2017-02-10T13:34:37-06:00 2016-06-30 390758449 Wipfli LLP PO Box 8010 Wausau WI 544028010 990 2015-07-01 382908586 Aspirus Grand View ASPI 9069322525 N10561 Grand View Lane Ironwood MI 49938 SHANE JACQUES Regional CFO 9069322525 2017-01-30 1 Kathleen J LaBrake CPA P00164006 7158453111 2017-01-30 2015 2021-01-29 14:40:06Z Shane Jacques 205 OSCEOLA LAURIUM MI 49913 60137937 0 X WWW.ASPIRUSGRANDVIEW.ORG X 1989 MI PROVISION OF HEALTH CARE SERVICES 12 5 499 62 14985 10171 8966 9377 53242083 58524239 -11460 229062 0 0 53239589 58762678 0 0 0 0 27374909 28343347 0 0 0 24002304 28486108 51377213 56829455 1862376 1933223 53270523 61560637 14299564 14633210 38970959 46927427 X ASPIRUS GRAND VIEW IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTHCARE SYSTEM WHICH LEADS BY ADVANCING INITITATIVES DEDICATED TO IMPROVING THE HEALTH OF ALL WE SERVE. WE WORK COLLABRATIVELY WITH OTHERS WHO SHARE OUR PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. 0 0 42736465 58509455 ASPIRUS GRAND VIEW 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 GRAND VIEW 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 GRAND VIEW 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 2014.ASPIRUS GRAND VIEW 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 GRAND VIEW PROVIDES THIS LOCAL, QUALITY HEALTH CARE TO MANY ELDERLY AND LOW INCOME INDIVIDUALS THAT ARE IN NEED OF HEALTH CARE. DURING FISCAL YEAR 2015, MORE THAN 67% OF THE HOSPITAL'S GROSS PATIENT SERVICE REVENUE WAS FROM BENEFICIARIES OF MEDICARE AND MEDICAID. 42736465 1 1 0 1 0 0 0 0 0 0 1 0 1 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 1 1 0 0 0 0 0 1 1 1 0 0 1 106 0 1 499 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 1 1 X SIDNEY SCZYGELSKI 7158472250 333 Pine Ridge Blvd Wausau WI 54401 JEFFREY NEHRING DDS Chairperson 1.00 X X 0 0 0 JOHN GARSKE VICE CHAIRPERSON 1.00 X X 0 0 0 Sara Lusignan Treasurer / VP OF FINANCE AI 1.00 41.00 X X 0 191644 27099 RICK NEVERS SECRETARY / SVP REG OPS SYSTEM INT OFFICER 1.00 50.00 X X 0 391429 71338 PAULA CHERMSIDE DIRECTOR/CEO 40.00 X X 235032 0 24778 RICHARD ARMSTRONG DIRECTOR 1.00 X 0 0 0 MARIA GULAN DIRECTOR 1.00 41.00 X 0 205283 47420 CHARLES IKNAYAN MD DIRECTOR 40.00 X 0 0 0 JAMES LORENSON DIRECTOR 1.00 X 0 0 0 CHRISTOPHER POGLIANO MD DIRECTOR 40.00 1.00 X 455470 0 25672 JACOB KEMPEN DIRECTOR 1.00 40.00 X 0 211928 36646 Kari Jacquart Director 1.00 X 0 0 0 MATT HEYWOOD CEO AI 1.00 50.00 X 0 884848 132937 SIDNEY C SCZYGELSKI CFO AI 1.00 50.00 X 0 580594 89459 CHUCK NELSON REGIONAL CEO - UP 1.00 41.00 X 0 353959 73509 SHANE JACQUES AKH CFO/ AGV CFO 12.00 28.00 X 0 211045 29665 GRACE TOUSIGNANT SVP 12.00 29.00 X 0 163844 22787 JOHN HEISLER SVP & CHIEF HR OFFICER 1.00 49.00 X 0 336213 63612 DEAN DANNER ACI President 1.00 48.00 X 0 333863 69073 MICHAEL MCGRAIL SYSTEM CMO 1.00 50.00 X 0 439142 69729 CARI LOGEMANN SVP & GENERAL COUNSEL 1.00 50.00 X 0 324135 70669 KATHRYNE MCGOWAN ANI EXECUTIVE DIRECTOR 1.00 50.00 X 0 288000 61581 RUTH RISLEY-GREY SVP & CNO 1.00 49.00 X 0 307360 65088 TODD RICHARDSON VP & CIO 1.00 50.00 X 0 334322 77297 NITIN NIGAM PHYSICIAN - AGV 40.00 X 525270 0 12357 ATHER MEHBOOB PHYSICIAN - AGV 40.00 X 502100 0 23801 ENRICO BRAUCHER PHYSICIAN - AGV 40.00 X 502359 0 37604 AJAY PURI RADIOLOGIST 40.00 X 500230 0 25551 DONNA CATALDO RADIOLOGIST 40.00 X 466663 0 