2018-04-04T17:37:28-05:00 2017-06-30 390758449 Wipfli LLP PO Box 8010 Wausau WI 544028010 990 2016-07-01 382908586 Aspirus Ironwood Hospital & Clinics Inc ASPI 9069322525 N10561 Grand View Lane Ironwood MI 49938 Sidney C Sczygelski CFO/SENIOR VP OF FINANCE 9069322525 2018-03-10 1 Kathleen J LaBrake CPA P00164006 7158453111 2018-03-10 50.50.56.238 2018-03-10 11:42:51 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FEDE6E2ED2B59B1C13DC36E78E84E5663127854C 2016 2021-01-29 14:40:06Z SIDNEY C SCZYGELSKI 2200 Westwood Drive Wausau WI 54401 64935858 0 X WWW.ASPIRUS.ORG X 1989 MI We heal people, promote health and strengthen communities. 12 5 457 72 10854 7242 9377 41760 58524239 63185333 229062 262727 0 0 58762678 63489820 0 0 0 0 28343347 28335255 0 0 0 28486108 32037643 56829455 60372898 1933223 3116922 61560636 75312267 14633209 24535586 46927427 50776681 X We heal people, promote health and strengthen communities. 1 0 45781258 63185333 ASPIRUS Ironwood Hospital and Clinics IS A 25-BED CRITICAL ACCESS HOSPITAL WHICH PROVIDES HEALTH CARE SERVICES TO RESIDENTS OF IRONWOOD, MICHIGAN AND ITS SURROUNDING COMMUNITIES. SOME OF THE SERVICES PROVIDED BEYOND TRADITIONAL INPATIENT HOSPITALIZATIONS INCLUDE SURGERY, EMERGENCY CARE, RADIOLOGY, LABORATORY, THERAPIES, EYE CARE, ONCOLOGY, SLEEP LAB, AND CARDIOLOGY, AMONG VARIOUS OTHER HEALTH CARE SERVICES.ASPIRUS Ironwood Hospital and Clinics PROVIDES HEALTH CARE SERVICES TO ALL PEOPLE, REGARDLESS OF THEIR ABILITY TO PAY. FOR THOSE INDIVIDUALS UNABLE TO PAY FOR THEIR HEALTH CARE NEEDS, ASPIRUS Ironwood Hospital and Clinics OFFERS SERVICES FOR FREE OR AT A REDUCED PRICE THROUGH THE FINANCIAL AID DISCOUNT POLICY. PLEASE REFER TO SCHEDULE H OF THE FORM 990 FOR ADDITIONAL INFORMATION ON THE COST OF FINANCIAL AID DISCOUNTS PROVIDED TO PATIENTS DURING FISCAL YEAR 2017.ASPIRUS Ironwood Hospital and Clinics ALSO PROVIDES HEALTH CARE SERVICES TO INDIVIDUALS COVERED UNDER GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID WHICH OFTEN REIMBURSE THE HOSPITAL AT AMOUNTS SUBSTANTIALLY LOWER THAN THE USUAL AND CUSTOMARY CHARGE. THOSE PEOPLE COVERED BY THESE TYPES OF PROGRAMS NEED ACCESS TO HEALTH CARE, BUT ARE OFTEN TIMES UNABLE TO TRAVEL LONG DISTANCES TO RECEIVE THIS CARE. ASPIRUS Ironwood Hospital and Clinics PROVIDES THIS LOCAL, QUALITY HEALTH CARE TO MANY ELDERLY AND LOW INCOME INDIVIDUALS THAT ARE IN NEED OF HEALTH CARE. DURING FISCAL YEAR 2017, MORE THAN 71.70% OF THE HOSPITAL'S GROSS PATIENT SERVICE REVENUE WAS FROM BENEFICIARIES OF MEDICARE AND MEDICAID. 45781258 1 1 0 1 0 0 0 0 0 0 1 0 1 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 1 0 0 0 0 0 1 1 1 0 0 1 81 0 1 457 1 1 1 0 0 0 0 0 0 0 0 0 X 12 5 0 0 1 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 JEFFREY NEHRING DDS Chairperson 1.00 0.00 X X 0 0 0 JOHN GARSKE VICE CHAIRPERSON 1.00 0.00 X X 0 0 0 Sara Lusignan Treasurer / VP OF FINANCE 1.00 41.00 X X 0 234937 40504 RICK NEVERS SECRETARY / SVP REG OPS SY 1.00 50.00 X X 0 381217 70836 PAULA CHERMSIDE DIRECTOR/CEO 40.00 0.00 X X 253795 0 25828 RICHARD ARMSTRONG termed 122016 DIRECTOR 1.00 0.00 X 0 0 0 MARIA GULAN DIRECTOR 1.00 41.00 X 0 203115 49939 CHARLES IKNAYAN MD DIRECTOR 1.00 0.00 X 0 0 0 JAMES LORENSON DIRECTOR 1.00 0.00 X 0 0 0 JACOB KEMPEN DIRECTOR 1.00 40.00 X 0 211424 39593 Kari Jacquart Director 1.00 0.00 X 0 0 0 Marcus Santini Director/Physician 40.00 0.00 X 293500 0 34272 PAUL ANDERSON DIRECTOR 1.00 0.00 X 0 0 0 Christopher