2019-05-15T13:37:47-05:00 2018-06-30 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-07-01 383236977 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC ASPI 9062656121 1400 W ICE LAKE RD IRON RIVER MI 49935 SIDNEY C SCZYGELSKI CFO/SENIOR VP OF FINANCE 9062656121 2019-05-10 1 PAUL M TRACZEK CPA P01368830 7158323407 2019-05-10 137.26.200.211 2019-05-10 15:12:53 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E4255D669FE7A429B540D12C0E645A16D05D3497 2017 2019-02-21 02:37:17Z SYDNEY C SCZYGELSKI 1400 W ICE LAKE RD IRON RIVER MI 49935 51480198 0 X WWW.ASPIRUS.ORG X 1995 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 9 2 318 33 0 87 188258 21914 38745551 40382451 273708 866911 3049110 2990097 42256627 44261373 9067 700 0 0 19209978 19953691 0 0 0 23976416 26069756 43195461 46024147 -938834 -1762774 37541570 33695790 25729460 24698343 11812110 8997447 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 32520135 700 40418520 - EMERGENCY DEPARTMENT: ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. OPERATES AN EMERGENCY DEPARTMENT 365 DAYS A YEAR, 24 HOURS A DAY. A PHYSICIAN IS ON-SITE, DEDICATED TO ONLY THE EMERGENCY DEPARTMENT. IN FISCAL YEAR 2018, 7,594 VISITS WERE MADE TO THIS DEPARTMENT. 85% OF ALL INPATIENT ADMISSIONS TO ASPIRUS IRON RIVER HOSPITAL COME FROM THE EMERGENCY DEPARTMENT. ALSO, ON MONDAY-FRIDAY, 4PM-8PM, WE OPERATE AN EXPRESS CARE CLINIC FOR THE NON-CRITICALLY ILL PATIENTS THAT CANNOT GET INTO THEIR OWN PHYSICIAN'S OFFICE THAT DAY. THE TOTAL VISITS LISTED ABOVE INCLUDE THE COUNTS FOR THE EXPRESS CARE CLINIC. MANY OF THESE TIMES, A MID-LEVEL PROVIDER IS ADDED TO HELP COVER FOR THESE PATIENTS, RELIEVING THE PHYSICIAN TO MANAGE THE CRITICALLY ILL AND TO PROVIDE EXPRESS (FASTER) FLOW THROUGH FOR PATIENTS. GROSS PATIENT REVENUE FOR THIS TIME PERIOD WAS $7,281,830, EXPENSES (INCLUDING CONTRACTUAL ALLOWANCES) WERE $7,393,110.-HOSPICE: ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. OPERATES A HOSPICE AGENCY BASED AWAY FROM THE MAIN HOSPITAL CAMPUS BUT STILL IN IRON RIVER, MI. DURING THE UPCOMING YEAR, THE DIRECT OWNERSHIP AND MANAGEMENT OF THIS AGENCY IS TO TRANSITION OVER TO ASPIRUS AT HOME WHICH IS ANOTHER AFFILIATE OF ASPIRUS, INC. THIS CHANGE WILL ALLOW MORE SERVICE AREA COVERAGE BY UTILIZING STAFF FROM OTHER ASPIRUS AT HOME LOCATIONS' STAFF. -DIALYSIS: ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. DISCONTINUED THE DIALYSIS PROGRAM IN CRYSTAL FALLS, MI WHICH IS 15 MILES TO THE WEST OF THE MAIN HOSPITAL CAMPUS. THIS HAPPENED IN APRIL 2018. THIS PROGRAM WAS ONE OF ONLY A COUPLE PROGRAMS IN THE ASPIRUS IRON RIVER GEOGRAPHICAL AREA OF 90 SQUARE MILES, AND IT PROVIDED A DEMONSTRATED COMMUNITY NEED. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. WORKED CLOSELY WITH FOUR OTHER REGIONAL PROVIDERS TO TRANSITION THE CURRENT PATIENTS ALONG WITH IMPLEMENTING A TRANSPORTATION SERVICE FOR THE PATIENTS IN NEED. 32520135 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 82 0 1 318 1 1 1 0 0 0 0 0 0 0 0 0 X 9 2 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SYDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 MARK D TOUSIGNANT CHAIRMAN 1.00 X X 0 0 0 RICK L NEVERS VICE-CHAIRMAN/SVP REG OPS SYSTEM INT OFFICER 1.00 50.00 X X 0 422587 79085 LORI PECK TREASURER/VP OF REVENUE CYCLE 1.00 50.00 X X 0 229106 31988 DONALD BASTIANELLO SECRETARY 1.00 X X 0 0 0 RAY KOIVUNEN DIRECTOR/VPMA 10.00 X 61875 0 0 CHUCK NELSON DIRECTOR/ REGINAL CEO-UP 16.00 24.00 X 0 389204 81847 NASSEEM RIZKALLA DIRECTOR/PHYSICIAN 40.00 X 431002 0 41825 STEVEN TINTI DIRECTOR 1.00 X 0 0 0 GARY SCALCUCCI DIRECTOR 1.00 X 0 0 0 CONNIE KOUTOUZOS CEO - AIR 40.00 X 248703 0 34110 GLENN E DOBSON CFO 40.00 X 164732 0 28004 SIDNEY SCYZGELSKI SVP OF FINANCE & CFO 1.00 50.00 X 0 644952 106596 MATT HEYWOOD PRESIDENT/CEO 1.00 50.00 X 0 1118732 163184 RENEE SMITH EXECUTIVE DIRECTOR ANI 1.00 50.00 X 0 431396 46277 SHANE JACQUES TERMED 519 REGIONAL CFO 16.00 24.00 X 0 223027 38117 DEAN DANNER SVP AMBULATORY SERVICES, PRESIDENT 1.00 50.00 X 0 388969 44042 ERIC ANDERSON SVP OF SERVICE LINE 1.00 50.00 X 0 274164 64677 RUTH RISLEY-GREY SVP NURSING, CNO 1.00 50.00 X 0 377496 77201 CARI LOGEMANN SVP AND GENERAL COUNSEL 1.00 50.00 X 0 421450 85137 TODD RICHARDSON SVP AND CIO 1.00 50.00 X 0 392900 87961 MICHAEL MCGRAIL SVP SYSTEM CMOS 1.00 50.00 X 0 486338 77636 JOHN HEISLER SVP CHIEF HR OFFICER 1.00 50.00 X 0 369321 76970 GRACE TOUSIGNANT REGIONAL CNO 16.00 24.00 X 0 195811 28752 HAROLD CLINE PHYSICIAN 40.00 X 561673 0 45313 MEDHAT FANOUS PHYSICIAN 40.00 X 455884 0 43252 RONALD DALTON PHYSICIAN 40.00 X 290823 0 31246 SHARON HAYWARD PHYSICIAN 40.00 X 262453 0 15600 NAGARAJU CHORAGUDI PHYSICIAN 40.00 X 288351 0 31184 2765496 6365453 1360004 22 0 1 0 ASPIRUS INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 CORPORATE ALLOCATIONS & STAFFING 6989436 INNOVA EMERGENCY SERVICES 700 N COLORADO BLVD SUITE 109 DENVER CO 80206 EMERGENCY DEPT DOCTORS 1294052 ARAMARK UNIFORM SERVICES INC 5330 INDUSTRIAL BLVD SUITE 616 FRIDLEY MN 55412 LAUNDRY/LINEN 618406 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LARIUM MI 49913 SHARED REGIONAL STAFF 600267 STAFF CARE 12400 HIGH BLUFF DR SAN DIEGO CA 92130 LOCUM DOCTOR 465697 18 21914 21914 NET PATIENT SERVICE REVENUE 900099 40267614 40267614 CAFETERIA MEALS 900099 114837 114837 40382451 358586 358586 53293 0 53293 53293 53293 7727150 7218825 508325 508325 508325 340 B PHARMACY REVENUE 900099 2085138 2085138 E.H.R INCENTIVE 900099 752673 752673 ALL OTHER REVENUE 900099 98993 98993 2936804 44261373 43204418 0 1035041 X 700 700 959413 419597 539816 14904160 12485800 2418360 721035 605717 115318 2224328 1666442 557886 1144755 958821 185934 37451 37451 35403 35403 4687 4687 13722 13722 12397857 6404302 5993555 243594 243594 646218 354274 291944 1544817 1102253 442564 127765 74259 53506 627580 627580 2277778 637404 1640374 116043 25720 90323 MEDICAL SUPPLIES 5828751 5828751 PROVISION FOR BAD DEBTS 1276531 1276531 HOSPITAL TAX 793585 793585 DUES & SUBSCRIPTION 122846 51984 70862 -24872 -24872 46024147 32520135 13504012 0 3912312 2036702 5861591 5657397 364009 420751 98505 117181 47765075 22967100 19118187 24797975 7792558 231421 394408 434363 37541570 33695790 1452151 940316 18866516 