2019-02-14T08:41:52-06:00 2018-03-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156352111 1280 CHANDLER DRIVE SPOONER WI 54801 MICHAEL D SCHAFER CHIEF EXECUTIVE OFFICER 7156352111 2019-02-11 1 KOREY BOELTER P00775161 6123764500 67.137.57.251 2019-02-11 06:58:10 CS P E168BB59A4AC1B98DF6FDFCBC72C1446FCA85D8B D58F7A891376973A2C688259087F0D91BA8942CB 2017 2019-02-21 02:37:17Z MICHAEL D SCHAFER 1280 CHANDLER DRIVE SPOONER WI 54801 33388846 0 X WWW.SPOONERHEALTH.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 7 7 175 65 0 0 629802 291121 22962463 24297638 1503739 320495 149075 143894 25245079 25053148 13458 5500 0 0 9685912 9585706 0 0 0 12256033 14447595 21955403 24038801 3289676 1014347 53739878 52490281 25817534 23193540 27922344 29296741 X TO PROVIDE HIGH QUALITY HEALTHCARE. 0 0 16262742 5500 23936624 SPOONER HEALTH SYSTEM PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, REHABILITATION, DIAGNOSTIC, AND HOSPICE CARE. FOR THE FISCAL YEAR ENDING 3/31/18, THERE WERE 2,272 INPATIENT DAYS, 423 INPATIENT DISCHARGES, 15,513 OUTPATIENT VISITS, 7,471 EMERGENCY ROOM VISITS, AND 372 SURGERIES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THIS PROGRAM INCLUDES FEE DISCOUNTS, AS WELL AS 100% FREE CARE. SPOONER HEALTH SYSTEM ALSO PROVIDES NUMEROUS HEALTHCARE AND WELLNESS CLASSES, SUPPORT GROUPS, AND VARIOUS EDUCATIONAL/HEALTH SCREENING OPPORTUNITIES AS A COMMUNITY BENEFIT. THESE PROGRAMS ARE OFFERED TO ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS AND THE GENERAL PUBLIC. SPOONER HEALTH SYSTEM ALSO RECEIVES DONATED SERVICES FROM COMMUNITY VOLUNTEERS. 649340 0 361014 THE HOME HEALTH AGENCY PROVIDES NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/18, THERE WERE 2,187 HOME HEALTH VISITS, 85 ADMITTED CASES, AND 88 DISCHARGED CASES. 16912082 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 20 0 175 1 0 0 0 0 0 1 1 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X REBECCA BUSCH CFO 7159391732 1280 CHANDLER DRIVE SPOONER WI 54801 JAMIE MORALES BOARD PRESIDENT 1.00 X X 0 0 0 MICHAEL KNOEPKE BOARD VICE PRESIDENT 1.00 X X 0 0 0 ADAM LIEGL BOARD TREASURER 1.00 X X 0 0 0 MARK VAN ETTEN MD BOARD SECRETARY/MEDICAL DIRECTOR 5.00 X X 0 0 0 LESLIE ARF BOARD MEMBER 1.00 X 0 0 0 BRIAN GASKILL MD BOARD MEMBER 1.00 X 0 0 0 NANCY MARKGREN BOARD MEMBER THROUGH JULY 2017 1.00 X 0 0 0 MAUREEN REVAK BOARD MEMBER 1.00 X 0 0 0 MICHAEL SCHAFER CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 REBECCA BUSCH CHIEF FINANCIAL OFFICER 40.00 X 113960 0 18471 TIMOTHY BASSETT PHARMACY DIRECTOR 40.00 X 148446 0 11594 KEN ENGEL PHARMACIST 40.00 X 134866 0 18276 PATRICK MCCANN MD ER MEDICAL DIRECTOR 40.00 X 249608 0 39475 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 40.00 X 151377 0 36390 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 40.00 X 189180 0 35091 987437 0 159297 8 0 1 0 WAPITI MEDICAL GROUP-WOOD RIVER LLC 107 FLYNN DR STE 600 MILBANK SD 57252 ER PHYSICIAN COVERAGE 1323018 ARAMARK 27310 NETWORK PLACE CHICAGO IL 60673 CULINARY/LAUNDRY 829240 HEALTHTECH MANAGEMENT SERVICES 5110 MARYLAND WAY STE 200 BRENTWOOD TN 37027 MANAGEMENT FEES 588911 SHARED MEDICAL TECHNOLOGY INC 202 W NEWTON ST RICE LAKE WI 54868 DIAGNOSTIC RADIOLOGY 529911 CPSI PO BOX 850309 MOBILE AL 36685 COMPUTER