Pogliano Term 082016 Board member/Physician 40.00 0.00 X 422736 0 27314 MATT HEYWOOD CEO AI 1.00 50.00 X 0 994138 146997 SIDNEY C SCZYGELSKI CFO AI 1.00 50.00 X 0 562384 93647 CHUCK NELSON REGIONAL CEO - UP 1.00 41.00 X 0 367059 75364 SHANE JACQUES REGIONAL CFO 12.00 28.00 X 0 213586 32961 GRACE TOUSIGNANT REGIONAL CNO 12.00 29.00 X 0 168141 24277 JOHN HEISLER SVP & CHIEF HR OFFICER 1.00 49.00 X 0 331227 67055 DEAN DANNER ACI President 1.00 48.00 X 0 367581 72374 MICHAEL MCGRAIL MD SYSTEM CMO 1.00 50.00 X 0 485324 82591 CARI LOGEMANN SVP & GENERAL COUNSEL 1.00 50.00 X 0 359569 76513 KATHRYNE MCGOWAN ANI EXECUTIVE DIRECTOR 1.00 50.00 X 0 309566 70073 RUTH RISLEY-GRAY SVP & CNO 1.00 49.00 X 0 347049 74562 TODD RICHARDSON VP & CIO 1.00 50.00 X 0 393488 80991 NITIN NIGAM PHYSICIAN - AIW 40.00 0.00 X 565775 0 25920 ATHER MEHBOOB PHYSICIAN - AIW 40.00 0.00 X 473367 0 24704 ENRICO BRAUCHER PHYSICIAN - AIW 40.00 0.00 X 572695 0 39296 DONNA CATALDO RADIOLOGIST 40.00 0.00 X 458203 0 3000 Daniel Lukes Physician 40.00 0.00 X 544114 0 19747 3584185 5929805 1298358 39 0 1 0 Miron Construction Co Inc PO Box 1372 Green Bay WI 543051372 Construction 8186624 Aspirus Inc 425 Pine Ridge Blvd Wausau WI 544021395 Management Services 7563056 aspirus wausau hospital inc 425 pine ridge blvd wausau WI 544021395 Lab & Management Services 4283403 MI Emergency Physicians PO Box 677979 Dallas TX 752677979 ER Physician Coverage 1565354 aspirus iron river hospital 1400 W Ice lake road iron river MI 49935 Physician Services 1558757 24 11760 30000 41760 Net PATIENT SERVICE REVENUE 621990 57266283 57255429 10854 OTHER OPERATING REVENUE 900099 5787419 5787419 RELATED PARTY RENTAL 531120 131341 131341 Other non-operating revenue 900099 290 290 63185333 251613 251613 1457152 1446038 11114 11114 11114 63489820 63174479 10854 262727 586874 381468 205406 22584526 19082143 3502383 950164 950164 2766989 1656514 1110475 1446702 1446702 7914082 3502522 4411560 45151 45151 27474 5500 21974 5722307 5281058 441249 213920 213920 869333 638121 231212 645948 645948 165980 75386 90594 149192 149192 63906 63906 3188451 988213 2200238 132986 132986 MEDICAL SUPPLIES 8480056 8365006 115050 MISCELLANEOUS 2204081 1057371 1146710 QAAP Expenses 2050321 2050321 REPAIRS AND MAINTENANCE 164455 151577 12878 60372898 45781258 14591640 0 440 2620 8959948 15106237 8516378 8204825 1185111 1312001 319962 233102 68194425 34595567 27692000 33598858 12273624 13556178 224999 236607 2388174 3061839 61560636 75312267 5571980 4165272 1263020 853247 2905290 2887217 255280 10445832 4637639 6184018 14633209 24535586 X 46042340 49861594 885087 915087 46927427 50776681 61560636 75312267 3116922 732332 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5703 5703 0 Part II-B, Line 1: ASPIRUS IRONWOOD HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND the MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND MHA HAVE NOTIFIED ASPIRUS IRONWOOD HOSPITAL & CLINICS THAT APPROXIMATELY $5,703 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 285000 285000 38533312 11924085 26609227 1912081 1075959 836122 26598821 21589035 5009786 865211 6488 858723 33598858 Under agreements for payroll liabilities 26298 F Deferred Compensation plan assets 4075567 F Investments in unconsolidated affiliates 1008219 F Investments - Program Related 8446094 F 13556178 DEFERRED COMPENSATION 4075567 LONG-TERM INSURANCE LIABILITY 434578 DUE TO OTHER 309216 Acc Insurance Deductibles 244450 