18483811 5410793 5274216 25729460 24698343 X 11690341 8875678 121769 121769 11812110 8997447 37541570 33695790 X -1762774 -196890 -854999 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4687 4687 0 PART II-B, LINE 1: A PORTION OF OUR ANNUAL MICHIGAN HOSPITAL ASSOCIATION (MHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) DUES ARE USED FOR LOBBYING ACTIVITIES. THE PERCENTAGES THAT ARE SPECIFIC TO LOBBYING PURPOSES ARE: MHA 16.96% AND AHA 22.12% FOR A GRAND TOTAL DOLLAR AMOUNT GOING TO LOBBYING OF $4,687. 210026 210026 33906031 12800241 21105790 813927 529113 284814 12821969 9637746 3184223 13122 13122 24797975 DUE TO RELATED PARTIES 1611437 OTHER ACCRUED EXPENSES 2900497 PENSION/ INSURANCE LIABILITY 702327 DEFFERED POSTREIREMENT BENEFITS 20000 DEFFERED COMP 39955 5274216 X PART X, LINE 2: ALL SUBSIDIARIES, EXCEPT FOR ASPIRUS NETWORK, INC. (ANI), ARE TAX-EXEMPT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(2) OF THE CODE. THEY ARE ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. ASPIRUS 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. INCOME TAXES FOR ANI, A NOT-FOR-PROFIT TAXABLE CORPORATION, WERE IMMATERIAL FOR THE YEARS ENDED JUNE 30, 2018 AND 2017. 1 1 X 1 X 1 X 1 1 1 0 1 1 508652 508652 0.01120 7748972 3564971 4184001 0.09230 8257624 3564971 4692653 0.10350 21730 21730 0.00050 3000 3000 0.00010 3477675 3420910 56765 0.00130 7180 7180 0.00020 3509585 3420910 88675 0.00210 11767209 6985881 4781328 0.10560 1 675216 14686660 14646375 40285 X 1 0 1 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 WWW.ASPIRUS.ORG 732-410 X X X X ASPIRUS IRON RIVER HOSPITAL & CLINICS I 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X WWW.WUPDHD.ORG/COMMUNITY-HEALTH/COMMUNITY-HEALTH-ASSESSMENT-2/ X X 1 15 1 WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 3J: IMPLEMENTATION STRATEGY AND BUDGET PROJECTIONS. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: BASED UPON THEIR COMMUNITY INVOLVEMENT INCLUDING THE SCHOOLS, WE HAD THEM REVIEW OUR ASSESSMENT TO AGREE OR TO ADD REASONS FOR DISAGREEMENTS. MEMBERS ON OUR TASK FORCE WERE: DICKINSON-IRON HEALTH DEPT., SCHOOLS' SUPERINTENDENTS, SCHOOL WELLNESS COORDINATOR, NURSING HOME DIRECTOR, FOUNDATION DIRECTOR AND BEHAVIORAL HEALTH DIRECTOR. ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 7D: THE CHNA IS AVAILABLE TO ALL LOCATIONS COVERED BY THE SIX COUNTY REGIONAL SURVEY ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: FOUR MAJOR PRIORITY AREAS WERE SELECTED BY THE STEERING COMITTEE ON A REGIONAL SCALE WITH A GOAL OF THE MEMBER ORGANIZATIONS TO CONTINUE TO WORK TOGETHER, ADD MEMBERS, POOL RESOURCES, LEADERSHIP, AND EXPERTISE TO DEVELOP INITIATIVES WITH AN EVEN GREATER IMPACT ON A REGIONAL BASIS THAN AN INDIVIDUAL ORGANIZATION MIGHT BE ABLE TO UNDERTAKE, ESPECIALLY WITH LIMITED RESOURCES. THE FIRST OF THE FOUR PRIORITY AREAS AND OVERARCHING THEME OF ALL FOUR PRIORITIES IS THE IMPORTANCE OF PREVENTION. ASPIRUS IRON RIVER WILL TARGET ROOT CAUSES OF HEART DISEASE, CANCER, STROKE, AND DIABETES. THE STRATEGIES AND GOALS ARE:1. FOCUS HUMAN RESOURCE AND LOCAL PUBLIC RELATIONS RESOURCES ON HEALTHY EATING AND NUTRITION COMMUNITY OUTREACH. 