2018-04-04T17:37:28-05:00 2017-06-30 390758449 Wipfli LLP PO Box 8010 Wausau WI 544028010 990 2016-07-01 381443361 Aspirus Keweenaw Hospital ASPI 9063376500 205 OSCEOLA LAURIUM MI 49913 SIDNEY C SCZYGELSKI CFO/SENIOR VP OF FINANCE 9063376500 2018-03-10 1 Kathleen J LaBrake CPA P00164006 7158453111 2018-03-10 50.50.56.238 2018-03-10 11:47:25 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FEDE6E2ED2B59B1C13DC36E78E84E5663127854C 2016 2021-01-29 14:40:06Z SIDNEY C SCZYGELSKI 2200 WESTWOOD DRIVE Wausau WI 54401 53188633 0 X www.aspirus.org X 1939 MI We heal people, promote health and strengthen communities. 10 6 417 39 0 -5491 12000 36186 52859532 52286028 186804 425488 854245 372908 53912581 53120610 0 30037 0 0 24084104 24546717 0 0 0 27724367 27284020 51808471 51860774 2104110 1259836 51639337 51178510 23672074 21959204 27967263 29219306 We heal people, promote health and strengthen communities. 0 0 41491900 30037 52419093 ASPIRUS KEWEENAW HOSPITAL PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, PHYSICIAN CLINIC SERVICES, AND EYE CLINIC SERVICES. 41491900 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 0 0 0 1 90 0 1 417 1 1 1 0 0 0 0 0 0 0 0 0 X 10 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE Wausau WI 54401 DANIEL DALQUIST CHAIRMAN 1.00 X X 0 0 0 EDWARD JENICH VICE CHAIRMAN 1.00 X X 0 0 0 DAVID GILBERT MD SECRETARY (Term 7/2016) 1.00 X X 0 0 0 CHARLES NELSON BOARD MEMBER / REGIONAL UP 20.00 22.00 X X 0 367059 75364 MATTHEW HEYWOOD BOARD MEMBER (Term 7/2016) / CEO OF AI 1.00 50.00 X X 0 994138 146997 MICHAEL HAUSWIRTH AKH CEO 28.00 12.00 X X 279324 0 22549 JERRY LUOMA MD BOARD MEMBER 1.00 X 0 0 0 Sara Lusignan Board member/ VP of Financ 1.00 41.00 X 0 234937 40504 DARRYL PIERCE BOARD MEMBER 1.00 X 0 0 0 Dr James Feeley Board Member (Term 7/2016) / Medical Staf 1.00 40.00 X 229592 0 34942 JOHN HEISLER BOARD MEMBER & SR VP/CHIEF 1.00 49.00 X 0 331227 67055 MICHAEL LUOMA MD BOARD MEMBER / Chief of staff 40.00 X 287419 0 30808 DALE R TAHTINEN BOARD MEMBER 1.00 X 0 0 0 JOEL TUORINIEMI BOARD MEMBER 1.00 X 0 0 0 Micheal McAllister DO BOARD MEMBER & MEDICAL STA 40.00 X 508144 0 16116 SIDNEY C SCZYGELSKI CFO OF AI 1.00 51.00 X 0 562384 93647 SHANE JACQUES REGIONAL CFO 20.00 20.00 X 213585 0 32961 Grace Tousignant Regional CNO 20.00 21.00 X 168141 0 24277 Dean Danner SVP Ambulatory Services, P 1.00 48.00 X 0 367581 72374 Kathyrne McGowan SVP Population Health, Exe 1.00 50.00 X 0 309566 70073 Ruth Risley-Gray SVP Nursing, CNO 1.00 49.00 X 0 347049 74562 Rick Nevers SVP Reg Ops System Int Off 1.00 50.00 X 0 381217 70836 Cari Logemann SVP & General Counsel 1.00 50.00 X 0 359569 76513 Todd Richardson SVP & CIO 1.00 50.00 X 0 393488 80991 MichaEl McGrail MD SVP System CMO 1.00 50.00 X 0 485324 82591 Fredrick Rau Physician 40.00 X 534483 0 37882 Shahar Madjar Physician 40.00 X 454312 0 33212 Bonnie Hafeman Physician 40.00 X 392968 0 31915 James Black Physician 40.00 X 377417 0 37721 Shalini Johnson Physician 40.00 X 355216 0 27032 3800601 5133539 1280922 36 0 1 0 ERX PLUS LLC 9724 KINGSTON PIKE STE 1300 Knoxville TN 37922 CONTRACTED PROVIDERS 677500 WEATHERBY LOCUMS INC PO BOX 972633 Dallas TX 75397 CONTRACTED PROVIDERS 480265 UP PATHOLOGY SERVICES PC 22381 State highway m26 hancock MI 49930 Contracted Pathology Services 315113 Thomas K Carlson 1 Aspen Lane Gladstone MI 49837 ContrACTED PROVIDERS 293600 Donald Patton MD 163 E Hagerman lake iron river MI 49935 CONTRACTED PROVIDERS 188867 11 9760 26426 36186 Net Patient Service Revenue 621990 48190581 48190581 340B Revenue Drug Program 900099 3951847 3951847 Cafeteria Revenue 624200 136690 136690 Vending revenue 624200 6910 6910 52286028 425488 425488 164266 68023 96243 96243 96243 E.H.R INCENTIVE 900099 436367 436367 Other Revenue 900099 -159702 -159702 276665 53120610 52419093 0 665331 30037 30037 1296638 837067 459571 18725299 17820678 904621 592306 551949 40357 2707365 2523268 184097 1225109 1136869 88240 14993 14993 33415 33415 3957281 3907602 49679 179403 15808 163595 8334997 8240697 94300 92109 84473 7636 530283 489517 40766 261101 196276 64825 737932 737932 3061809 3027415 34394 227897 133640 