SCHOOL DISTRICTDALE HUSTEDT PRESIDENT ASPIRUS MEDFORD HOSPITAL & CLINICSPATRICIA MERTENS BOARD MEMBER TAYLOR COUNTY PUBLIC HEALTHMICHELLE GRIMM COMMUNITY DEVELOPMENT UW-EXTENSIONJUSTINE THICKE OUTREACH COORDINATOR HEALTHFIRSTJOHN LANGE AVP RETAIL BANKING OFFICER NICOLET NATIONAL BANKPATTY KRUG HEALTH OFFICER TAYLOR COUNTY HEALTH DEPARTMENTAMANDA LANGE DIRECTOR OF COMMUNITY HEALTH & FOUNDATION ASPIRUS MEDFORD HOSPITAL & CLINICSCOMMUNITY STAKEHOLDERS INCLUDED (PRICE COUNTY): ASCENSION WISCONSINCHEQUAMEGON SCHOOL DISTRICTCOMMUNITY MEMBERSEMBRACE (DOMESTIC VIOLENCE AND SEXUAL ASSAULT PROGRAM FOR WASHBURN, RUSK & PRICE COUNTIES)UW EXTENSION- PRICE COUNTYFLAMBEAU HOME HEALTH AND HOSPICEFLAMBEAU HOSPITALLIMBERG & ASSOCIATES COUNSELING, LLCMARSHFIELD CLINIC HEALTH SYSTEMNEW HORIZONS NORTH (NOT FOR PROFIT SOCIAL SERVICES & SUPPORT AGENCY)PARK FALLS POLICE DEPARTMENTPHILLIPS PUBLIC LIBRARYPHILLIPS SCHOOL DISTRICTPRICE COUNTY AGING AND DISABILITY RESOURCE CENTER UNITPRICE COUNTY BEHAVIORAL HEALTH UNITPRICE COUNTY BOARD OF SUPERVISORSPRICE COUNTY CHILDREN AND YOUTH UNITPRICE COUNTY PUBLIC HEALTH UNITPRICE COUNTY SHERRIFF DEPARTMENT ASPIRUS MEDFORD HOSPITAL PART V, SECTION B, LINE 6B: TAYLOR COUNTY HEALTH DEPARTMENTPRICE COUNTY HEALTH DEPARTMENT ASPIRUS MEDFORD HOSPITAL PART V, SECTION B, LINE 11: ASPIRUS MEDFORD HOSPITAL & CLINICS DEFINES SIGNIFICANT HEALTH NEEDS AS THE TOP 3 HEALTH PRIORITIES IDENTIFIED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT. AMHC HAS ADOPTED A PLAN TO ADDRESS THESE PRIORITIES THROUGH THE ESTABLISHMENT OF GOALS, OBJECTIVES AND STRATEGIES THAT TARGET SPECIFIC ISSUES IDENTIFIED BY THE PRIORITIES. MORE DETAILED INFORMATION REGARDING THESE GOALS, OBJECTIVES AND STRATEGIES CAN BE FOUND IN OUR COMMUNITY HEALTH IMPLEMENTATION PLAN LOCATED HERE: HTTPS://WWW.ASPIRUS.ORG/UPLOAD/PUBLIC/DOCUMENTS/CHNAS/AMH-CHNA-2109.PDF ASPIRUS MEDFORD HOSPITAL PART V, SECTION B, LINE 13H: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 13 1 - ASPIRUS MEDFORD CLINIC 143 SOUTH GIBSON STREET MEDFORD WI 54451 OUTPATIENT CLINIC 2 - ASPIRUS CARE & REHAB 135 SOUTH GIBSON STREET MEDFORD WI 54451 SKILLED NURSING FACILITY 3 - ASPIRUS PHARMACY - MEDFORD 139 SOUTH GIBSON STREET MEDFORD WI 54451 RETAIL PHARMACY 4 - ASPIRUS THERAPY & FITNESS - MEDFORD 103 SOUTH GIBSON STREET MEDFORD WI 54451 THERAPY FITNESS CENTER 5 - ASPIRUS COUNTRY GARDENS 635 WEST CEDAR STREET MEDFORD WI 54451 ASSISTED LIVING FACILITY 6 - ASPIRUS KIDNEY CARE - MEDFORD 111 SOUTH GIBSON STREET MEDFORD WI 54451 DIALYSIS CENTER 7 - ASPIRUS PRENTICE CLINIC 1511 RAILROAD AVENUE PRENTICE WI 54456 OUTPATIENT CLINIC 8 - ASPIRUS PHILLIPS CLINIC 625 PETERSON AVENUE PHILLIPS WI 54555 OUTPATIENT CLINIC 9 - ASPIRUS THERAPY - PRENTICE 619 BRIDGE STREET PRENTICE WI 54456 THERAPY FITNESS CENTER 10 - ASPIRUS RIB LAKE CLINIC 1121 HIGHWAY 102 RIB LAKE WI WI 54451 OUTPATIENT CLINIC 11 - ASPIRUS GILMAN CLINIC 320 EAST MAIN STREET MEDFORD WI 54433 OUTPATIENT CLINIC 12 - ASPIRUS FASTCARE CLINIC - ABBOTSFORD 