2. CONTINUE TO SUPPORT THE DIABETES EDUCATION PROGRAM THROUGH OFFERING A VARIETY OF AVENUE FOR EDUCATION TO THE COMMUNITY. GROW PATIENT ENCOUNTERS BY 5 PERCENT ANNUALLY OVER 3 YEARS. 3. REACH 50 PERCENT OF IRON COUNTY POPULATION ANNUALLY WITH "HOW-TO" INFORMATION REGARDING POSITIVE DISEASE PREVENTION BEHAVIORS AND ACCESS TO SERVICES. 4. IDENTIFY PATIENT POPULATION WHO HAVE DIABETES AND ALSO USE TOBACCO PRODUCTS AND PROVIDE CESSATION EDUCATION TO 20 PERCENT OF THE IDENTIFIED POPULATION. 7 1 - ASPIRUS IRON RIVER DIALYSIS 1328 US HWY 2 CRYSTAL FALLS MI 49920 ESRD 2 - SURGICAL ASSOCIATES 1500 WEST ICE LAKE ROAD IRON RIVER MI 49935 SURGEON PRACTICE 3 - CRYSTAL FALLS CLINIC 1328 US HWY 2 CRYSTAL FALLS MI 49920 FAMILY PRACTICE 4 - GENESEE CLINIC 229 W GENESEE ST IRON RIVER MI 49935 ORTHOPEDICS/REHAB 5 - ICE LAKE CLINIC 1300 WEST ICE LAKE IRON RIVER MI 49935 FAMILY PRACTICE 6 - RIVERSIDE CLINIC 927 RIVERSIDE PLAZA IRON RIVER MI 49935 FAMILY PRACTICE 7 - ASPIRUS HOSPICE 3255 US HWY 2 IRON RIVER MI 49935 HOSPICE PART I, LINE 7: THE COSTING METHODOLOGY USED WAS A COST-TO-CHARGE RATIO. 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 $2,965,806 AND DIRECT OFFSETING REVENUE OF $2,919,525, DIABETIC EDUCATION WITH COSTS OF $11,834 AND DIRECT OFFSETING REVENUE OF $11,662, DIALYSIS WITH COSTS OF $492,075 AND DIRECT OFFSETTING REVENUE OF $483,551, AND HOSPICE WITH COSTS OF $7,961 AND DIRECT OFFSETING REVENUE OF $6,172. PART I, LN 7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $675,216 WAS EXCLUDED FROM THE DENOMINATOR. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES. THE COSTING METHODOLOGY USED WAS THE PATIENT CARE COST TO CHARGE RATIO WHICH WAS DERIVED FROM THE CALCULATION ON IRS WORKSHEET 2. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE ALLOWABLE COSTS REPORTED ABOVE IS THE COST TO CHARGE RATIO. PART III, LINE 9B: UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENT'S ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORKQUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FIANCIAL 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 PATIENT DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AS WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: THE CHNA GIVES A DETAILED BREAKDOWN OF THE COMMUNITY THAT ASPIRUS IRON RIVER SERVES ALONG WITH THE DETAILS ABOUT THE SEVERE CHALLENGES TO A RURAL COMMUNITY WITH A SIGNIFCANT AGING POPULATION. PART VI, LINE 5: ASPIRUS IRON RIVER HAS A BOARD OF DIRECTORS THAT INCLUDES SEVERAL INDIVIDUALS FROM THE COMMUNITY WITH A FOCUS ON HAVING THEM BE INDEPENDENT (IE, HAVING NO DIRECT TIES TO THE HOSPITAL SYSTEM). MEDICAL PRIVILEGES ARE EXTENDED TO ALL LOCAL, QUALIFIED PROVIDERS. THROUGH MANY OPPORTUNITIES IN THE COMMUNITIES THAT WE SERVE, INVESTMENTS ARE MADE BACK INTO THE COMMUNITY INCLUDING DONATIONS TO SUPPORT LOCAL, HEALTH INSPIRED ACTIVITIES ANNUALLY. THESE OPPORTUNITIES RELATE TO THE SCHOOLS, ELDERLY CARE SERVICES, AMERICAN CANCER SOCIETY, HEALTH SCREENING, AND OTHERS. PART VI, LINE 6: ASPIRUS IRON RIVER IS A PART OF THE ASPIRUS, INC. SYSTEM WITH THE MAIN BASE IN WAUSAU WI. TOGETHER WE PROMOTE THE MISSION AND WORK COLLABORATIVELY TO SHARE THE PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. THE COMBINED EFFORTS ARE ABLE TO PROVIDE THE SMALLER COMMUNITIES WITH THE ACCESS TO CARE THAT THEY MAY NOT OTHERWISE BE ABLE TO HAVE. ALSO AS PART OF THIS SYSTEM ARE 3 OTHER UPPER PENINSULA OF MI HOSPITALS AND 3 OTHER HOSPITAL SYSTEMS IN WI ALONG WITH POST-ACUTE CARE PROGRAMS, MANY PROVIDER CLINICS, AMBULANCE SERVICE AND LONG-TERM CARE. PART VI, LINE 7, REPORTS FILED WITH STATES MI X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 RICK L NEVERS VICE-CHAIRMAN/SVP REG OPS SYSTEM INT 0 322120 0 61986 0 38481 0 19030 0 60055 0 501672 0 0 LORI PECK TREASURER/VP OF REVENUE CYCLE 0 200139 0 27956 0 1011 0 12737 0 19251 0 261094 0 0 CHUCK NELSON DIRECTOR/ REGINAL CEO-UP 0 286094 0 58000 0 45110 0 18965 0 62882 0 471051 0 0 NASSEEM RIZKALLA DIRECTOR/PHYSICIAN 413081 0 7000 0 10921 0 13137 0 28688 0 472827 0 0 0 CONNIE KOUTOUZOS CEO - AIR 205378 0 41415 0 1910 0 7721 0 26389 0 282813 0 0 0 GLENN E DOBSON CFO 137793 0 18672 0 8267 0 5109 0 22895 0 192736 0 0 0 SIDNEY SCYZGELSKI SVP OF FINANCE & CFO 0 500272 0 97238 0 47442 0 19030 0 87566 0 751548 0 0 MATT HEYWOOD PRESIDENT/CEO 0 822805 0 293232 0 2695 0 19030 0 144154 0 1281916 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 344370 0 42139 0 44887 0 19030 0 27247 0 477673 0 0 SHANE JACQUES TERMED 519 REGIONAL CFO 0 192438 0 26521 0 4068 0 7697 0 30420 0 261144 0 0 DEAN DANNER SVP AMBULATORY SERVICES, PRESIDENT 0 291709 0 50695 0 46565 0 19030 0 25012 0 433011 0 0 ERIC ANDERSON SVP OF SERVICE LINE 0 233292 0 40147 0 725 0 4819 0 59858 0 338841 0 0 RUTH RISLEY-GREY SVP NURSING, CNO 0 275808 0 58636 0 43052 0 19030 0 58171 0 454697 0 0 CARI LOGEMANN SVP AND GENERAL COUNSEL 0 319704 0 64915 0 36831 0 19030 0 66107 0 506587 0 0 TODD RICHARDSON SVP AND CIO 0 292477 0 62933 0 37490 0 19030 0 68931 0 480861 0 0 MICHAEL MCGRAIL SVP SYSTEM CMOS 0 391427 0 82975 0 11936 0 12004 0 65632 0 563974 0 0 JOHN HEISLER SVP CHIEF HR OFFICER 0 292124 0 63187 0 14010 0 18924 0 58046 0 446291 0 0 GRACE TOUSIGNANT REGIONAL CNO 0 169578 0 23536 0 2697 0 6553 0 22199 0 224563 0 0 HAROLD CLINE PHYSICIAN 548513 0 7000 0 6160 0 17007 0 28306 0 606986 0 0 0 MEDHAT FANOUS PHYSICIAN 448276 0 7000 0 608 0 13446 0 29806 0 499136 0 0 0 RONALD DALTON PHYSICIAN 282229 0 4592 0 4002 0 8849 0 22397 0 322069 0 0 0 SHARON HAYWARD PHYSICIAN 231203 0 25000 0 6250 0 0 0 15600 0 278053 0 0 0 NAGARAJU CHORAGUDI PHYSICIAN 264194 0 23297 0 860 0 8223 0 22961 0 319535 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE, WHEN APPLICABLE, WAS ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. HOUSING ALLOWANCE - S. HAYWARD $4,000 - INCLUDED IN INCOME. PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRON RIVER HOSPITAL & CLINIC, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(B) DISTRIBUTION: S. SCZYGELSKI $ 38,440 D. DANNER $ 35,422 R. NEVERS $ 32,268 C. NELSON $ 35,012 R. RISLEY-GRAY $ 38,590 T. RICHARDSON $ 35,685 C. LOGEMANN $ 34,955 R. SMITH $ 10,121 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 463003AA1 2015-05-07 19765185 REFUND 2008 ISSUE 0 0 0 A 75000 19765185 2010 1 0 1 1 A 0 0 1 0 0 1 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 2015 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. (EIN 38-3236977); AND ASPIRUS KEWEENAW HOSPITAL (EIN 38-1443361). INFORMATION REGARDING THE SERIES 2015 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2015 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2015 BONDS.] PART III, LINES 3A AND 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. SCHEDULE K, PART III, LINE 9 SUPPLEMENTAL INFORMATION ON THE EXEMPT BONDS: POLICY STATES WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. JODY TOUSIGNANT EMPLOYED SPOUSE OF BOARD MEMBER 66970 PAYROLL 0 CAROL BASTIANELLO EMPLOYED SPOUSE OF BOARD MEMBER 104370 PAYROLL 0 DEBRA RIZKALLA EMPLOYED SPOUSE OF BOARD MEMBER 27303 PAYROLL 0 FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 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 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 NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPRIUS IRON RIVER 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 OF COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE FILED FORM 990 IS AVAILABLE TO THE PUBLIC THROUGH A REQUEST FROM ANY MEMBER OF THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 6,366,427. MANAGEMENT AND GENERAL EXPENSES 449,124. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,815,551. CORPORATE ALLOCATIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,544,431. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,544,431. MEDICAL DIRECTORS: PROGRAM SERVICE EXPENSES 37,875. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,875. FORM 990, PART XI, LINE 9: AI TRANSFERS -854,999. 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 HEALTHCARE 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 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 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 HEALTH CARE 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 LIFELINE EMERGENCY SYSTEM MI 501(C)(3) LINE 10 ASPIRUS IRONWOOD HOSPITAL & CLINICS 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 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS IRON AREA HEALTH FOUNDATION 1400 WEST ICE LAKE ROAD IRON RIVER MI 49935 383762132 CHARITABLE FOUNDATION MI 501(C)(3) LINE 3 N/A 0 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 DR 11202 WAUSAU WI 54401 391931679 HEALTH CARE NETWORK WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 0 1 0 1 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 ASPIRUS WAUSAU HOSPITAL INC O 222954 COST ASPIRUS WAUSAU HOSPITAL INC P 3367198 COST ASPIRUS INC B 855000 COST ASPIRUS INC M 5539129 COST ASPIRUS INC O 1949053 COST ASPIRUS INC P 818263 COST ASPIRUS VNA HOME HEALTH INC O 867802 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC L 370000 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC M 83751 COST ASPIRUS IRONWOOD HOSPITAL & CLINICS INC O 167398 COST ASPIRUS KEWEENAW HOSPITAL O 607917 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.