3000 Duane L Erwin Former CEO AI 0.00 0.00 X 0 988906 1308 3187124 6546515 1161980 38 1 1 0 Aspirus Inc 425 Pine Ridge Beoulevard Wausau WI 544021395 Management Services 5763821 Miron Construction Co Inc PO Box 1372 Green Bay WI 543051372 Construction 4683408 aspirus wausau hospital inc 425 pine ridge beoulevard wausau WI 544021395 management services 3954767 MI Emergency Physicians PO Box 793 Traverse City MI 496850793 ER Physician Coverage 1694663 aspirus iron river hospital 1400 W Ice lake road iron river MI 49935 management services 975352 31 9377 9377 Net PATIENT SERVICE REVENUE 621990 55146164 55131179 14985 OTHER OPERATING REVENUE 900099 3116083 3116083 RELATED PARTY RENTAL 531120 210399 210399 Other non-operating revenue 900099 51593 51593 58524239 328200 328200 1276121 1375259 -99138 -99138 -99138 58762678 58509254 14985 229062 684126 439791 244335 22108446 18037083 4071363 773095 773095 3346709 1930032 1416677 1430971 1430971 5535517 2436896 3098621 26269 5050 21219 68748 68748 5310137 4732396 577741 207316 207316 787642 519950 267692 652734 652734 206302 98806 107496 146468 146468 118576 118576 2558975 1159273 1399702 177441 177441 Income tax expense -5659 -5659 MEDICAL SUPPLIES 8072838 7971781 101057 MISCELLANEOUS 2582745 1077230 1505515 QAAP Expenses 1766786 1766786 273273 216516 56757 56829455 42736465 14092990 0 587 440 5941414 8959948 13752989 7702831 1171428 1185111 1437718 555514 61808193 34116194 15841460 27691999 813771 925694 11237745 11347930 3073411 3191170 53270523 61560637 5461356 6515521 2923365 2905290 638224 255280 5276619 4957119 14299564 14633210 X 38086372 46042340 884587 885087 38970959 46927427 53270523 61560637 X 1933223 -261090 6284334 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 7215 7215 0 Part II-B, Line 1: ASPIRUS GRAND VIEW 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 GRAND VIEW THAT APPROXIMATELY $7,215 OF THE ANNUAL DUES WERE USED IN CONJUCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 285000 285000 28849403 13638118 15211285 1543484 52553 1490931 25499671 20425523 5074148 5630635 5630635 27691999 Under agreements for payroll liabilities 26258 F Deferred Compensation plan assets 3393307 F Funded depreciation investments 400000 F Investments in unconsolidated affiliates 1019972 F Investments - Program Related 6508393 F 11347930 Interest in net assets of supporting organiations 484587 Long term insurance receivable 611489 Estimated third-party payor settlements 1870095 GOODWILL & OTHER INTANGIBLES 224999 3191170 DEFERRED COMPENSATION 3393307 LONG-TERM INSURANCE LIABILITY 1562490 DUE TO OTHER 1322 4957119 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, 2016 AND 2015. 1 1 X 1 X 1 X 1 1 0 1 1 1528610 1528610 0.02690 10699733 3073834 7625899 0.13420 12228343 3073834 9154509 0.16110 57300 5700 51600 0.00090 16669 16669 0.00030 73969 5700 68269 0.00120 12302312 3079534 9222778 0.16230 3500 3500 0.00010 8000 8000 0.00010 11500 11500 0.00020 1 1056727 14863100 14929896 -66796 X 1 1 1 WESTERN UPPER MICHIGAN EYE CARE LLC EYE CLINIC 0.51000 0.00000 0.49000 1 1 ASPIRUS GRAND VIEW N10561 GRAND VIEW LANE IRONWOOD MI 49938 www.aspirusgrandview.org X X X X Aspirus Grand View 1 0 0 1 X X X X X X X X 15 1 1 0 1 X See Part V, Section B, Line 5d X X 1 15 1 http://aspirus.org/Main/Community-Resources.aspx?srcaud=Main 