1011 EAST SPRUCE ST SUITE 6 ABBOTSFORD WI 54405 OUTPATIENT CLINIC 13 - ASPIRUS ATHENS CLINIC 729 PINE STREET ATHENS WI 54411 OUTPATIENT CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF: PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% OF FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200%, THE 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 THE 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 ON FORM 990, SCHEDULE H IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR FORM 990. PART I, LINE 7G: DIALYSIS HAD COSTS OF $1,027,248 WITH DIRECT OFFSETTING REVENUE OF $770,496. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,962,712. PART II, COMMUNITY BUILDING ACTIVITIES: ONE OF THE LARGER COMMUNITY BUILDING ACTIVITIES ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) IS INVOLVED IN IS GETTING PHYSICIANS AND HEALTH CARE WORKERS TO THE AREA TO IMPROVE THE ACCESS TO HEALTH CARE NEEDS IN THE SERVICE AREA. AMHC ALSO PROMOTES HEALTH CARE RELATED JOBS AND EDUCATION TO THE STUDENTS IN THE COMMUNITY. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON AMHC'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO AMHC. AMHC ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO AMHC. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, AMHC ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OR REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, AMHC ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS 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), AMHC 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 AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. 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 AMHC 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, RADIOLOGY, AMBULANCE, AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL 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, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT AMHC PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR 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 MEDFORD HOSPITAL & CLINICS, INC. (AMHC) UTILIZES SEVERAL METHODS IN ASSESSING COMMUNITY HEALTH CARE NEEDS. SOME OF THEM ARE AS FOLLOWS: 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. AMHC, AT THE END OF FISCAL YEAR 2016, COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND WILL USE THE DATA AND FINDINGS OF THIS REPORT TO GUIDE AMHC 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: ALTHOUGH ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) IS LOCATED IN MEDFORD, WISCONSIN, WE HAVE HISTORICALLY DEFINED OUR "COMMUNITY" AS A MUCH BROADER AREA, INCLUDING ALL OF TAYLOR COUNTY, THE SOUTHERN AREA OF PRICE COUNTY, THE NORTHEAST PORTION OF CLARK COUNTY, AND THE NORTHWEST CORNER OF MARATHON COUNTY. WITHIN THIS AREA OUR PRIMARY SERVICE AREA CONSISTS OF A 5 TO 20 MILE RADIUS AROUND MEDFORD. APPROXIMATELY 80% OF OUR PATIENT VOLUME COMES FROM OUR PRIMARY AREA. TAYLOR AND PRICE COUNTIES ARE LARGELY CAUCASIAN AND ARE