Medicaid, Medicare & Blue Cross Payables 1120207 6184018 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 1 0 1 1 662689 662689 0.01100 11375921 6731798 4644123 0.07690 12038610 6731798 5306812 0.08790 79000 79000 0.00130 16945 16945 0.00030 95945 95945 0.00160 12134555 6731798 5402757 0.08950 3000 3000 0.00000 8000 8000 0.00010 11000 11000 0.00010 1 1071704 16430830 16625370 -194540 X 1 1 1 WESTERN UPPER MICHIGAN EYE CARE LLC EYE CLINIC 0.51000 0.00000 0.49000 1 1 ASPIRUS Ironwood Hospital & Clinics N10561 GRAND VIEW LANE IRONWOOD MI 49938 WWW.ASPIRUS.ORG X X X X Aspirus Ironwood Hospital & Clinics Inc 1 0 0 1 X X X X X X X X 15 1 1 0 1 X See Part V, Section B, Line 7d X X 1 15 1 http://aspirus.org/Main/Community-Resources.aspx?srcaud=Main 0 1 X 200.000000000000 300.000000000000 1 1 X X X 1 X http://aspirus.org/Main/Pay-My-Bill.aspx?srcaud=Main#tab2 X http://aspirus.org/Main/Pay-My-Bill.aspx?srcaud=Main#tab2 X http://aspirus.org/Main/Pay-My-Bill.aspx?srcaud=Main#tab2 X X X X X 1 X 0 X X X X 1 X 0 0 Aspirus Ironwood Hospital & Clinics, Inc. Part V, Section B, Line 5: AS part of the Community Health Needs Assessment (CHNA) process, Aspirus Ironwood Hospital and Clinics 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 our region and rural communities, from the underserved minorities to the general population. The steering committee issued a survey which was mailed to 8,000 households across the Western Upper Peninsula. A random 2,000 households of Gogebic County were also sent a survey. Five-hundred seventy-nine responses were returned, yielding a 32.5 percent survey response. As a whole, the survey produces an impressive 95 percent confidence level. Aspirus Ironwood Hospital & Clinics, Inc. Part V, Section B, Line 6a: The Community Health Needs Assessment was conducted in joint effort with the following other hospitals:- Aspirus Ontonagon Hospital, Inc.- U.P. Health System - Portage- Baraga County Memorial Hospital- Aspirus Keweenaw Hospital Aspirus Ironwood Hospital & Clinics, Inc. Part V, Section B, Line 7d: The CHNA can be found on the hospital facility's website: http://aspirus.org/Uploads/Public/Documents/AGV/Aspirus%20Ironwood%20Community%20Health%20Needs%20Assessment%202016.pdf Aspirus Ironwood Hospital & Clinics, Inc. Part V, Section B, Line 11: See the attached implementation strategy for the significant identified needs and Aspirus Ironwood Hospital and Clinics's plan to address the identified needs. PART V, SECTION B, LINE 16(I) THE FAP PLAIN LANGUAGE SUMMARY AND 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. 4 2 - Aspirus EYE CENTER E6112 BLUFF VIEW ROAD IRONWOOD MI 49938 EYE CLINIC 3 - Aspirus SURGICAL CENTER E6112 BLUFF VIEW ROAD IRONWOOD MI 49938 SURGEON OFFICES 4 - ASPIRUS IRONWOOD CLINIC N10565 GRAND VIEW LANE IRONWOOD MI 49938 Provider based clinic 5 - ASPIRUS HURLEY CLINIC 501 GRANITE STREET HURLEY WI 54534 Provider based clinic Part I, Line 6a: ASPIRUS IRONWOOD HOSPITAL & CLINICS PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE MICHIGAN HOSPITAL ASSOCIATION (MHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC THROUGH MHA'S DATABASE AND WEBSITE. 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 SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FROM THE FORM 990. Part I, Line 7g: Subsidized health services at Aspirus Ironwood Hospital & Clinics include the operation of the hospital's inpatient medical/surgical nursing unit as well as the intensive care unit. The hospital inpatient and intensive care units operate 24 hours per day seven days per week and are staffed by a group of highly trained nursing staff including registered nurses, licensed practical nurses, and other support staff. Many of the admissions to the hospital inpatient and intensive care units come from the hospital's emergency department which is operated to provide emergency care to patients of the community and surrounding areas. These subsidized health services work in support and cooperation with the combined efforts of Aspirus Ironwood Hospital & Clinics and share many support functions of the hospital in an effort to provide excellent low cost care to patients in their local community and area. A significant payor for these programs is the Medicare program which does not reimburse the hospital for these services in all cases based on cost so a significant loss is absorbed by the hospital to provide these services to members of the community. It is the goal of Aspirus Ironwood Hospital & Clinics to provide these services to the community regardless of a patient's ability to pay. Part II, Community Building Activities: ASPIRUS IRONWOOD HOSPITAL & CLINICS PROMOTE THE HEALTH OF THE COMMUNITY BY ALLOCATING TIME AND FUNDING INTO DEVELOPING PROGRAMS THAT FOCUS ON HEALTHY LIFESTYLES FOR FAMILIES AND INDIVIDUALS. COALITION BUILDING IS A LARGE PART OF THIS. THROUGH COALITIONS SUCH AS INTEGRATED FAMILY SERVICES and a substance abuse network, ASPIRUS IRONWOOD HOSPITAL & CLINICS PROMOTE HEALTHY BEHAVIORS AND REGULAR PHYSICAL ACTIVITY. ECONOMIC DEVELOPMENT IS PROMOTED THROUGH COLLABORATION WITH LOCAL CHAMBERS OF COMMERCE AND KIWANIS. Part III, Line 4: Patient Accounts Receivable and Credit Policy: 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 ORGANIZATION 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 SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULES AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND SURGICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND THEREFORE THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ASPIRUS Ironwood Hospital & Clinics PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2017 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). Part III, Line 9b: PATIENT FINANCIAL SERVICES (PFS) PROACTIVELY IDENTIFIES UNINSURED PATIENTS AND UNDER-INSURED PATIENTS AND SCREENS THEM FOR FINANCIAL ASSISTANCE AND COUNSELING WITHOUT REGARD TO RACE, ETHNICITY, GENDER, RELIGION, OR NATIONAL ORIGIN. THESE SERVICES ARE PROVIDED AT NO CHARGE. PFS COUNSELORS WORK WITH UNINSURED AND UNDER-INSURED PATIENTS TO HELP THEM UNDERSTAND THE SYSTEM'S FINANCIAL ASSISTANCE/DISCOUNTING POLICIES AND HOW THEY CAN QUALIFY FOR ASSISTANCE AND/OR DISCOUNTS INCLUDING A REFERRAL TO PUBLIC AND PRIVATE PROGRAMS TO DETERMINE ELIGIBILITY. Part VI, Line 2: ASPIRUS IRONWOOD HOSPITAL & CLINICS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY EXAMINING THE NEEDS OF THE PATIENT. THIS IS DONE THROUGH ANALYSIS OF PATIENT VOLUMES IN DEPARTMENTS, SPECIALISTS, AND THE DIFFERENT CLINIC LOCATIONS WITHIN THE Organization'S AREAS OF SERVICE. INFORMATION IS ALSO GATHERED DIRECTLY FROM THE PATIENTS TO SEE WHAT AREAS THEY WOULD LIKE TO SEE ADDITIONAL SUPPORT. INFORMATION REGARDING THE NEEDS OF THE GENERAL COMMUNITY IS OBTAINED FROM THE MICHIGAN HOSPITAL ASSOCIATION AND THE WISCONSIN HOSPITAL ASSOCIATION AND ANALYZED FOR POTENTIAL NEW SERVICE AREAS. Aspirus Ironwood Hospital & Clinics also recently collaborated with other area hospitals to complete a community health needs assessment (CHNA). The CHNA is an important tool in identifying the health needs of the community and results of the project assist in prioritizing health needs that lead to the allocation of appropriate resources and the creation of new partnerships to improve the health of the population. Part VI, Line 3: A SUMMARY OF FINANCIAL ASSISTANCE CONTACT INFORMATION IS AVAILABLE IN THE FORM OF A BROCHURE IN THE WAITING AREAS THROUGHOUT ASPIRUS IRONWOOD HOSPITAL & CLINICS. PATIENT FINANCIAL SERVICES PERSONNEL ARE AVAILABLE TO DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE PROCEDURES AND PROGRAMS WITH PATIENTS. ASPIRUS IRONWOOD HOSPITAL & CLINICS ALSO HAS A SECTION ON ITS WEBSITE THAT PROVIDES CONTACT INFORMATION FOR FINANCIAL ASSISTANCE FOR THOSE HAVING DIFFICULTY MEETING THEIR FINANCIAL OBLIGATIONS. Part VI, Line 4: THE COMMUNITIES THAT ASPIRUS IRONWOOD HOSPITAL & CLINICS SERVE COVER AN APPROXIMATE 50-MILE RADIUS SURROUNDING THE IRONWOOD, MICHIGAN AREA. THIS AREA INCLUDES PORTIONS OF THE UPPER PENINSULA GOGEBIC COUNTY, UP TO THE ONTONAGON COUNTY REGION, INTO WISCONSIN COVERING IRON COUNTY, PARTS OF ASHLAND COUNTY, AND PARTS OF VILAS COUNTY. THE GEOGRAPHIC AREA THAT ASPIRUS IRONWOOD HOSPITAL & CLINICS SERVE INCLUDES AN ECONOMICALLY DEPRESSED AREA THAT IS BASED ON A MAJORITY OF FAMILIES THAT DO NOT HAVE HEALTH INSURANCE, OR THAT ARE UTILIZING MEDICAID. Part VI, Line 5: ASPIRUS IRONWOOD HOSPITAL & CLINICS HAVE NUMEROUS CONTINUING EDUCATION EVENTS THAT ARE SET UP TO HELP IMPROVE THE MEDICAL CARE AND KNOWLEDGE OF THE LOCAL POPULATION. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. ASPIRUS IRONWOOD HOSPITAL & CLINICS CONTINUE TO REINVEST IN EQUIPMENT, TRAINING, AND RESEARCH AREAS IN ORDER TO IMPROVE PATIENT CARE IN THE COMMUNITIES THAT IT SERVES, AS WELL AS PROVIDING RESEARCH TO HELP THE LOCAL COMMUNITIES. Part VI, Line 6: ASPIRUS IRONWOOD HOSPITAL & CLINICS IS AN AFFILIATED HEALTH SYSTEM WHICH SERVES THE COMMUNITY SURROUNDING IRONWOOD, MICHIGAN. AFFILIATES OF ASPIRUS IRONWOOD HOSPITAL & CLINICS PROMOTE THE HEALTH OF THE COMMUNITY BY FULFILLING THEIR INDIVIDUAL MISSIONS. ASPIRUS IRONWOOD HOSPITAL & CLINICS PROVIDES PHYSICIAN SERVICES IN AN OUTPATIENT CLINIC. ASPIRUS Ironwood Hospital & Clinics, Inc. IS ALSO AN AFFILIATE OF ASPIRUS, INC. ASPIRUS IS AN INTERGRATED, COMMUNITY-GOVERNED HEALTH CARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES DEDICATED TO IMPROVING THE HEALTH OF ALL WE SERVE. WE WORK COLLABORATIVELY WITH OTHERS WHO SHARE OUR PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. Part VI, Line 7, Reports Filed With States MI X X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 Sara Lusignan Treasurer / VP OF FINANCE 0 205193 0 29064 0 680 0 4469 0 36035 0 275441 0 0 RICK NEVERS SECRETARY / SVP REG OPS SY 0 287340 0 59975 0 33902 0 18830 0 52006 0 452053 0 0 PAULA CHERMSIDE DIRECTOR/CEO 192201 0 47334 0 14260 0 10808 0 15020 0 279623 0 0 0 MARIA GULAN DIRECTOR 0 166377 0 19924 0 16814 0 11054 0 38885 0 253054 0 0 JACOB KEMPEN DIRECTOR 0 180588 0 27013 0 3823 0 12066 0 27527 0 251017 0 0 Marcus Santini Director/Physician 283045 0 0 0 10455 0 8084 0 26188 0 327772 0 0 0 Christopher Pogliano Term 082016 Board member/Physician 400291 0 11724 0 10721 0 3000 0 24314 0 450050 0 0 0 MATT HEYWOOD CEO AI 0 734056 0 257815 0 2267 0 18830 0 128167 0 1141135 0 0 SIDNEY C SCZYGELSKI CFO AI 0 441313 0 93183 0 27888 0 18830 0 74817 0 656031 0 0 CHUCK NELSON REGIONAL CEO - UP 0 258636 0 66258 0 42165 0 17949 0 57415 0 442423 0 0 SHANE JACQUES REGIONAL CFO 0 176023 0 30875 0 6688 0 7481 0 25480 0 246547 0 0 GRACE TOUSIGNANT REGIONAL CNO 0 142421 0 24657 0 1063 0 5885 0 18392 0 192418 0 0 JOHN HEISLER SVP & CHIEF HR OFFICER 0 265586 0 56537 0 9104 0 13026 0 54029 0 398282 0 0 DEAN DANNER ACI President 0 281530 0 50514 0 35537 0 17796 0 54578 0 439955 0 0 MICHAEL MCGRAIL MD SYSTEM CMO 0 382842 0 81065 0 21417 0 11948 0 70643 0 567915 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 295196 0 63114 0 1259 0 18556 0 57957 0 436082 0 0 KATHRYNE MCGOWAN ANI EXECUTIVE DIRECTOR 0 253530 0 54574 0 1462 0 12888 0 57185 0 379639 0 0 RUTH RISLEY-GRAY SVP & CNO 0 263353 0 56735 0 26961 0 17865 0 56697 0 421611 0 0 TODD RICHARDSON VP & CIO 0 284010 0 61187 0 48291 0 18830 0 62161 0 474479 0 0 NITIN NIGAM PHYSICIAN - AIW 517475 0 36875 0 11425 0 3000 0 22920 0 591695 0 0 0 ATHER MEHBOOB PHYSICIAN - AIW 461942 0 0 0 11425 0 3000 0 21704 0 498071 0 0 0 ENRICO BRAUCHER PHYSICIAN - AIW 549656 0 11614 0 11425 0 13250 0 26046 0 611991 0 0 0 DONNA CATALDO RADIOLOGIST 451203 0 0 0 7000 0 3000 0 0 0 461203 0 0 0 Daniel Lukes Physician 496524 0 42019 0 5571 0 3000 0 16747 0 563861 0 0 0 Part I, Line 1a Companion travel, Gross-up payments and housing allowance, when applicable, were added to the individual's compensation at fair market value. Companion Travel - R. Nevers $206, S. Lusignan $149, S. Sczygelski $188, C. Nelson $188, J. Heisler $181, D. Danner $184, K. McGowan $199, R. Risley-Gray $152, M. Heywood $188. Gross-up Payments - P. Chermside $2,706, N. Nigam $4,425, E. Braucher $4,425, M. Santini $3,455, C. Pogliano $4,425 and D. Lukes $3,455. Housing Allowance - P. Chermside $4,499. Part I, Line 1b ASPIRUS IRONWOOD HOSPITAL & CLINICS FOLLOWS THE COMPENSATION REVIEW PROCEDURES AND POLICIES OF ASPRIUS, INC. THE PHYSICIAN COMPENSATION OF ASPIRUS IRONWOOD HOSPITAL & CLINICS ALSO IS REVIEWED BY A COMMITTEE WHICH ALSO INCLUDES A REPRESENTATIVE FROM ASPIRUS, INC. TO PROVIDE ADDITIONAL ADMINISTRATIVE REVIEW AND SUPPORT TO THE COMPENSATION REVIEW PROCESS. Part I, Line 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS Ironwood HOSPITAL & Clinics, 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, Line 4b Schedule J, Part I, Line 4B - Supplemental Nonqualified Retirement 457(f) distribution: R. Nevers $31,318 M. Gulan $15,854 S. Sczygelski $20,721 C. Nelson $33,594 D. Danner $30,171 R. Risley-Gray $24,196 T. Richardson $47,095 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 WI Health & Education Facilities Authority 391337855 97710b7x4 2013-04-12 2998547 Construct, renovate, and equip facilities 0 0 0 A 2998547 2015 0 0 1 1 A 0 0 1 0 0 0.00030 0.00030 0 0 1 A 0 0 1 1 0 0 0 0 0 A 1 Date Rebate Computation Performed Issuer Name: WI Health & Education Facilities Authority Date the Rebate Computation was Performed: 06/19/2015 Form Part VI The proceeds of the Wisconsin Health and Educational Facilities Authority Revenue Bonds, Series 2013 (Aspirus, Inc. Obligated Group) were borrowed by the following organizations: Aspirus Wausau Hospital, Inc. (EIN 39-1138241); Aspirus Medford Hospital & Clinics, Inc. (EIN 39-0964813); Aspirus Ironwood Hospital & Clinics, Inc. (EIN 38-2908586); and Langlade Hospital Hotel Dieu of St. Joseph of Antigo Wisconsin (EIN 