94257 Corporate Allocations 7342099 7342099 EQUIPMENT RENTAL AND MA 1067485 926912 140573 Provision for bad debts 802150 802150 DUES AND SUBSCRIPTIONS/ 624741 25680 599061 16325 3930 12395 51860774 41491900 10368874 0 4723307 5572959 6458511 3494586 4523026 4977336 557759 1365678 936212 604523 48585555 21903303 28030694 26682252 360344 3306786 2207602 1147425 32324 8081 3809558 4018884 51639337 51178510 4652043 3910812 1387115 971523 16804846 16848684 828070 228185 23672074 21959204 X 27967263 29219306 27967263 29219306 51639337 51178510 X 1259836 -7793 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 6304 6304 0 Part II-B, Line 1: Organization has indirect lobbying activities through the payment of hospital association dues. 874763 874763 23601360 8114998 15486362 1894962 962905 932057 22321114 12825400 9495714 -106644 -106644 26682252 Due from Aspirus Keweenaw enterprises 1831811 Due from Aspirus Keweenaw Foundation 3136 Note Receivable 892500 Due from other entities 644132 THIRD PARTY RECEIVABLES 53445 Other 593860 4018884 Long Term Insurance Payable 249085 Asbestos Liability 21448 Medicare Payable -347577 Blue Cross Payable 305229 228185 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, 2017 AND 2016. 1 1 X 1 X 1 X 1 1 0 1 1 486873 0 486873 0.00950 8978971 6157524 2821447 0.05530 9465844 6157524 3308320 0.06480 85102 85102 0.00170 12197502 10180902 2016600 0.03950 30037 30037 0.00060 12312641 10180902 2131739 0.04180 21778485 16338426 5440059 0.10660 1 395571 11526951 11580991 -54040 X 1 0 1 1 Aspirus keweenaw hospital 205 Osceola Street Laurium MI 49913 www.aspiruskeweenaw.org 1060000151 X X X X PHYSICIAN CLINIC, HOME MEDICAL EQUIPMENT, & PHARMACY Aspirus Keweenaw Hospital 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X http://www.aspirus.org/Main/Community-Resources.aspx?srcaud=Main X 1 15 1 http://www.aspirus.org/Main/Community-Resources.aspx?srcaud=Main 0 1 X 200.000000000000 300.000000000000 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 Keweenaw Hospital Part V, Section B, Line 5: Survey by mail and participation in regional health assessments with other hospitals and agencies. Aspirus Keweenaw Hospital Part V, Section B, Line 6a: Aspirus Grand View, Aspirus Ontonagon, Baraga County Memorial Hospital, U.P. Health System - Portage. Aspirus Keweenaw Hospital Part V, Section B, Line 6b: Western Upper Peninsula Health Department and Copper County Memorial Health Services Aspirus Keweenaw Hospital Part V, Section B, Line 11: Four major priority areas were selected by the steering committee 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 region basis than an individual organization might be able to undertake, especially with limited resources.The 1st of the four priority areas and overarching theme of all four priorities is The Importance of Prevention. Aspirus Keweenaw 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. Expand attendance of fitness classes or personal training sessions and facility usage by 5% annually at Laurium Fitness Center. Target 50 percent of that expansion to aging population.3. Continue to support the diabetes education program through offering a variety of avenues for education to the community. Grow patient encounters by 5 percent annually over 3 years.4. Identify patient population who have diabetes and also use tobacco products and provide cessation education to 20 percent of the identified population5. Reach 50 percent of Houghton and Keweenaw County population annually with "how-to" information regarding positive disease prevention behaviors and access to services. Aspirus Keweenaw Hospital Part V, Section B, Line 16j: BILLING INVOICES CONTAIN CONTACT INFORMATION FOR MORE INFORMATION ABOUT THE THE FINANCIAL ASSISTANCE POLICY. A POSTING OF HOW TO OBTAIN MORE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY IS LOCATED IN THE EMERGENCY AND WAITING ROOMS. PART V, SECTION B, LINE 5A HOSPTIAL WEB ADDRESS TO LOCATE CHNA: http://aspirus.org/Main/Community-Resources.aspx PART V, SECTION B, LINE 16(I) THE FAP PLAIN LANGUAGE SUMMARY AND THE FAP APPLICATION ARE TRANSLATED INTO THE PRIMARY LANGUAGES SPOKEN BY LEP POPULATIONS. ASPIRUS IS CURRENTLY WORKING TO FINALIZE THE TRANSLATION OF THE FAP POLICY INTO THE PRIMARY LANGUAGES SPOKEN BY LEP POPULATIONS. 5 1 - ASPIRUS HOUGHTON CLINIC 1000 CEDAR STREET HOUGHton MI 49931 CLINIC & Outpatient Therapy 2 - Aspirus Keweenaw Outpatient Therapies 342 Hecla Street Laurium MI 49913 Outpatient Therapy 3 - Aspirus Keweenaw Laurium Wellness 300 Hecla Street Laurium MI 49913 Clinic 4 - Aspirus Eye Clinic 404 East Sharon Avenue Houghton MI 49931 Clinic 5 - Aspirus Keweenaw Lake Linden Clinic 110 Calumet StREET Lake Linden MI 49945 Clinic Part I, Line 7: The cost method that is used on the Form 990 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. This is then divided by gross patient services revenue. Part I, Line 7g: The cost of subsidized heatlh services are related to the Aspirus Keweenaw Clinics. Aspirus Keweenaw Hospital utilized an internal departmental financial statement to report the cost and direct offsetting revenue that calculates the community benefit expense. Part I, Ln 7 Col(f): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $802,150. Part II, Community Building Activities: While there is growing agreement in the United States about what constitutes a non-profits hospital's community benefit and charity care, these efforts continue to be a work in progress. Aspirus Keweenaw Hospital, Inc., in addition to providing significant charity care and other community benefits as defined by the IRS, the organization believes that it provides a critically important benefit which is not quantified. Aspirus Keweenaw Hospital, like most community hospitals, was created and is maintained in order to provide care locally which without the hospital would not be available locally. In addition to inpatient hospitalizations, the organization provides local access to many services including: Emergency services, respiratory therapy, occupational therapy, physical therapy, family practice clinics, and laboratory and pathology services. Part III, Line 4: In evaluating the collectability of accounts receivable, the Organization analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and the provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. Specifically, for receivables relating to services provided to patients having third-party coverage, the Organization analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts for expected uncollectible deductibles and copayments 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), the Organization 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 off against the allowance for doubtful accounts. Part III, Line 8: Allowable Medicare costs were obtained from the Organization's filed Medicare Cost Report. As such they only include the amounts allowed in the form 990 instructions. Therefore, they only include a portion of the gross Medicare revenue of the organization and do not consider all of the contractual adjustments for services reimbursed by the Medicare program. The Medicare revenues amounts listed do not include physician services for the coverage of the emergency department at the hospital as well as anesthesia professional services, revenues for any patients covered under Medicare advantage plan programs, physical therapy services provided to nursing home residents, and a significant portion of lab services provided to area clinic patients. 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: The organization meets with a local federally qualified health center to consult and determine how to meet the health care needs in the organization's geographical area. In addition, the organization itself evaluates its' own services offered in their service area and evaluates other services that could be provided to benefit the community served. 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: The organization provides services primarily to the elderly and frail of Northern Houghton and Keweenaw counties. The largest cities in these regions include Houghton, Hancock, Laurium and Calumet. As a percentage of total revenue, Medicare and Medicaid comprise of 51% and 18%, respectively for the organization. Part VI, Line 5: The board of director's is comprised of independent community members. The organization provides, free of charge to the local school, an athletic trainer. Part VI, Line 6: ASPIRUS KEWEENAW IS AN AFFILIATED HEALTH SYSTEM WHICH SERVES THE COMMUNITY SURROUNDING LAURIUM, MICHIGAN. AFFILIATES OF ASPIRUS KEWEENAW PROMOTE THE HEALTH OF THE COMMUNITY BY FULFILLING THEIR INDIVIDUAL MISSIONS. ASPIRUS KEWEENAW PROVIDES PHYSICIAN SERVICES IN OUTPATIENT CLINICS. 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 CHARLES NELSON BOARD MEMBER / REGIONAL UP 0 258636 0 66258 0 42165 0 17949 0 57415 0 442423 0 0 MATTHEW HEYWOOD BOARD MEMBER (Term 7/2016) / CEO OF 0 734056 0 257815 0 2267 0 18830 0 128167 0 1141135 0 0 MICHAEL HAUSWIRTH AKH CEO 215604 0 58038 0 5682 0 8417 0 14132 0 301873 0 0 0 Sara Lusignan Board member/ VP of Financ 0 205193 0 29064 0 680 0 4469 0 36035 0 275441 0 0 Dr James Feeley Board Member (Term 7/2016) / Medical 227396 0 0 0 2196 0 9200 0 25742 0 264534 0 0 0 JOHN HEISLER BOARD MEMBER & SR VP/CHIEF 0 265586 0 56537 0 9104 0 13026 0 54029 0 398282 0 0 MICHAEL LUOMA MD BOARD MEMBER / Chief of staff 270381 0 12000 0 5038 0 7333 0 23475 0 318227 0 0 0 Micheal McAllister DO BOARD MEMBER & MEDICAL STA 458591 0 0 0 49553 0 5300 0 10816 0 524260 0 0 0 SIDNEY C SCZYGELSKI CFO OF AI 0 441313 0 93183 0 27888 0 18830 0 74817 0 656031 0 0 SHANE JACQUES REGIONAL CFO 176022 0 30875 0 6688 0 7481 0 25480 0 246546 0 0 0 Grace Tousignant Regional CNO 142421 0 24657 0 1063 0 5885 0 18392 0 192418 0 0 0 Dean Danner SVP Ambulatory Services, P 0 281530 0 50514 0 35537 0 17796 0 54578 0 439955 0 0 Kathyrne McGowan SVP Population Health, Exe 0 253530 0 54574 0 1462 0 12888 0 57185 0 379639 0 0 Ruth Risley-Gray SVP Nursing, CNO 0 263353 0 56735 0 26961 0 17865 0 56697 0 421611 0 0 Rick Nevers SVP Reg Ops System Int Off 0 287340 0 59975 0 33902 0 18830 0 52006 0 452053 0 0 Cari Logemann SVP & General Counsel 0 295196 0 63114 0 1259 0 18556 0 57957 0 436082 0 0 Todd Richardson SVP & CIO 0 284010 0 61187 0 48291 0 18830 0 62161 0 474479 0 0 MichaEl McGrail MD SVP System CMO 0 382842 0 81065 0 21417 0 11948 0 70643 0 567915 0 0 Fredrick Rau Physician 529911 0 0 0 4572 0 10600 0 27282 0 572365 0 0 0 Shahar Madjar Physician 452932 0 0 0 1380 0 9454 0 23758 0 487524 0 0 0 Bonnie Hafeman Physician 392637 0 0 0 331 0 7690 0 24225 0 424883 0 0 0 James Black Physician 376048 0 0 0 1369 0 10600 0 27121 0 415138 0 0 0 Shalini Johnson Physician 355000 0 0 0 216 0 10600 0 16432 0 382248 0 0 0 Part I, Line 1a TRAVEL FOR COMPANIONS, AND HOUSING ALLOWANCES, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR VALUE. TRAVEL FOR COMPANIONS: C. NELSON $188, J. HEISLER $181, M. Luoma $188, M. HEYWOOD $188, S. SCZYGELSKI $188, S. LUSIGNAN $149, M. Hauswirth $622, D. DANNER $184, K. MCGOWAN $199, R. RISLEY-GRaY $152, R. NEVERS $206 - INCLUDED IN INCOME. Part I, Line 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, ASPIRUS KEWEENAW HOSPITAL RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICIES 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 retirment 457 (f) Distribution: 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 TERIMINATION 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 A DEATH OR DISABILITY; THE DATE ON WHICH THE PARTICIANT INCURS AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CASUSE; 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 FROM 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. C. NELSON $33,594 S. SCZYGELSKI $20,721 D. DANNER $30,171 R. Risley-Gray $24,196 R. NEVERS $31,318 T. Richardson $47,095 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG9 2015-05-07 16997543 NEW CONSTRUCTION 0 0 0 A 16997543 17005919 2016 0 0 1 1 A 0 0 1 0 0 0.00500 0.00500 1 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K, 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.] Schedule k, part III -line 3a and 3b ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS KEWEENAW HOSPITAL, 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 PROPERY. 