ALMOST EXCLUSIVELY RURAL WITH 14% OF ADULTS BEING UNINSURED AND 24% OF CHILDREN IN THE MEDFORD SCHOOL DISTRICT ARE ELIGIBLE FOR FREE OR REDUCED SCHOOL LUNCHES. FROM AN EDUCATIONAL STAND POINT, 59% OF OUR SERVICE AREA ONLY HAS A HIGH SCHOOL DIPLOMA OR LESS. THE MEDIAN HOUSEHOLD INCOME IS BELOW THE STATE AVERAGE, WHILE THE STATE AVERAGE IS ALSO BELOW THE NATIONAL AVERAGE. THE MAJOR OCCUPATIONS IN THE COMMUNITY ARE MANUFACTURING, AGRICULTURE, HEALTHCARE, AND SALES/OFFICE POSITIONS. PART VI, LINE 5: ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) IS IN A PHYSICIAN SHORTAGE AREA AND WORKS HARD TO RECRUIT PROVIDERS TO OUR AREA TO FILL THE NEEDS OF OUR COMMUNITY. WE ALSO HAVE EMPLOYEES THAT ARE REPRESENTING AMHC AND ARE ACTIVE IN OTHER GROUPS TO HELP IN BUILDING COMMUNITY EFFORTS TO IMPROVE HEALTHCARE IN OUR SERVICE AREA. AMHC ALSO GIVES CASH DONATIONS TO PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS IN THE COMMUNITY.ONE-THIRD OF AMHC'S GOVERNING BODY IS COMPRISED OF RESIDENTS THAT ARE IN AMHC'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE FAMILY MEMBERS THEREOF. AMHC ALSO EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO INSURE THAT OUR SERVICE AREA HAS THE HEALTHCARE NEEDED. PART VI, LINE 6: ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) IS A PARTNER WITH ASPIRUS, INC. A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. AMHC 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 AMHC 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 AMHC WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE TO PROVIDE HIGH QUALITY CARE TO MEMBERS OF COMMUNITIES WHICH OTHERWISE WITHOUT THE EFFORTS OF A COMBINED PARTNERSHIP MAY NOT HAVE ACCESS TO THIS CARE LOCALLY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 150000 COST FOR THE ASPIRUS FAMILY HOUSING PROJECT 1 0 PART I, LINE 2: AS A MAJOR EMPLOYER AND COMMUNITY SUPPORTER, ASPIRUS MEDFORD HOSPITALS & CLINICS, INC. (AMHC) RECEIVES MANY REQUESTS FOR DONATIONS OF BOTH MONEY AND MATERIAL GOODS BY VARIOUS LOCAL AGENCIES AND INDIVIDUALS. AS A NONPROFIT, AMHC MUST CONTINUOUSLY JUSTIFY ITS TAX-EXEMPT STATUS TO THE IRS. AMHC NEEDS TO UTILIZE ITS RESOURCES AND ENDORSE THOSE ACTIVITIES THAT SUPPORT ITS TAX-EXEMPT PURPOSE, WHICH IS TO PROVIDE HEALTH CARE SERVICES AND PROMOTE HEALTH AND WELLNESS TO THE COMMUNITIES IT SERVES. REQUESTS ARE CHANNELED IN A WAY THAT MAXIMIZES BENEFIT TO THE COMMUNITY AND ASSURES COMPLIANCE WITH CORPORATE NOT-FOR-PROFIT RULES. AMHC'S WRITTEN DONATIONS POLICY OUTLINES ACCEPTABLE RECIPIENTS AND APPROPRIATE OBJECTIVES PRIOR TO AWARDING ANY ASSISTANCE. DUE TO THE CHARITABLE NATURE OF THE GRANTS AND ALLOCATIONS AWARDED, NO FORMAL MONITORING IS REQUIRED. X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 RUTH RISLEY-GRAY VICE CHAIRPERSON / SVP NURSING SYSTE 0 286934 0 52327 0 52861 0 16506 0 60755 0 469383 0 45015 MATTHEW HEYWOOD BOARD MEMBER 0 869672 0 267317 0 19754 0 16506 0 179058 0 1352307 0 0 SUSAN FRAZIER PHYSICIAN / BOARD MEMBER 286098 0 0 