2019-05-15T13:39:35-05:00 2018-06-30 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-07-01 260806477 ASPIRUS ONTONAGON HOSPITAL INC ASPI 9068848000 601 SEVENTH STREET ONTONAGON MI 49953 SIDNEY C SCZYGELSKI CFO/SENIOR VP OF FINANCE 9068848000 2019-05-13 1 PAUL M TRACZEK CPA P01368830 7158323407 2019-05-13 137.26.200.211 2019-05-13 09:30:42 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 558C6F47C777A73CECB93EB9107DCB0C387663C8 2017 2019-02-21 02:37:17Z MATT HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 14207587 0 X WWW.ASPIRUS.ORG X 2007 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 6 2 153 4 0 0 45619 38757 14580022 14156452 1421 2843 8346 9535 14635408 14207587 4219 0 0 0 7673990 7707855 0 0 0 7745411 7858628 15423620 15566483 -788212 -1358896 7694506 8024166 8389518 3751938 -695012 4272228 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 10063830 14156452 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, 2018, AOH SERVICED THE COMMUNITY THROUGH 402 INPATIENT DAYS, 108 SWING BED INPATIENT DAYS, 13,626 SKILLED NURSING FACILITY DAYS OF CARE, AND 13,680 OUTPATIENT VISITS. IN ADDITION, THE FAMILY PRACTICE CLINIC HAD 5,868 VISITS, THE UP CLINIC HAD 1,517 VISITS AND THE ONCOLOGY CLINIC HAD 260 VISITS. AOH COMPLETED ITS EMERGENCY DEPARTMENT RENOVATION PROJECT THIS YEAR IN ORDER TO FURTHER IMPROVE PATIENT ACCESS AND CARE.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. 10063830 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 0 0 0 0 0 0 0 1 1 1 0 0 1 40 0 1 153 1 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MI X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 X JOHN HEISLER CHAIRMAN / SVP AND CHIEF 1.00 49.00 X X 0 369321 76970 SARA LUSIGNAN VICE CHAIRMAN/ VP OF FINAN 1.00 41.00 X X 0 274914 46484 JR RICHARDSON SECRETARY / TREASURER 1.00 X X 0 0 0 JENNIFER WEAVER BOARD TRUSTEE / NURSE PRACTITIONER 40.00 X 94000 0 35763 BILL WOOD BOARD TRUSTEE 1.00 X 0 0 0 KIRK SCHOTT BOARD TRUSTEE/ CONTRACTED PHYSICIAN 1.00 X 0 0 0 CHUCK NELSON REGIONAL CEO- UP (TERM 9/2018) 1.00 41.00 X 0 383204 81847 SHANE JACQUES UP REGIONAL CFO (TERM 4/2018) 4.00 36.00 X 0 223027 38117 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 1.00 50.00 X 0 1118732 163184 SIDNEY SCZYGELSKI SR.VP OF FINANCE.CFO 1.00 50.00 X 0 644952 106596 DEANNA WILSON VP PATIENT CARE SERVICES 40.00 0.00 X 162098 0 21556 DEAN DANNER SVP AMBULATORY SERVICES & PRESIDENT ACI 1.00 48.00 X 0 388969 44042 MICHAEL MCGRAIL SVP SYSTEM CMO 1.00 50.00 X 0 486338 77636 CARI LOGEMANN SVP & GENERAL COUNSEL 1.00 50.00 X 0 421450 85137 RUTH RISLEY-GRAY SVP NURSING, CNO 1.00 49.00 X 0 377496 77201 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXPERIENCE 1.00 49.00 X 0 274164 64677 TODD RICHARDSON SVP CIO 1.00 50.00 X 0 392900 87961 RICK NEVERS SVP REG OPS SYSTEM INT OFFICER 1.00 50.00 X 0 422587 79085 GRACE TOUSIGNANT REGIONAL CNO 4.00 37.00 X 0 195811 28752 RENEE SMITH EXECUTIVE DIRECTOR ANI 1.00 49.00 X 0 431396 46277 TERRENCE ASPLUND PHYSICIAN 40.00 0.00 X 150240 0 14278 RICHARD CHALTRY PHYSICIAN 40.00 0.00 X 134897 0 17022 541235 6405261 1192585 3 0 1 0 ERX LLC 9724 KINGSTON PIKE STE 1300 KNOXVILLE TN 37922 CONTRACTED ER PHYSICIANS 1145340 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 MEDICAL/MANAGEMENT SERVICES 797327 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 