SUPPORT 234235 10 7374 8467 275280 291121 PATIENT SERVICE REVENUE 621400 23949120 23949120 JOINT VENTURE REVENUE 621400 348518 348518 24297638 297309 297309 43520 0 43520 43520 43520 8347556 8324370 23186 23186 23186 6765 7374 11126 -4361 -4361 755 202 553 553 MEAL INCOME 900099 83888 83888 MISCELLANEOUS 900099 20294 20294 104182 25053148 24297638 0 464389 X 5500 5500 133123 133123 7077222 5968833 1108389 198602 167498 31104 1595717 1345806 249911 581042 490043 90999 654945 654945 148159 148159 79663 79663 2896 2896 3701566 3584281 117285 250239 250239 242048 138646 103402 610590 162190 448400 951192 933662 17530 77813 62368 15445 37231 30429 6802 804582 804582 2353773 2353773 96587 96587 DRUGS 1942023 1942023 BAD DEBT EXPENSE 1262361 272609 989752 MEDICAL SUPPLIES 940054 902737 37317 MISCELLANEOUS 128202 128202 163671 100875 62796 24038801 16912082 7126719 0 1200 1200 9715559 6334488 2787614 3948462 222758 463505 141750 262506 35566978 6478114 29989388 29088864 9964770 11550882 506839 840374 410000 0 53739878 52490281 2217326 3342063 20140616 19593477 3459592 0 0 258000 25817534 23193540 X 27922344 29296741 27922344 29296741 53739878 52490281 1014347 361550 -1500 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2896 2896 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND WISCONSIN HOSPITAL ASSOCIATION WERE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF SPOONER HEALTH SYSTEM AND OTHER MEMBERS. 1217277 1217277 20259759 1945775 18313984 793575 120580 672995 13262913 4411759 8851154 33454 33454 29088864 THIRD PARTY PAYOR SETTLEMENT 258000 258000 X 24145675 361550 -1262361 -900811 25046486 6662 6662 25053148 22771278 -5162 -5162 22776440 1262361 1262361 24038801 PART X, LINE 2: THE SYSTEM IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE SYSTEM FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE SYSTEM FOLLOWS THE ACCOUNTING STANDARD FOR INCOME TAXES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -1,262,361. PART XI, LINE 4B - OTHER ADJUSTMENTS: MISCELLANEOUS INCOME 5,162. IN-KIND SPECIAL EVENT REVENUE 1,500. PART XII, LINE 2D - OTHER ADJUSTMENTS: MISCELLEANOUS INCOME -5,162. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,262,361. SH GOLF OUTING 14139 7374 6765 2265 1882 1440 5539 14139 7374 6765 2265 1882 1440 5539 11126 -4361 1 1 X 1 X 1 X 1 1 1 0 1 1 253004 253004 0.01110 4291752 1591392 2700360 0.11860 4544756 1591392 2953364 0.12970 27 16809 77905 9776 68129 0.00300 6 41 39029 39029 0.00170 2 288 656539 328154 328385 0.01440 17 100 43399 43399 0.00190 52 17238 816872 337930 478942 0.02100 52 17238 5361628 1929322 3432306 0.15070 12 30 10954 10954 0.00050 1 894 894 0.00000 4 1478 1478 0.00010 4 206 5794 5794 0.00030 21 236 19120 19120 0.00090 1 1262361 0 11133425 11293905 -160480 X 1 1 1 1 SPOONER HEALTH SYSTEM INC 1280 CHANDLER DRIVE SPOONER WI 54801 WWW.SPOONERHEALTH.COM 1024 X X X X HOME HEALTH AGENCY SPOONER HEALTH SYSTEM 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X 1 15 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X WWW.SPOONERHEALTHSYSTEM.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFO/ X WWW.SPOONERHEALTHSYSTEM.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFO/ X WWW.SPOONERHEALTHSYSTEM.