39-0806429). Information regarding the Series 2013 Bonds is reported in the Schedule K for each organization. [The information reported in Part I, Part II and Part III relates only to the portion of the Series 2013 Bonds loaned to the Organization. The information reported in Part IV relates to the entire issue of the Series 2013 Bonds.] Part III, Lines 3A and 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS Ironwood Hospital & Clinics, 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 tax exempt bonds: Policy states that we will seek bond counsel opinion on all remedial actions. Diana Lorenson Spouse of James Lorenson, Board director 24650 Employment Compensation 0 Northern Lower Peninsula Labs Corporation wholly owned by Charles Iknayan, MD-Board Director 71545 Payment for contracted Pathology 0 Coleman Engineering Co Company employs Paul Anderson - Board Director 2200 Payment for Engineering Services 0 Form 990, Part III, line 2 New programs in FY 2017 include Wound Care, ENT, and Urology. There was also a mental health expansion which includes a Psychiatrist. Form 990, Part VI, Section A, line 1 THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE WHICH CONSISTS OF THE CHAIRPERSON, VICE CHAIRPERSON, SECRETARY, TREASURER, PAST CHAIRPERSON, AND CEO. THIS COMMITTEE HAS THE POWER TO ACT ON BEHALF OF THE ORGANIZATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD, SUBJECT TO ANY PRIOR AUTHORIZATION GRANTED BY THE BOARD. Form 990, Part VI, Section A, line 4 Aspirus Ironwood Hospital & Clinics, Inc., formerly known as Aspirus Grand View, changed its name during fiscal year 2017 and as a result updated its governing documents since filing the 2015 tax return. 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 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 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, OFFICERS 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 ORGANIZATIONS'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 IRONWOOD HOSPITAL & CLINICS 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 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. GRAND VIEW HOSPITAL AUXILIARY N10561 GRAND VIEW LANE IRONWOOD MI 49938 237178363 SUPPORTING ORGANIZATION OF THE HOSPITAL AND LIFELINE EMERGENCY SYSTEM MI 501(c)(3) Line 10 ASPIRUS Ironwood Hospital & Clinics Inc 1 ASPIRUS INC 425 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 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 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 IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE RD IRON RIVER MI 49935 383236977 HOSPITAL MI 501(c)(3) Line 3 ASPIRUS 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 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 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI ASPIRUS Ironwood Hospital & Clinics INC RELATED -6505 105724 0 1 0.51000 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 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 1 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 ASPIRUS WAUSAU HOSPITAL P 152457 COST ASPIRUS WAUSAU HOSPITAL O 3690568 COST Aspirus Inc M 7957946 COST Aspirus Inc O 1136919 COST Aspirus Inc P 301191 COST aspirus Inc Q 64812 COST Aspirus Iron River Hospital & Clinics Inc P 402210 COST ASPIRUS Keewenaw hospital inc O 653622 COST Schedule R, Part V, Line 1D All outstanding obligated group debt is guaranteed by all members of the obligated group.