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 Jerry Luoma and Michael Luoma have a family relationship. Form 990, Part VI, Section A, line 6 Aspirus, Inc. is the sole corporate and voting member of Aspirus Keweenaw Hospital. Form 990, Part VI, Section A, line 7a THE BOARD OF DIRECTORS IS COMPRISED OF 7 MEMBERS FROM ASPIRUS, INC. AND 3 MEMBERS FROM KEWEENAW HEALTH FOUNDATION. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS, CONSISTING OF THREE NOMINATED BY THE FOUNDATION BOARD OF TRUSTEES AND THREE NOMINATED BY ASPIRUS, INC. WITH CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD, AND ELECTED BY ASPIRUS, INC., TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTORS CONSISTING OF PHYSICIANS IN THE ACTIVE CATEGORY OF THE MEDICAL STAFF AT THE HOSPITAL, NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. Form 990, Part VI, Section A, line 7b The following actions must be approved by the members of the organization: 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 officer; 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 accumulated 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 Annually, board members are required to disclose conflicts to the board. An interested person must disclose the existence and nature of his or her financial interest to the directors and members of committees with board delegated powers. An interested person is an director, principal, officer, or member of a committe with board delegated powers who has a direct or indirect financial interest. After disclosure, the interested person shall leave the board or committee meeting while the financial interest is discussed and voted upon. The remaining members shall decide if a conflict exists. The member will abstain from voting on this issue if a conflict of interest is discovered. Form 990, Part VI, Section B, line 15 For purposes of determining compensation, Aspirus Keewenaw Hospital 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 committe, independent compensation consultant, written employment contract, compensation survery or study, and approval by the board or compensation committee. Form 990, Part VI, Section C, line 19 The organization has deemed that its governing documents, conflict of interest policy, and financial statements are the property of the organization and are not available for public inspection. Form 990, Part XI, line 9: Equity Transfer Aspirius, Inc. -7,793. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTE 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 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 260806447 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 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 Supporting Organization to Hospital and Lifeline Emergency Center MI 501(c)(3) Line 10 Aspirus Ironwood hospital & Clinics inc 1 Aspirus Inc 333 Pine Ridge Blvd wausau WI 54401 391328331 health care management system WI 501(c)(3) Line 12b, II N/A 0 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 inc 410 dewey street wisconsin rapids WI 54494 390868982 HOSPITAL WI 501(c)(3) Line 3 ASPIRUS INC 1 western upper michigan eye care llc 131 w genesee street iron river MI 49935 272324957 MI N/A Aspirus Keweenaw Enterprises Inc 205 Osceola Street Laurium MI 49913 383390273 Pharmacy MI aspirus keweenaw hospital C 1544105 1568683 1.00000 1 Aspirus Network Inc 3000 Westhill Drive 202 Wausau WI 54401 391931678 Health care services WI N/A C 1 0 0 0 1 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 aspirus wausau hospital inc J 118627 cost aspirus wausau hospital inc M 404521 cost aspirus wausau hospital inc O 3763290 cost aspirus wausau hospital inc P 70299 cost Aspirus inc M 7366118 cost aspirus inc O 248280 cost aspirus inc P 406734 cost Aspirus clinic inc O 156289 cost Aspirus clinic inc P 24983 cost aspirus ontonagon hospital inc L 114427 cost aspirus ontonagon hospital inc O 567939 cost aspirus ontonagon hospital inc Q 517109 cost ASPIRUS IRONWOOD HOSPITAL & CLINICS INC O 653622 cost ASPIRUS IRON RIVER HOSPITAL & CLINICS INC O 367898 cost schedule r, part v, line 1d all outstanding obligated group debt is guaranteed by all members of the obligated group.