MEDICAL/MANAGEMENT SERVICES 658335 ERX PLUS LLC 9724 KINGSTON PIKE STE 1300 KNOXVILLE TN 37922 CONTRACTED ER PHYSICIANS 222512 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 ADMINISTRATIVE/MANAGEMENT SERVICES 175340 5 6508 13801 18448 38757 NET PATIENT REVENUE 621110 13159512 13159512 340B REVENUE 900099 783062 783062 CONTRACT SERVICE REVENUE 621110 99428 99428 FOOD SERVICE REVENUE 722210 88755 88755 FITNESS CENTER REVENUE 621110 20923 20923 4772 4772 14156452 2843 2843 7358 0 7358 7358 7358 2177 0 2177 2177 14207587 14156452 0 12378 X 94000 94000 5829277 4227674 1601603 237892 173568 64324 1360999 964086 396913 185687 134958 50729 147 147 3825526 1909058 1916468 27881 1759 26122 172553 104638 67915 57413 57413 256066 24433 231633 31166 22159 9007 18779 12752 6027 142875 142875 646242 280538 365704 74313 74313 MEDICAL SUPPLIES/EXP 1430522 1121385 309137 HOSPITAL ASSESSMENT PAY 701634 701634 EQUIPMENT RENTAL/MAINTE 412167 266822 145345 DUES AND SUBSCRIPTIONS 32979 6651 26328 28365 17715 10650 15566483 10063830 5502653 0 1192790 1179914 273357 303790 1575101 1943431 203289 192164 135164 113096 8297245 4082004 4186542 4215241 128263 76530 7694506 8024166 1252872 1182230 1973915 4737569 437111 2399077 158682 8389518 3751938 X -695012 4272228 -695012 4272228 7694506 8024166 X -1358896 6326136 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1921 1921 0 PART II-B, LINE 1: ASPIRUS ONTONAGON HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA), HEALTH CARE ASSOCIATION OF MICHIGAN (HCAM), AMERICAN MEDICAL ASSOCIATION (AMA), ASSOCIATION OF NUTRITION & FOODSERVICE PROFESSIONALS (ANFP), NATIONAL ASSOCIATION OF RURAL HEALTH CLINICS, AND MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA, HCAM, AMA, ANFP, NARHC, AND MHA HAVE NOTIFIED ASPIRUS ONTONAGON HOSPITAL THAT APPROXIMATELY $1,920.89 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT.ASPIRUS ONTONAGON HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA), HEALTH CARE ASSOCIATION OF MICHIGAN (HCAM), AMERICAN MEDICAL ASSOCIATION (AMA), ASSOCIATION OF NUTRITION & FOODSERVICE PROFESSIONALS (ANFP), NATIONAL ASSOCIATION OF RURAL HEALTH CLINICS, AND MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA, HCAM, AMA, ANFP, NARHC, AND MHA HAVE NOTIFIED ASPIRUS ONTONAGON HOSPITAL THAT APPROXIMATELY $1,920.89 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 59006 59006 3370273 723023 2647250 173226 80559 92667 4594460 3278422 1316038 100280 100280 4215241 ASBESTOS LIABILITY 56765 DUE TO AFFILIATES 3131 LONG-TERM INSURANCE LIABILITY 32000 DEFERRED MEANINGFUL USE REVENUE 66786 158682 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 237110 237110 0.01520 4081534 3865154 216380 0.01390 4318644 3865154 453490 0.02910 1958 1958 0.00010 2335271 1665822 669449 0.04300 8549 8549 0.00050 2345778 1665822 679956 0.04360 6664422 5530976 1133446 0.07270 7700 7700 0.00050 7700 7700 0.00050 1 121003 4575156 4501508 73648 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 15 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 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 ASPIRUS.ORG/FINANCIALAID X ASPIRUS.ORG/FINANCIALAID X ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 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 1700 RANDOM HOUSEHOLDS IN GOGEBIC COUNTY. 