0 2397 0 7938 0 14405 0 310838 0 0 0 MATT BREWER BOARD MEMBER / VP OF OPERATIONS AI 0 213660 0 26807 0 1058 0 6269 0 49714 0 297508 0 0 RICK NEVERS TERM 718 INTERIM CEO/BOARD MEMBER 0 356162 0 55425 0 44966 0 16506 0 62775 0 535834 0 38383 GREG SHAW CFO 155952 0 19872 0 1063 0 4919 0 30784 0 212590 0 0 0 SID SCZYGELSKI SVP OF FINANCE AND CFO OF 0 514118 0 87791 0 52974 0 16506 0 101162 0 772551 0 49137 CARI LOGAMAN SVP & GENERAL COUNSEL 0 372200 0 58440 0 21758 0 16506 0 65130 0 534034 0 19856 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXPERIENC 0 274871 0 45840 0 13291 0 15344 0 64786 0 414132 0 11262 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 348984 0 64382 0 42194 0 16506 0 29102 0 501168 0 33431 TODD RICHARDSON SVP & CIO OF AI 0 297875 0 56000 0 41413 0 16506 0 71874 0 483668 0 38563 MICHAEL MCGRAIL SVP SYSTEM CMO OF AI 0 400085 0 73833 0 11606 0 14262 0 66485 0 566271 0 0 JOHN HEISLER SVP & CHIEF HR OFFICER OF 0 304853 0 56609 0 54606 0 16506 0 23636 0 456210 0 40214 F DEAN DANNER JR SVP AMBULATORY SERVICES, PRES ACI (T 0 161114 0 111152 0 113959 0 14413 0 13293 0 413931 0 66173 ERICK T BRANSTETTER PHYSICIAN 340387 0 32400 0 15256 0 5127 0 15066 0 408236 0 0 0 SUJATHA ROBERTS PHYSICIAN 690367 0 0 0 7322 0 8250 0 28426 0 734365 0 0 0 TROY SENNHOLZ PHYSICIAN 437873 0 0 0 5552 0 6440 0 32854 0 482719 0 0 0 CARY TAUCHMAN PHYSICIAN 368221 0 0 0 8765 0 7718 0 26294 0 410998 0 0 0 DAVID VANDERKIN PHYSICIAN 451896 0 0 0 7239 0 8250 0 20813 0 488198 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - E. BRANSTETTER $14,851- INCLUDED IN INCOME. TRAVEL FOR COMPANIONS, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. TRAVEL FOR COMPANIONS- M. HEYWOOD- $177; S. SCZYGELSKI- $273; E. ANDERSON- $237; R. NEVERS- $273; R. RISLEY-GRAY- $199; J. HEISLER- $177; R. SMITH $135; D. HUSTEDT $237; M. BREWER $237 PART I, LINE 4B AMHC SPONSORS A NONQUALIFIED TAX EQUALIZED ANNUITY PLAN COVERING EMPLOYED PHYSICIANS. PHYSICIANS ARE ELIGIBLE TO PARTICIPATE IN THE PLAN AFTER ONE YEAR OF SERVICE. PARTICIPANTS IN THE PLAN ARE IMMEDIATELY 100% VESTED. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $ 49,137 D. DANNER $ 66,173 R. NEVERS $ 38,383 T. RICHARDSON $ 38,563 R. RISLEY-GRAY $ 45,015 R. SMITH $ 33,431 C. LOGEMANN $ 19,856 E. ANDERSON $ 11,262 J. HEISLER $ 40,214 A WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 97710B7X4 2013-04-12 16902595 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 A 1730000 16902595 2006 1 0 1 1 A 0 1 1 0 0 0.00890 0.00100 0.00990 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WI HEALTH & EDUCATION FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/05/2018 PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2013 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (EIN 39-0964813); ASPIRUS GRAND VIEW (EIN 38-2908586); AND LANGLADE HOSPITAL HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN (EIN 39-0806429). INFORMATION REGARDING THE SERIES 2013 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2013 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2013 BONDS.] PART III, LINES 3A AND 3B ASPIRUS, INC., A MEMBER OF ASPIRUS MEDFORD 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-FINANCE PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. FORM 990, PART VI, SECTION A, LINE 2 RICK NEVERS, MATTHEW HEYWOOD, RUTH RISLEY-GREY AND F. DEAN DANNER, JR. HAVE A BUSINESS RELATIONSHIP. THESE BOARD MEMBERS ARE EMPLOYED BY ASPIRUS, INC. AND IT'S AFFILIATES. (SEE INFORMATION RELATED TO ASPIRUS, INC. DESCRIBED IN FORM 990, PART VI, SECTION A, LINES 6 AND 7.) FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CORPORATE MEMBERS: MEMORIAL MEMBER ASSOCIATION, INC. (50%) AND ASPIRUS, INC. (50%), BOTH WISCONSIN NONSTOCK CORPORATIONS. FORM 990, PART VI, SECTION A, LINE 7A AMHC'S BOARD OF DIRECTORS IS ELECTED AS FOLLOWS: (A) FOUR DIRECTORS ARE APPOINTED BY MEMORIAL MEMBER ASSOCIATION. (B) FOUR DIRECTORS ARE APPOINTED BY ASPIRUS, INC. (C) TWO DIRECTORS REPRESENT PROVIDERS ASSOCIATED WITH THE CORPORATION AS FOLLOWS: TWO PROVIDER CLASS DIRECTORS, CONSISTING OF LICENSED HEALTH PROFESSIONALS IN THE ACTIVE MEDICAL OR ALLIED HEALTH CATEGORIES OF THE MEDICAL STAFF OF THE HOSPITAL, WITH CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD, AND ELECTED JOINTLY BY MMA & ASPIRUS INC. FORM 990, PART VI, SECTION A, LINE 7B POWERS RESERVED TO THE CORPORATE MEMBERS: IN ADDITION TO DOING ALL THINGS REQUIRED BY LAW AND EXCEPT AS OTHERWISE PROVIDED, THE CORPORATE MEMBERS HAVE THE FOLLOWING SPECIFIC RIGHTS AND RESPONSIBILITIES: (A) INITIATE AND APPROVE ANY CHANGE IN THE PHILOSOPHY, CHARACTER, OR MISSION OF THE CORPORATION AND ITS STRATEGIC PLANS. (B) APPROVE ANY CHANGES TO THE USE OF THE HOSPITAL'S NAME AND BRANDING OF THE HOSPITAL. (C) INITIATE AND APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION. (D) AMEND THE BYLAWS OF THE CORPORATION AND ALL SUBSIDIARIES. (E) TAKE ANY ACTION ABLE TO BE TAKEN BY THE JOINT MEMBERS COUNCIL. (F) INITIATE AND APPROVE THE ADDITION OF NEW MEMBERS OF THE CORPORATION. (G) INITIATE AND APPROVE BORROWING OF MONEY AND OTHER FORMS OF INDEBTEDNESS. (H) INITIATE AND APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, ENCUMBRANCE OR ALIENATION OF PROPERTY WITH A VALUE IN EXCESS OF $1,000,000. (I) APPROVE THE ESTABLISHMENT, TRANSFER OF OWNERSHIP AND/OR DISSOLUTION OF ANY SUBSIDIARY CORPORATIONS. (J) INITIATE AND APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION. (K) APPROVES STRATEGIC ALLIANCES AND AFFILIATIONS OF CORPORATION WITH OTHER HOSPITALS AND HEALTH SYSTEMS. (L) SELECTION AND RETENTION OF THE PRESIDENT/CEO. (M) FINAL APPROVAL OF OPERATING AND CAPITAL BUDGETS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 AND 990-T INFORMATION, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 AND THE 990-T ARE REVIEWED 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 EACH BOARD MEMBER AND EMPLOYEE SHALL DISCLOSE TO THE APPROPRIATE LEVEL OF MANAGEMENT ANY CIRCUMSTANCE UNDER WHICH THE BOARD