1 0 1 X 200.000000000000 300.000000000000 X X X 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 1 X X X X 1 X X 0 0 Aspirus Grand View Part V, Section B, Line 5: AS part of the Community Health Needs Assessment (CHNA) process, Aspirus Grand View 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 Grand View 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 Grand View Part V, Section B, Line 7d: The CHNA can be found on the hospital facility's website: http://aspirus.org/Uploads/Public/Documents/Comm-Benefit-Report-AGV.pdf Aspirus Grand View Part V, Section B, Line 11: See the attached implementation strategy for the significant identified needs and Aspirus Grand View's plan to address the identified needs. Aspirus Grand View Part V, Section B, Line 22d: Aspirus hospitals use the look-back method for determining Amount Generally Billed (AGB) percentages. Aspirus hospitals calculate one average AGB percentage for all emergency and medically necessary care provided by the hospital facility. Using allowed traditional Medicare claims for service dates July 1, 2015 to June 30, 2016. Patients approved for Aspirus Financial Assistance will not be charged more than this percentage of gross charges for emergent and medically necessary care. 4 2 - GRAND VIEW EYE CENTER E6112 BLUFF VIEW ROAD IRONWOOD MI 49938 EYE CLINIC 3 - GRAND VIEW SURGICAL CENTER E6112 BLUFF VIEW ROAD IRONWOOD MI 49938 SURGEON OFFICES 4 - ASPIRUS GRAND VIEW IRONWOOD CLINIC N10565 GRAND VIEW LANE IRONWOOD MI 49938 Provider based clinic 5 - ASPIRUS GRAND VIEW HURLEY CLINIC 501 GRANITE STREET HURLEY WI 54534 Provider based clinic Part I, Line 3c: The patient/guarantor, husband or wife, and dependents may not have property in excess of:Primary residence is exempt for patients under 200% federal poverty guidelines. For those over 200% equity allowance is $75,000 (financial statements and tax bills are required). Income producing land (e.g., dairy farm) is evaluated individually on a case-by-case basis. Cash assets in excess of $4,000 at the time of application. Specifically excluded from consideration are IRA and Pension Plans and Irrevocable Burial Trust Funds.Total net assets cannot exceed 800% of federal poverty guidelines. This includes all assets including cash assets above. Part I, Line 6a: ASPIRUS GRAND VIEW 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 Grand View 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 Grand View 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 Grand View to provide these services to the community regardless of a patient's ability to pay. Part II, Community Building Activities: ASPIRUS GRAND VIEW PROMOTES 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 GRAND VIEW PROMOTES 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 GRAND VIEW 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, 2014 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 GRAND VIEW 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 Grand View 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 GRAND VIEW. PATIENT FINANCIAL SERVICES PERSONNEL ARE AVAILABLE TO DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE PROCEDURES AND PROGRAMS WITH PATIENTS. ASPIRUS GRAND VIEW 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 GRAND VIEW SERVES 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 GRAND VIEW SERVES 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 GRAND VIEW HAS 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 GRAND VIEW CONTINUES 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 GRAND VIEW IS AN AFFILIATED HEALTH SYSTEM WHICH SERVES THE COMMUNITY SURROUNDING IRONWOOD, MICHIGAN. AFFILIATES OF ASPIRUS GRAND VIEW PROMOTE THE HEALTH OF THE COMMUNITY BY FULFILLING THEIR INDIVIDUAL MISSIONS. ASPIRUS GRAND VIEW 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 1 1 0 0 0 0 0 0 0 Sara Lusignan Treasurer / VP OF FINANCE AI 0 169081 0 10000 0 12563 0 0 0 27099 0 218743 0 0 RICK NEVERS SECRETARY / SVP REG OPS SYSTEM INT O 0 291780 0 68268 0 31381 0 18145 0 53193 0 462767 0 0 PAULA CHERMSIDE DIRECTOR/CEO 193348 0 26778 0 14906 0 10272 0 14506 0 259810 0 0 0 MARIA GULAN DIRECTOR 0 157186 0 29060 0 19037 0 10413 0 37007 0 252703 0 0 CHRISTOPHER POGLIANO MD DIRECTOR 435296 0 8000 0 12174 0 3000 0 22672 0 481142 0 0 0 JACOB KEMPEN DIRECTOR 0 176877 0 31283 0 3768 0 11740 0 24906 0 248574 0 0 MATT HEYWOOD CEO AI 0 649912 0 232922 0 2014 0 13360 0 119577 0 1017785 0 0 SIDNEY C SCZYGELSKI CFO AI 0 376534 0 157197 0 46863 0 18660 0 70799 0 670053 0 0 CHUCK NELSON REGIONAL CEO - UP 0 248933 0 62538 0 42488 0 17371 0 56138 0 427468 0 0 SHANE JACQUES AKH CFO/ AGV CFO 0 172833 0 31462 0 6750 0 7417 0 22248 0 240710 0 0 GRACE TOUSIGNANT SVP 0 138628 0 23939 0 1277 0 5725 0 17062 0 186631 0 0 JOHN HEISLER SVP & CHIEF HR OFFICER 0 256725 0 70436 0 9052 0 12179 0 51433 0 399825 0 0 DEAN DANNER ACI President 0 232445 0 63986 0 37432 0 17028 0 52045 0 402936 0 0 MICHAEL MCGRAIL SYSTEM CMO 0 370677 0 58414 0 10051 0 3750 0 65979 0 508871 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 253718 0 69397 0 1020 0 15593 0 55076 0 394804 0 0 KATHRYNE MCGOWAN ANI EXECUTIVE DIRECTOR 0 245256 0 41541 0 1203 0 4662 0 56919 0 349581 0 0 RUTH RISLEY-GREY SVP & CNO 0 237122 0 67504 0 2734 0 14872 0 50216 0 372448 0 0 TODD RICHARDSON VP & CIO 0 261084 0 71992 0 1246 0 18113 0 59184 0 411619 0 0 NITIN NIGAM PHYSICIAN - AGV 492890 0 25000 0 7380 0 3000 0 9357 0 537627 0 0 0 ATHER MEHBOOB PHYSICIAN - AGV 496928 0 0 0 5172 0 3000 0 20801 0 525901 0 0 0 ENRICO BRAUCHER PHYSICIAN - AGV 494978 0 0 0 7381 0 13250 0 24354 0 539963 0 0 0 AJAY PURI RADIOLOGIST 495337 0 -7500 0 12393 0 3000 0 22551 0 525781 0 0 0 DONNA CATALDO RADIOLOGIST 459663 0 0 0 7000 0 3000 0 0 0 469663 0 0 0 Duane L Erwin Former CEO AI 0 0 0 0 0 988906 0 0 0 1308 0 990214 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 $202, S. Lusignan $132, C. Pogliano $152, S. Sczygelski $166, C. Nelson $160, J. Heisler $184, D. Danner $105, K. McGowan $120, R. Risley-Grey $175, T. Richardson $105; M. Heywood $174. Gross-up Payments - C. Pogliano $5,022, P. Chermside $3.072, N. Nigam $380, A. Mehboob $5,022, E. Braucher $381, A.Puri $5,022. Housing Allowance - S. Lusignan $3,600, P. Chermside $4,833, M. McGrail $1,200 Part I, Line 1b ASPIRUS GRAND VIEW FOLLOWS THE COMPENSATION REVIEW PROCEDURES AND POLICIES OF ASPRIUS, INC. THE PHYSICIAN COMPENSATION OF ASPIRUS GRAND VIEW 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 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 4A - SEVERANCE PAYMENT: D. ERWIN - $67,610 Schedule J, Part I, Line 4B - Supplemental Nonqualified Retirement 457(f) distribution: R. Nevers $29,240 M. Gulan $16,394 S. Sczygelski $40,323 C. Nelson $35,744 D. Danner $31,730 D. ERWIN $921,521 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 0 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 Grand View (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, LINE 3A AND 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS GRAND VIEW, 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. Diana Lorenson Spouse of James Lorenson, Board director 19470 Employment Compensation 0 Northern Lower Peninsula Labs Corporation wholly owned by Charles Iknayan, MD, Board Director 292802 Payment for contracted pathology 0 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 effective july 1, 2015 aspirus, inc. became the sole corporate member of aspirus grand view. the by-laws were updated to reflect this change. 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 FROMULA 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 11 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 DTERMINED 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 GRAND VIEW RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABISHING 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 XI, line 9: Other changes in Net Assets 500. equity transfer- AGSC -932,010. equity transfer - cci 631,941. difference in fixed asset basis 6,183,903. Equity Transfers - AI 400,000. 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 GRAND VIEW SERVICE CORPORATION N10565 GRAND VIEW LANE IRONWOOD MI 49938 383005582 PHYSICIAN SERVICES MI 501(c)(3) Line 3 ASPIRUS GRAND VIEW 1 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 9 ASPIRUS GRAND VIEW 1 ASPIRUS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE SYSTEM MANAGEMENT WI 501(c)(3) Line 11b, 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 9 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501(c)(3) Line 9 ASPIRUS INC 1 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501(c)(3) Line 9 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 9 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501(c)(3) Line 9 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 GREATER IRON COUNTY EMS Inc 1400 W ICE LAKE RD IRON RIVER MI 49935 383236977 Emergency medical care and transportation MI 501(c)(3) Line 11a, I Aspirus Iron River Hospital & Clincs 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 GRAND VIEW RELATED 7236 112229 0 1 0.51000 ASPIRUS GRAND VIEW CARING CAREGIVERS INC N10561 GRAND VIEW LANE IRONWOOD MI 49938 382902754 PERSONAL NEEDS SERVICES MI ASPIRUS GRAND VIEW C 1.00000 1 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 0 1 0 0 0 0 1 0 0 1 1 1 1 0 1 1 ASPIRUS WAUSAU HOSPITAL P 200677 COST ASPIRUS WAUSAU HOSPITAL O 3396162 COST Aspirus Inc M 5535517 COST Aspirus Inc O 914137 COST Aspirus Inc P 252403 COST aspirus inc E 255280 cost aspirus Inc B 600000 cash aspirus inc C 1000000 cash aspirus Inc Q 86978 COST Aspirus Clinics Inc M 78551 COST ASPIRUS VNA HOME HEALTH INC O 59100 COST ASPIRUS VNA HOME HEALTH INC L 68222 COST Aspirus Iron River Hospital & Clinics Inc P 375000 COST ASPIRUS Keewenaw hospital inc O 295094 COST aspirus keewenaw hospital inc P 162847 cost ASPIRUS GRAND VIEW CARING CAREGIVERS INC C 932010 COST ASPIRUS GRAND VIEW SERVICE CORPORATION B 631941 COST