360 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 GRAND VIEW HOSPITAL- ASPIRUS KEWEENAW HOSPITAL- ASPIRUS IRON RIVER HOPSITAL- PORTAGE HEALTH- BARAGA COUNTY MEMORIAL HOSPITAL ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 6B: WESTERN UPPER PENINSULA HEALTH DEPARTMENT, COPPER COUNTRY MENTAL HEALTH SERVICES, GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY, UPPER GREAT LAKES FAMILY HEALTH CENTER, IRON COUNTY HEALTH DEPARTMENT ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 11: THE FOUR MAJOR PRIORITY AREAS FOR ONTONAGON COUNTY WERE IDENTIFIED AS IMPACT OF AGING POPULATION, IMPORTANCE OF PREVENTION RELATED TO OBESITY, DIABETES, AND SMOKING, CORRELATION BETWEEN SOCIO-ECONOMIC STATUS AND POOR HEALTH, AND EXPANDED ACCESS TO CARE VIA THE EVOLVING AFFORDABLE CARE ACT. 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. TO ADDRESS THE IMPORTANCE OF PREVENTION, WE PROVIDE NUTRITION AND EXERCISE COUNSELING TO REDUCE PREVALANCE OF OBESITY, DIABETES AND PRE-DIABETES SCREENINGS, EDUCATION, AND PERSONAL COUNSELING, AND WE OFFER SMOKING CESSATION PROGRAMS. TO ADDRESS THE CORRELATION BETWEEN LOWER SOCIO-ECONIMC STATUS AND POOR HEALTH, WE AIM TO INCREASE EDUCATION AND COUNSELING TO HIGH RISK PATIENTS IN THOSE CATEGORIES. TO ADDRESS THE ISSUE EXPANDED ACCESS TO THE ACA, WE PLAN TO INCREASE PROGRAMS TO MAKE ACCESS EASY FOR NEW PATIENTS. THE THREE BIGGEST NEEDS IDENTIFIED FOR ONTONAGON COUNTY WERE HYPERTENSION, OBESITY, AND DIABETES. WE HOLD BLOOD PRESSURE SCREENINGS REGULARLY AT LOCAL HEALTH FAIRS AND COMMUNITY EVENTS. COMMUNITY MEMBERS ARE GIVEN RESULTS AND RECOMMENDED TO FOLLOW-UP WITH A PROVIDER IF THE BP READINGS ARE HIGHER THAN NORMAL. WE CONDUCT DIABETIC CLINICS MONTHLY AT BOTH OF OUR CLINICS, ONE ATTACHED TO THE HOSPITAL, AND ONE LOCATED IN THE SOUTHERN END OF THE COUNTY. THE CLINICS FOCUS HIGHEST PRIORITY ON OUR PATIENTS WHO DEMONSTRATE THE TRIAD OF DIABETES, OBESITY, AND HYPERTENSION, SINCE THEY ARE AT GREATEST RISK OF COMPLICATIONS. WE HOLD DIABETIC SUPPORT GROUPS MONTHLY HERE IN ONTONAGON, AND ALSO IN THE SOUTHERN END OF THE COUNTY IN EWEN. WE HAVE ALSO HELD LUNCH N LEARN PROGRAMS FOCUSED ON NUTRITION. 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 $796,433 AND DIRECT OFFSETTING REVENUE OF $659,144 THE INPATIENT UNIT WITH COSTS OF $317,261 AND DIRECT OFFSETTING REVENUE OF $265,554 THE NURSING HOME WITH COSTS OF $563,157 AND DIRECT OFFSETTING REVENUE OF $201,249 AND THE RHC WITH COSTS OF $658,421 AND DIRECT OFFSETTING REVENUE OF $539,876. THE SUBSIDIZED HEATLH 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 ORGANIZAITON 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 HOSPTIAL 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, 2018 AND DOES NOT CONSIDER MEDCIARE 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 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 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 2018, 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 FINACIAL 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 EFFOTS 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 X X 1 1 0 0 0 0 0 0 0 JOHN HEISLER CHAIRMAN / SVP AND CHIEF 0 292124 0 63187 0 14010 0 18924 0 58046 0 446291 0 0 SARA LUSIGNAN VICE CHAIRMAN/ VP OF FINAN 0 218284 0 31363 0 25267 0 5944 0 40540 0 321398 0 0 CHUCK NELSON REGIONAL CEO- UP (TERM 9/2018) 0 280094 0 58000 0 45110 0 