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFO/ X X X X X X 1 X 0 X X X 1 X 0 0 SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 5: SPOONER HEALTH SYSTEM WORKED IN PARTNERSHIP WITH WASHBURN COUNTY ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT. COMMUNITY INPUT WAS GATHERED THROUGH A STEERING COMMITTEE (INDIVIDUALS SELECTED FOR THEIR PROFESSIONAL INSIGHT REPRESENTING THE COMMUNITIES INTERESTS) AND A PUBLIC COMMUNITY SURVEY. A NEWS RELEASE WAS SENT TO THE LOCAL PAPERS TO INFORM AND INVITE THE PUBLIC TO BE PART OF THE PROCESS. THE SURVEY WAS DEVELOPED TO CAPTURE THE COMMUNITY PERCEPTION OF THE PRESENT AND FUTURE HEALTH NEEDS OF WASHBURN COUNTY. SPOONER HEALTH SYSTEM CONTRACTED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER TO DEVELOP, DISTRIBUTE, AND COLLATE THE SURVEY RESULTS.IN THE SUMMER OF 2015, SURVEYS WERE MAILED TO A RANDOM STRATIFIED SAMPLE OF 800 COMMUNITY RESIDENCES. ONE HUNDRED ADDITIONAL SURVEYS WERE MADE AVAILABLE FOR DISTRIBUTION AT THE HOSPITAL AND PUBLIC HEALTH. ADDITIONALLY, THE SURVEY WAS MADE AVAILABLE ELECTRONICALLY AND THE SURVEY LINK WAS PUBLICIZED AND AVAILABLE ON SPOONER HEALTH SYSTEM AND WASHBURN COUNTY WEBSITES. RESPONDENTS WERE ENCOURAGED TO COMPLETE THE ASSESSMENT USING ONE OF THE THREE MODALITIES. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 6B: SPOONER HEALTH SYSTEM COLLABORATED WITH WASHBURN COUNTY PUBLIC HEALTH AND THE NATIONAL RURAL HEALTH RESOURCE CENTER OF DULUTH, MN WHEN COMPLETING THEIR CHNA. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 11: TO REDUCE ALCOHOL, TOBACCO, AND OTHER DRUG ABUSE, WE CONTINUE TO USE THE PRESCRIPTION DRUG DATABASE AS WE CARE FOR PATIENTS. WE KEEP AN UPDATED LIST OF RESOURCES FOR PATIENTS AND MAKE THEM AVAILABLE THROUGH OUR CAREGIVERS. WE ALSO MAKE THOSE RESOURCES AVAILABLE ON OUR WEBSITE. WE CONTINUE TO PROVIDE TOBACCO CESSATION CLASSES AND NOW HOST THE ALCOHOLICS ANONYMOUS MEETINGS ON A WEEKLY BASIS IN OUR FACILITY. WE PARTICIPATE IN COLLABORATIVE COMMUNITY GROUPS SUCH AS THE WASHBURN COUNTY DRUG TEAM AND THE M-TEAM, WHICH IS A MULTI-DISCIPLINARY TEAM TO PROVIDE SERVICES FOR CHILDREN FOUND AT DRUG LAB SITES.TO REDUCE MENTAL HEALTH BARRIERS, WE KEEP AN UPDATED LIST OF RESOURCES FOR PATIENTS AND MAKE THEM AVAILABLE THROUGH OUR CAREGIVERS. WE CONTINUE TO SUPPORT A DEMENTIA FRIENDLY COMMUNITY THROUGH LEADING AND MANAGING THE APHASIA SUPPORT GROUP, MEMORY CLINIC, AND ALZHEIMER'S ASSOCIATION SUPPORT GROUP. WE HOST A GRIEF SUPPORT GROUP AT OUR FACILITY AND PROVIDE AN ANNUAL GRIEF PRESENTATION OPEN TO THE COMMUNITY. TO INCREASE ACCESS TO HEALTHCARE, WE MAKE INFORMATION ON FINANCIAL ASSISTANCE WIDELY AVAILABLE THROUGH OUR WEBSITE AND PATIENT EDUCATION. WE CONTINUE FINANCIAL AND IN-KIND SUPPORT FOR THE RICE LAKE AREA FREE CLINIC. WE WORKED WITH THE LOCAL NEWSPAPER AND THEY HAVE MADE SPACE AVAILABLE FOR US MONTHLY TO INCLUDE ARTICLES RELATED TO HEALTH ISSUES CALLED "COMMUNITY HEALTH CORNER". WE HELD FREE REHAB SCREENING EVENTS FOR THE COMMUNITY. WE ALSO HELD NUMEROUS FLU SHOT CLINICS OUT IN THE COMMUNITY AND DID FREE LAB CHOLESTEROL SCREENINGS AT OUR ANNUAL HEALTH FAIR, AS WELL AS FREE BLOOD PRESSURES AT A LOCAL BUSINESS. TO INCREASE CHRONIC DISEASE PREVENTION, WE PROMOTED INCREASED AWARENESS OF CHRONIC DISEASES AT OUR ANNUAL HEALTH FAIR. WE ALSO HAD A BOOTH AT THE AGING & DISABILITY RESOURCE CENTER SENIOR EXPO. RESOURCES ARE AVAILABLE ON OUR WEBSITE.REGARDING NUTRITION, OBESITY, AND PHYSICAL ACTIVITY ISSUES, WE HAD A BOOTH AT OUR HEALTH FAIR REGARDING THESE TOPICS. WE RUN THE POWERUP VOICE & MOVEMENT GROUP, WHICH ASSISTS INDIVIDUALS TO IMPROVE SPEECH AND MOBILITY SO THEY CAN FUNCTION MORE SAFELY AND INDEPENDENTLY WITH A BETTER QUALITY OF LIFE. WE CONTINUE TO PARTICIPATE IN THE AFTERSCHOOL ADVISORY BOARD AND SUPPORT SPOONER SCHOOLS, LAKELAND FAMILY RESOURCE CENTER, AND THE RICE LAKE AREA FREE CLINIC REGARDING THESE ISSUES. OUR DIETICIAN PROVIDED A HEALTHY LIVING TALK AT THE LOCAL LIBRARY. RESOURCES ARE AVAILABLE ON OUR WEBSITE. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE ALL AVAILABLE ON THE WEBSITE. THE INFORMATION ON THE WEBSITE EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE AT REGISTRATION. A FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE. PART V, LINE 7A, CHNA REPORT HOSPITAL FACILITY'S WEBSITE: WWW.SPOONERHEALTH.COM/ABOUT-US/COMM-HEALTH-ASSESSMENT/ PART V, LINE 7B, CHNA REPORT OTHER WEBSITE: WWW.CO.WASHBURN.WI.US/DEPARTMENTS/HEALTH-HUMAN-SERVICES/PUBLIC-HEALTH PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE: WWW.SPOONERHEALTH.COM/ABOUT-US/COMM-HEALTH-ASSESSMENT/ PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED PRIMARILY ON HOUSEHOLD INCOME COMPARED TO FEDERAL POVERTY GUIDELINES. HOWEVER, QUALIFIED HOUSEHOLD ASSETS ARE ALSO CONSIDERED WHEN DETERMINING AN INDIVIDUAL'S ABILITY TO PAY FOR HEALTHCARE SERVICES. FINALLY, INSURANCE STATUS CAN IMPACT A PERSON'S ELIGIBILITY IF THEY HAVE ACCESS TO HEALTH INSURANCE, THIRD-PARTY REIMBURSEMENT OR GOVERNMENTAL ASSISTANCE BUT FAIL TO TAKE ADVANTAGE OF IT OR FAIL TO MAINTAIN ELIGIBILITY. PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7A-C WERE COMPUTED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H, IRS INSTRUCTIONS. THE AMOUNTS REPORTED IN LINES 7E-I WERE REPORTED BASED ON DIRECT COSTS INCURRED BY SH. PART I, LINE 7G: INCLUDED IN PART I, LINE 7G ARE THE MEMORY CLINIC, WHICH IS A PHYSICIAN CLINIC, AND THE HOME HEALTH AGENCY. BOTH SERVICES ARE LISTED AS SUBSIDIZED HEALTH SERVICES BECAUSE THEY ARE OPERATED BY SHS TO PROVIDE A SERVICE THAT IS NEEDED IN THE COMMUNITY BUT THAT CANNOT BE SUSTAINED ON THEIR OWN. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE HOME HEALTH AGENCY WAS $625,115 WITH DIRECT OFFSETTING REVENUE OF $304,416, RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $320,699. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $31,424 WITH DIRECT OFFSETTING REVENUE OF $23,738, RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $7,686. PART I, LN 7 COL(F): THE HOSPITAL IS REPORTING $1,262,361 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24B. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $22,771,278. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: SPOONER HEALTH (SH) IS PARTNERED WITH WASHBURN COUNTY AND THE STATE OF WISCONSIN IN THEIR EMERGENCY PREPAREDNESS EFFORTS THROUGH INVOLVEMENT WITH THE NORTHWEST WISCONSIN HEALTH CARE COALITION AND REGIONAL TRAUMA ADVISORY COUNCIL. SH IS ALSO PARTNERED WITH THE FOLLOWING ORGANIZATIONS THAT DIRECTLY PROMOTE HEALTH OF PERSONS LIVING IN WASHBURN AND BURNETT COUNTIES: DRUG ENDANGERED CHILDREN M TEAM, WASHBURN COUNTY SAFETY COALITION, ELDER ABUSE INTERDISCIPLINARY TEAM, WASHBURN COUNTY AND POLK-BURNETT COUNTY TRANSITIONS OF CARE COALITION, WASHBURN COUNTY COORDINATED COMMUNITY RESPONSE TEAM, CHILD DEATH REVIEW TEAM, FAITH IN ACTION, EMBRACE, AND BURNETT COUNTY CRISIS OVERSIGHT COMMITTEE. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 3: A PORTION OF THE BAD DEBT EXPENSE REPORTED IN LINE 2 WOULD BE CONSIDERED CHARITY CARE IF THE PROPER PAPERWORK WAS COMPLETED BY THE PATIENTS, HOWEVER THIS AMOUNT CANNOT BE QUANTIFIED. PART III, LINE 4: FOR INFORMATION ABOUT BAD DEBT EXPENSE, SEE THE "PATIENT RECEIVABLES, NET" SECTION OF NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2018 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $160,480 SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THESE ARE THE COSTS OF PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE HOSPITAL DIDN'T PROVIDE THESE SERVICES, NO OTHER ORGANIZATION IN THE COMMUNITY WOULD. PART III, LINE 9B: AFTER FINANCIAL ASSISTANCE IS PROVIDED, SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. SPOONER HEALTH SYSTEM MAKES ALL REASONABLE ATTEMPTS TO CONFIRM THAT PATIENTS ARE NOT ELIGIBLE FOR OTHER ASSISTANCE PROGRAMS PRIOR TO COLLECTION AGENCY ASSIGNMENT. PRIOR TO TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND STATEMENTS AND COLLECTION LETTERS TO THE PATIENT AT THE ADDRESS PROVIDED BY THE PATIENT. STATEMENTS AND COMMUNICATIONS WILL INFORM THE PATIENT OF THEIR FINANCIAL RESPONSIBILITY AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN. PART VI, LINE 2: THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED IN PART V, SECTION B WAS THE ONLY ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS CONDUCTED DURING THE FISCAL YEAR. PART VI, LINE 3: PATIENTS WITHOUT INSURANCE ARE GIVEN THE FINANCIAL ASSISTANCE (FA) APPLICATION. OUR FINANCIAL COUNSELOR CALLS THEM AFTER DISCHARGE AND EXPLAINS WHAT ASSISTANCE (FROM THE GOVERNMENT OR SHS) MAY BE AVAILABLE TO THEM. SHE ASKS THEM TO FILL IT OUT AND MAKES AN APPOINTMENT WITH THEM IN THE OFFICE IF THEY NEED ASSISTANCE WITH THE FA APPLICATION OR GOING TO WWW.ACCESS.GOV TO APPLY FOR GOVERNMENTAL ASSISTANCE. WHEN THEY COME IN, SHE WILL ASSIST THEM WITH THE APPLICATION PROCESS AS MUCH AS SHE CAN. IF THEY NEED FURTHER ASSISTANCE, ARE OF RETIREMENT AGE, OR IF THERE IS A DISABILITY INVOLVED, SHE REFERS THEM TO THE WASHBURN COUNTY AGING AND DISABILITY RESOURCE CENTER WHERE THEY WILL HELP THE PATIENTS IN GETTING ADDITIONAL ASSISTANCE. OUR FINANCIAL COUNSELOR ALSO REFERS PATIENTS TO THE COUNTY'S PUBLIC HEALTH DEPARTMENT IF THEY NEED FAMILY OR WOMEN'S HEALTH ASSISTANCE. WE ALSO PUBLICIZE THE AVAILABILITY OF FA IN OUR ANNUAL REPORT TO THE COMMUNITY THAT IS SENT OUT TO EVERY ADDRESS IN OUR PRIMARY SERVICE AREA. PART VI, LINE 4: SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURN COUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 30TH LARGEST COUNTY BY LAND AREA IN WISCONSIN WITH AN ESTIMATED POPULATION OF 15,758 (PER JULY 2017 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $46,592 WITH 13.0% OF PERSONS BELOW POVERTY LEVEL (PER 2013-2017 DATA). WASHBURN COUNTY HAD A 4.8% UNEMPLOYMENT RATE IN MARCH 2018 PER DWD, BUREAU OF WORKFORCE TRAINING. PART VI, LINE 6: SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 HIGH SCHOOL STUDENT SCHOLARSHIPS 1 1000 EMPLOYEE TUITION ASSISTANCE 2 4500 PART I, LINE 2: SPOONER HEALTH SYSTEM AWARDS SCHOLARSHIPS TO HIGH SCHOOL SENIORS WHO ARE GOING ON TO COLLEGE IN A HEALTH CARE FIELD. THE FUNDS ARE PAID DIRECTLY TO THE COLLEGE TO ENSURE THEY ARE USED FOR THE PURPOSE OF TUITION. SPOONER HEALTH SYSTEM ALSO OFFERS TUITION ASSISTANCE FOR EMPLOYEES THAT ARE FURTHERING THEIR EDUCATION TO ENHANCE THEIR JOB RELATED SKILLS, KNOWLEDGE AND IMPROVE THEIR POTENTIAL FOR PROMOTION OR CAREER DEVELOPMENT OPPORTUNITIES. TO RECEIVE TUITION REIMBURSEMENT FROM THE HOSPITAL, AN EMPLOYEE MUST SUBMIT A TUITION ASSISTANCE IN EXCHANGE FOR SERVICE FROM THE HUMAN RESOURCES DEPARTMENT ALONG WITH THE APPROPRIATE DOCUMENTATION. THIS INCLUDES WRITTEN PROOF OF SUCCESSFUL COMPLETION OF THE COURSE PER THE COURSE REQUIREMENTS AND ITEMIZED BILLS, RECEIPTS OR STATEMENTS WITH PROOF OF PAYMENT FOR EXPENSES. X X X 0 0 0 0 0 0 0 0 0 TIMOTHY BASSETT PHARMACY DIRECTOR 148446 0 0 0 0 0 4633 0 6961 0 160040 0 0 0 KEN ENGEL PHARMACIST 134866 0 0 0 0 0 4172 0 14104 0 153142 0 0 0 PATRICK MCCANN MD ER MEDICAL DIRECTOR 249608 0 0 0 0 0 7816 0 31659 0 289083 0 0 0 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 151377 0 0 0 0 0 4808 0 31582 0 187767 0 0 0 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 189180 0 0 0 0 0 5871 0 29220 0 224271 0 0 0 A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-10-23 21200000 CONSTRUCTING REPLACEMENT HOSPITAL 0 0 0 A 1115000 21200000 619 518316 20681065 2016 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 SPOONER HEALTH SYSTEM CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. INCLUDED IN THE FEES PAID TO HEALTHTECH MANAGEMENT SERVICES IS THE COMPENSATION FOR THE CEO. THE AMOUNT OF COMPENSATION PAID TO THE CEO WAS $242,363 OF TAXABLE PAY, $24,000 OF NONTAXABLE DEFERRED COMPENSATION, AND $7,531 OF OTHER NONTAXABLE BENEFITS. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 WAS REVIEWED WITH BOARD MEMBERS WHO APPROVED IT. THE 990 WAS THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ANY OFFICER, BOARD MEMBER, OR KEY EMPLOYEE OF THE ORGANIZATION ON AN ANNUAL BASIS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE PERSON WITH THE CONFLICT SHALL LEAVE MEETINGS DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 MICHAEL SCHAFER, CEO, IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE AND LABOR COSTS FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION, INCLUDING COMPENSATION SURVEYS, TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL, WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. ALL OFFICERS AND KEY EMPLOYEES' COMPENSATION IS REVIEWED ON AN ANNUAL BASIS AND COMPARED TO MARKET DATA GATHERED BY THE HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 2,945,399. MANAGEMENT AND GENERAL EXPENSES 18,509. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,963,908. SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 532,818. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 532,818. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 106,064. MANAGEMENT AND GENERAL EXPENSES 98,776. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 204,840.