MEMBER, EMPLOYEE, OR AN IMMEDIATE FAMILY MEMBER, BY VIRTUE OF A FINANCIAL INTEREST, MAY BE INFLUENCED, OR MAY APPEAR TO BE INFLUENCED, EITHER IN WHOLE OR IN PART, BY ANY PURPOSE OR MOTIVE OTHER THAN THE SUCCESS AND WELL BEING OF AMHC AND ITS SUBSIDIARIES AND THE ACHIEVEMENT OF ITS PUBLIC CHARITABLE PURPOSES. PRIOR TO ENTERING INTO ANY ARRANGEMENT WITH AN OUTSIDE ORGANIZATION, INDIVIDUALS MUST DISCLOSE POTENTIAL CONFLICTS OF INTEREST TO THEIR RESPECTIVE SUPERVISOR; BOARD MEMBERS TO THE BOARD PRESIDENT. EACH CIRCUMSTANCE OF A POTENTIAL CONFLICT OF INTEREST WILL BE REVIEWED ON AN INDIVIDUAL BASIS. THE MANAGER WILL RESPOND IN WRITING (WITH A COPY TO THE PERSONNEL FILE) AFTER CONSULTATION WITH THE APPROPRIATE VICE PRESIDENT AS TO WHETHER THE ARRANGEMENT IS OR IS NOT ACCEPTABLE. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS MEDFORD HOSPITAL & CLINICS, 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 AMHC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, EXPLANATION OF HOURS WORKED: SOME OFFICERS AND DIRECTORS ALSO PROVIDED SERVICE TO OTHER RELATED ORGANIZATIONS OTHER THAN ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE OF THE ASPIRUS, INC. BOARD PROVIDES OVERSIGHT OF THE AUDIT PROCESS. ASPIRUS MEDFORD FOUNDATION INC 135 SOUTH GIBSON STREET MEDFORD WI 54451 391777081 CHARITABLE FOUNDATION WI 501(C)(3) LINE 7 MEMORIAL MEMBER ASSOCIATION INC 1 CEDAR COURT APARTMENTS INC 135 SOUTH GIBSON STREET MEDFORD WI 54451 391412339 LOW INCOME HOUSING WI 501(C)(3) LINE 7 MEMORIAL MEMBER ASSOCIATION INC 1 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501(C)(3) LINE 10 ASPIRUS INC 0 ASPIRUS ONTONAGON HOSPITAL INC 601 SEVENTH ST ONTONAGON MI 49953 260806477 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 CENTER 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 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 INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HOSPITAL 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 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA 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 INC 3000 WESTHILL DRIVE 303 WAUSAU WI 54401 474925640 OTHER INS RELATED - INS HOLDING COMPANY WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 3000 WESTHILL DRIVE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLANS WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 3000 WESTHILL DRIVE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLANS MI N/A C 1 0 1 0 1 1 0 0 0 0 1 0 1 1 1 1 1 1 0 0 ASPIRUS WAUSAU HOSPITAL L 57028 COST ASPIRUS WAUSAU HOSPITAL M 636982 COST ASPIRUS WAUSAU HOSPITAL O 6844217 COST ASPIRUS WAUSAU HOSPITAL P 764889 COST ASPIRUS WAUSAU HOSPITAL Q 97145 COST ASPIRUS INC M 10181955 COST ASPIRUS INC O 14848916 COST ASPIRUS INC P 407357 COST ASPIRUS INC Q 57155 COST ASPIRUS CLINICS INC J 50674 COST ASPIRUS CLINICS INC O 313610 COST ASPIRUS EXTENDED SERVICES O 141235 COST ASPIRUS HEALTH FOUNDATION INC B 150000 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.