18965 0 62882 0 465051 0 0 SHANE JACQUES UP REGIONAL CFO (TERM 4/2018) 0 192438 0 26521 0 4068 0 7697 0 30420 0 261144 0 0 MATT HEYWOOD PRESIDENT & CEO ASPIRUS 0 822805 0 293232 0 2695 0 19030 0 144154 0 1281916 0 0 SIDNEY SCZYGELSKI SR.VP OF FINANCE.CFO 0 500272 0 97238 0 47442 0 19030 0 87566 0 751548 0 0 DEANNA WILSON VP PATIENT CARE SERVICES 139115 0 20155 0 2828 0 9004 0 12552 0 183654 0 0 0 DEAN DANNER SVP AMBULATORY SERVICES & PRESIDENT 0 291709 0 50695 0 46565 0 19030 0 25012 0 433011 0 0 MICHAEL MCGRAIL SVP SYSTEM CMO 0 391427 0 82975 0 11936 0 12004 0 65632 0 563974 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 319704 0 64915 0 36831 0 19030 0 66107 0 506587 0 0 RUTH RISLEY-GRAY SVP NURSING, CNO 0 275808 0 58636 0 43052 0 19030 0 58171 0 454697 0 0 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXPERIENC 0 233292 0 40147 0 725 0 4819 0 59858 0 338841 0 0 TODD RICHARDSON SVP CIO 0 292477 0 62933 0 37490 0 19030 0 68931 0 480861 0 0 RICK NEVERS SVP REG OPS SYSTEM INT OFFICER 0 322120 0 61986 0 38481 0 19030 0 60055 0 501672 0 0 GRACE TOUSIGNANT REGIONAL CNO 0 169578 0 23536 0 2697 0 6553 0 22199 0 224563 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 344370 0 42139 0 44887 0 19030 0 27247 0 477673 0 0 TERRENCE ASPLUND PHYSICIAN 132775 0 15000 0 2465 0 2700 0 11578 0 164518 0 0 0 RICHARD CHALTRY PHYSICIAN 126956 0 0 0 7941 0 3294 0 13728 0 151919 0 0 0 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 $ 38,440 D. DANNER $ 35,422 R. NEVERS $ 32,268 R. RISLEY-GRAY $ 38,590 T. RICHARDSON $ 35,685 C. NELSON $ 35,012 S. LUSIGNAN $16,087 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 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 1 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 WAUSA 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 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 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 11,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,200. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 322,477. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,477. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 37,896. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,896. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,575,381. MANAGEMENT AND GENERAL EXPENSES 37,784. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,613,165. CORPORATE ALLOCATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,840,788. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,840,788. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS 6,326,136. 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 1 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 391931679 HEALTH CARE NETWORK WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 0 1 1 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 ASPIRUS WAUSAU HOSPITAL INC L 53906 COST ASPIRUS WAUSAU HOSPITAL INC M 89437 COST ASPIRUS WAUSAU HOSPITAL INC O 1208250 COST ASPIRUS INC C 2200000 COST ASPIRUS INC B 260000 COST ASPIRUS KEWEENAW HOSPITAL M 184064 COST ASPIRUS KEWEENAW HOSPITAL O 636095 COST ASPIRUS KEWEENAW HOSPITAL P 440911 COST ASPIRUS WAUSAU HOSPITAL INC P 54027 COST ASPIRUS INC E 391131 COST ASPIRUS INC M 1837866 COST ASPIRUS INC O 209025 COST ASPIRUS INC P 84014 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP