2015-05-13T10:00:46-05:00 2014-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2013-07-01 381443361 ASPIRUS KEWEENAW HOSPITAL ASPI 9063376500 205 OSCEOLA LAURIUM MI 49913 CHUCK NELSON CEO 9063376500 2015-05-11 1 TERRI REXRODE CPA MST P00096513 9206620016 2015-05-11 2013 2016-04-25 22:37:26Z CHUCK NELSON 205 OSCEOLA STREET LAURIUM MI 49913 42725162 0 X WWW.ASPIRUSKEWEENAW.ORG X 1939 MI ASPIRUS KEWEENAW HOSPITAL PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL AND PHYSICIAN CLINIC SERVICES. 14 6 448 97 -695 -695 48379 37883 39922092 37698743 153578 528184 114713 2575013 40238762 40839823 0 0 0 0 22886026 24282960 0 0 0 15264587 15862376 38150613 40145336 2088149 694487 29541483 32573455 9479565 11664523 20061918 20908932 TO PROVIDE COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, AND PHYSICIAN CLINIC SERVICES. 0 0 34959790 37527209 ASPIRUS KEWEENAW HOSPITAL PROVIDES COMPREHENSIVE INPATIENT, OUTPATIENT, EMERGENCY, MEDICAL, AND PHYSICIAN CLINIC SERVICES. 34959790 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 1 0 0 1 89 0 1 448 1 1 1 0 0 0 0 0 0 0 0 0 X 14 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHUCK NELSON 9063376500 205 OSCEOLA STREET LAURIUM MI 49913 DANIEL DALQUIST CHAIRMAN 0.50 1.00 X X 0 0 0 EDWARD JENICH VICE CHAIRMAN 0.50 1.00 X X 0 0 0 DAVID GILBERT MD SECRETARY 0.50 1.00 X X 0 0 0 MATTHEW HEYWOOD BOARD MEMBER & PRESIDENT/CEO OF ASPIRUS, INC. 0.50 39.50 X 0 340183 62474 CHUCK NELSON BOARD MEMBER & ASPIRUS UP REGIONAL CEO 24.00 17.00 X X 0 291946 67232 SANDRA HUUKI BOARD MEMBER 0.50 1.00 X 0 0 0 DARRELL LENTZ BOARD MEMBER & PRESIDENT OF ASPIRUS WAUSAU HOSPITA 0.50 39.50 X 0 262768 54894 JERRY LUOMA MD BOARD MEMBER & MEDICAL DIRECTOR 20.00 1.00 X 99826 0 34277 MICHAEL LUOMA MD BOARD MEMBER & CHIEF OF STAFF 40.00 X 220536 0 46094 RICK NEVERS BOARD MEMBER & SR VP OF REGIONAL OPERATIONS 0.50 39.50 X 0 262069 66517 MARIANA PERINOT MD BOARD MEMBER & MEDICAL STAFF REP 40.00 X 118290 0 4508 DARRYL PIERCE BOARD MEMBER 0.50 1.00 X 0 0 0 DALE R TAHTINEN BOARD MEMBER 0.50 1.00 X 0 0 0 JOEL TUORINIEMI BOARD MEMBER 0.50 1.00 X 0 0 0 DUANE ERWIN FORMER BOARD MEMBER & PRESIDENT/CEO OF ASPIRUS, IN 0.50 39.50 X 0 781943 138308 MICHAEL HAUSWIRTH COO 40.00 X 198628 0 42292 SHANE JACQUES CFO 40.00 X 24201 0 3332 GRACE TOUSIGNANT CNO 40.00 X 149392 0 33602 FREDERICK RAU ORTHOPEDIC SURGEON 40.00 X 442782 0 44474 KENNETH PHERSON ORTHOPEDIC SURGEON 40.00 X 374579 0 16706 BONNIE HAFEMAN PHYSICIAN 40.00 X 363639 0 43896 JOHN NOVOSAD ANESTHESIOLOGIST 40.00 X 291978 0 24972 JAMES BLACK ED PHYSICIAN 40.00 X 304980 0 52490 2588831 1938909 736068 31 0 1 0 MIRON CONSTRUCTION CO INC PO BOX 1372 GREEN BAY WI 54305 CONSTRUCTION SERVICES 4382652 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CONTRACTED PROVIDERS 684482 COAST TO COAST HEALTH CARE 5195 HAMPSTED VILLAGE CENTER SUITE NEW ALBANY OH 43054 CONTRACTED PROVIDERS 430775 CHG COMPANIES INC 6440 SOUTH MILLROCK DRIVE SUITE 175 SALT LAKE CITY UT 84121 CONTRACTED PROVIDERS 329540 MARK R SHEBUSKI MD PC 301 W LAKE AVENUE HOUGHTON MI 49931 PROVIDER SERVICES & BUILDING 304584 9 7956 29927 37883 NET PATIENT SERVICE REVENUE 621990 37527209 37527209 CAFETERIA REVENUE 624200 109808 109808 MEDICAL OFFICE RENTAL 900099 51050 51050 VENDING REVENUE 624200 10676 10676 37698743 219551 219551 123158 116054 7104 7104 -695 7799 1973502 104416 1602706 166579 370796 -62163 308633 308633 340B REVENUE 999999 2212189 2212189 OTHER REVENUE 999999 355720 355720 2567909 40839823 37527209 -695 3275426 X 1190485 706525 483960 17317208 15774838 1542370 592875 528001 64874 3915484 3487389 428095 1266908 1128279 138629 78371 78371 83525 83525 19299 19299 4409903 3721517 688386 238498 28489 210009 4374118 4280028 94090 139031 75313 63718 493193 493193 239959 168872 71087 123879 123879 1033724 940656 93068 97122 91492 5630 EQUIPMENT RENTAL AND MA 1996589 1785484 211105 PROVISION FOR BAD DEBTS 1381121 1381121 DUES AND SUBSCRIPTIONS/ 1022288 119217 903071 RECRUITMENT EXPENSE 119390 119390 12366 6107 6259 40145336 34959790 5185546 0 1024969 218165 9062674 7002868 4555966 4285153 431100 392746 847336 926915 28937914 16024707 7103617 12913207 3054478 2317190 1412643 1505234 91833 0 1956867 3011977 29541483 32573455 3701434 4955498 3655860 6337654 2122271 371371 9479565 11664523 X 19805016 20908932 256902 0 20061918 20908932 29541483 32573455 694487 152527 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 7765 7765 0 PART II-B, LINE 1: ORGANIZATION HAS INDIRECT LOBBYING ACTIVITIES THROUGH THE PAYMENT OF HOSPITAL ASSOCIATION DUES. 871587 871587 18355354 10857174 7498180 8616133 5167533 3448600 1094840 1094840 12913207 DUE FROM ASPIRUS KEWEENAW ENTERPRISES 1270359 DUE FROM ASPIRUS KEWEENAW FOUNDATION 9818 NOTE RECEIVABLE 892500 DUE FROM OTHER ENTITIES 26274 THIRD PARTY RECEIVABLES 813026 3011977 LONG TERM INSURANCE PAYABLE 291371 ASBESTOS LIABILITY 80000 371371 X 39396080 -1384680 -1384680 40780760 19299 39764 59063 40839823 38701593 -39764 -39764 38741357 19299 1384680 1403979 40145336 PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2014 OR 2013. FEDERAL RETURNS FOR THE YEAR ENDED JUNE 30, 2011, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 109,262. BAD DEBT EXPENSE -1,381,121. RECRUITMENT EXPENSE -112,821. PART XI, LINE 4B - OTHER ADJUSTMENTS: DONATIONS 39,764. PART XII, LINE 2D - OTHER ADJUSTMENTS: DONATIONS -39,764. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE -109,262. BAD DEBT EXPENSE 1,381,121. RECRUITMENT EXPENSE 112,821. 1 1 1 X 1 X 1 1 1 0 0 289988 289988 0.00760 5069979 3669655 1400324 0.03660 5359967 3669655 1690312 0.04420 102396 102396 0.00270 26014 26014 0.00070 128410 128410 0.00340 5488377 3669655 1818722 0.04760 1 1087970 12709933 12891366 -181433 X 1 1 1 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 WWW.ASPIRUSKEWEENAW.ORG 1060000151 X X X X ASPIRUS KEWEENAW HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X SEE PART V FOR FULL ADDRESS X X X X X X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X 1 0 1 X X 0 0 ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 3: SURVEY BY MAIL AND PARTICIPATION IN REGIONAL HEALTH ASSESSMENTS WITH OTHER HOSPITALS AND AGENCIES. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 4: WESTERN UPPER PENINSULA HEALTH DEPARTMENT, ASPIRUS GRAND VIEW, ASPIRUS ONTONAGON BARAGA COUNTY MEMORIAL HOSPITAL, PORTAGE HEALTH, COPPER COUNTY MEMORIAL HEALTH SERVICES. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 7: THE HOSPITAL HAS SUCCESSFULLY ADDRESS ALL ITEMS IDENTIFIED IN THE CHNA EXCEPT ONE. THIS IS MAINTAINING A ONE-ON-ONE HYPERTENSION CLINIC. THE NURSE PRACTITIONER SUPPORTING THE EFFORT IS NO LONGER WITH THE ORGANIZATION. THE CLINIC MANAGERS HAVE BEEN IN THE PROCESS OF WORKING WITH OTHER STAFF TO FILL GAPS AND ADDRESS THE NEEDS OF THE HYPERTENSION CLINIC. THE HOSPITAL EXPECTS SOLUTIONS AND SUPPORT OF THE CLINIC IN FALL OF 2015. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 14G: 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. ASPIRUS KEWEENAW HOSPITAL PART V, SECTION B, LINE 20D: THE AMOUNTS CHARGED ARE BASED ON FPL LEVEL. THIS IS DISCOUNTED USING AVERAGE AMOUNTS PAID BY COMMERCIALLY INSURED AND MEDICARE PATIENTS. PART V, SECTION B, LINE 5A HOSPTIAL WEB ADDRESS TO LOCATE CHNA: HTTP://ASPIRUS.ORG/MAIN/COMMUNITY-RESOURCES.ASPX 5 ASPIRUS HOUGHTON CLINIC 1000 CEDAR STREET HOUGHTON MI 49931 CLINIC ASPIRUS KEWEENAW OUTPATIENT THERAPIES 342 HECLA STREET LAURIUM MI 49913 OUTPATIENT THERAPY LAURIUM WELLNESS 300 HECLA STREET LAURIUM MI 49913 CLINIC ASPIRUS KEWEENAW LAKE LINDEN CLINIC 110 CALUMET STREET LAKE LINDEN MI 49945 CLINIC ASPIRUS KEWEENAW FASTCARE 9900 MEMORIAL ROAD HOUGHTON MI 49931 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 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,936,589. 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.THE HOSPITAL ESTIMATES THAT APPROXIMATELY 56% OF BAD DEBT EXPENSE DURING FY2014 WAS ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY THAT DID NOT COMPLETE THE APPLICATION PROCESS.THE ORGANIZATION BELIEVES THIS SHOULD BE CHARITY CARE BECAUSE IF THE PROPER APPLICATION WOULD HAVE BEEN COMPLETED, THIS AMOUNT WOULD HAVE BEEN APPROPRIATELY RECORDED. 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: UNDER THE ORGANIZATION'S COLLECTION AND CHARITY CARE POLICIES, ASPIRUS KEWEENAW HOSPITAL MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATION'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE.ASPIRUS KEWEENAW HOSPITAL WILL PROVIDE MEDICALLY ACUTE SERVICES TO PATIENTS WHO MEET THE CRITERIA OF THE PATIENT FINANCIAL ASSISTANCE PROGRAM WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES FOR QUALIFYING PATIENTS. THIS PROGRAM IS PROVIDED FOR PATIENTS WHO ARE UNINSURED, UNDERINSURED, AND/OR MEDICALLY INDIGENT. PATIENTS AND THEIR FAMILIES HAVE A RESPONSIBILITY TO HELP THE HOSPITAL QUALIFY THEM FOR THE APPROPRIATE LEVEL OR TYPE OF FINANCIAL ASSISTANCE GIVEN THEIR CIRCUMSTANCES.DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM.AN ACCOUNT WILL BE CONSIDERED DELINQUENT IF ADEQUATE AND TIMELY PAYMENTS ARE NOT MADE AND/OR THERE IS A LACK OF COMMUNICATION FROM THE PATIENT/FAMILY:1.) 60 DAYS AFTER BALANCE BECOMES THE RESPONSIBILITY OF THE PATIENT/GUARANTOR. 2.) IF A PATIENT/GUARANTOR REFUSES TO PAY AN ACCOUNT WITHOUT VALID REASON. 3.) STATEMENTS ARE MAIL-RETURNED AND THE PATIENT/GUARANTOR CANNOT BE LOCATED. 4.) A PATIENT/GUARANTOR ACCOUNT HISTORY SHOWS THE DEBT IS UNLIKELY TO BE PAID. 5.) ACCOUNT PAYMENTS ARE INADEQUATE FOR THE BALANCE AND AGE OF ACCOUNT. 6.) THE PATIENT/GUARANTOR STOPS MAKING SCHEDULED PAYMENTS. 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: ASPIRUS KEWEENAW HOSPITAL WILL PROVIDE MEDICALLY ACUTE SERVICES TO PATIENTS WHO MEET THE CRITERIA OF THE PATIENT FINANCIAL ASSISTANCE PROGRAM (PFAP) WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES FOR QUALIFYING PATIENTS. THIS PROGRAM IS PROVIDED FOR PATIENTS WHO ARE UNINSURED, UNDERINSURED, AND/OR MEDICALLY INDIGENT. PATIENTS AND THEIR FAMILIES HAVE A RESPONSIBILITY TO HELP THE HOSPITAL QUALIFY THEM FOR THE APPROPRIATE LEVEL OR TYPE OF FINANCIAL ASSISTANCE GIVEN THEIR CIRCUMSTANCE.A PFAP BROCHURE IS GIVEN TO EACH INPATIENT. THE BROCHURE INFORMS PATIENTS OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM AND HOW TO APPLY. WE HAVE SIGNS POSTED IN ALL ASPIRUS KEWEENAW HOSPITAL AND CLINIC LOCATIONS THAT LET THE PATIENT KNOW ABOUT OUR PFAP PROGRAM. PFAP BROCHURES ARE DISPLAYED IN PATIENT AREAS OF OUR CLINICS AND HOSPITAL. SIGNS ARE POSTED THROUGHOUT AKH TO INFORM THE PATIENT THAT WE PARTICIPATE IN THE MEDICAID PROGRAM. A NOTICE REGARDING OUR SLIDING FEE SCALE AND HOW TO APPLY FOR IT, IS POSTED AT ALL PHYSICIAN RECEPTION AREAS. ALL BILLERS AND FRONT LINE STAFF DIRECT PATIENT INQUIRIES REGARDING PAYMENT, MEDICAID, AND FINANCIAL ASSISTANCE TO A FINANCIAL COUNSELOR. SELF PAY PATIENTS ARE INFORMED OF THE COST OF HIGH DOLLAR PROCEDURES AND OFFERED OPTIONS FOR PAYMENT AND ASSISTANCE PROGRAMS PRIOR TO SCHEDULING THE PROCEDURE. AN ASPIRUS KEWEENAW SOCIAL WORKER COUNSELS PATIENTS AND MAKES THEM AWARE OF ALL AVAILABLE COMMUNITY RESOURCES, INCLUDING MEDICAID AND OUR AKH PATIENT FINANCIAL ASSISTANCE PROGRAM. SHE ASSISTS THEM IN COMPLETING THE MEDICAID APPLICATION. A FINANCIAL COUNSELOR WILL VISIT THE PATIENT IF REQUESTED DURING THE SOCIAL WORKER INTERVIEW WITH THE PATIENT. FINANCIAL COUNSELORS SUGGEST OUR PFAP TO ELIGIBLE PATIENTS WHILE MAKING PAYMENT ARRANGEMENTS. 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 53% AND 14%, 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. X X X 0 0 0 0 0 0 0 0 0 MATTHEW HEYWOOD BOARD MEMBER & PRESIDENT/CEO OF ASPI 0 280310 0 50000 0 9873 0 4359 0 58115 0 402657 0 0 CHUCK NELSON BOARD MEMBER & ASPIRUS UP REGIONAL C 0 233814 0 54196 0 3936 0 8974 0 58258 0 359178 0 0 DARRELL LENTZ BOARD MEMBER & PRESIDENT OF ASPIRUS 0 215441 0 23595 0 23732 0 10444 0 44450 0 317662 0 0 MICHAEL LUOMA MD BOARD MEMBER & CHIEF OF STAFF 141168 0 78900 0 468 0 5780 0 40314 0 266630 0 0 0 RICK NEVERS BOARD MEMBER & SR VP OF REGIONAL OPE 0 202368 0 38216 0 21485 0 12256 0 54261 0 328586 0 0 DUANE ERWIN FORMER BOARD MEMBER & PRESIDENT/CEO 0 410177 0 136236 0 235530 0 15200 0 123108 0 920251 0 0 MICHAEL HAUSWIRTH COO 171924 0 26352 0 352 0 6980 0 35312 0 240920 0 0 0 GRACE TOUSIGNANT CNO 130459 0 18047 0 886 0 5404 0 28198 0 182994 0 0 0 FREDERICK RAU ORTHOPEDIC SURGEON 438210 0 0 0 4572 0 4328 0 40146 0 487256 0 0 0 KENNETH PHERSON ORTHOPEDIC SURGEON 374122 0 0 0 457 0 5500 0 11206 0 391285 0 0 0 BONNIE HAFEMAN PHYSICIAN 177872 0 185436 0 331 0 3714 0 40182 0 407535 0 0 0 JOHN NOVOSAD ANESTHESIOLOGIST 290946 0 0 0 1032 0 11366 0 13606 0 316950 0 0 0 JAMES BLACK ED PHYSICIAN 303507 0 175 0 1298 0 11696 0 40794 0 357470 0 0 0 A VILLAGE OF LAURIUM FINANCE AUTHORITY 386007184 2004-03-05 3546723 REFUNDING BOND SERIES 1997 0 0 0 A 1296826 3546723 3546723 1998 1 0 1 1 A 0 0 0 0 1 0 1 A 0 1 0 0 1 0 0 0 0 A 0 SCHEDULE K, PART IV, LINE 7 WE ARE ANALYZING AND EVALUATING POLICIES AND PROCEDURES RELATED TO OUR TAX-EXEMPT BONDS AND WILL UPDATE AS APPROPRIATE. 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. AND KEWEENAW HEALTH FOUNDATION ARE VOTING MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS IS COMPRISED OF 3 MEMBERS FROM ASPIRUS, INC. AND 11 MEMBERS FROM KEWEENAW HEALTH FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B MAJOR OPERATING DECISION ITEMS UPON APPROVAL BY THE BOARD OF ASPIRUS KEWEENAW HOSPITAL REQUIRE APPROVAL BY THE ASPIRUS, INC. BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS HAS DELEGATED THE REVIEW PROCESS OF THE FORM 990 TO THE CFO. THE FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS ELECTRONICALLY PRIOR TO FILING. 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 COMPENSATION IS DETERMINED BY USE OF STATE HOSPITAL ASSOCIATION SURVEY AND SYSTEM SURVEY. THE COMPENSATION OF THE CEO IS DETERMINED BY AN EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. WAGE DETERMINATION FOR OTHER EXECUTIVE POSITIONS, AN ANNUAL WAGE ANALYSIS IS COMPLETED. THE ORGANIZATION USES SALARY SURVEYS AND SALARY AGENCIES TO DETERMINE THE WAGE SCALE. CONSULTATION ON THE SETTING OF PAY IS PROVIDED TO THE ORGANIZATION BY ASPIRUS, INC. HUMAN RESOURCES. ANY INCREASES IN EXECUTIVE COMPENSATION IS APPROVED BY THE BOARD WITH THE ACTUAL AMOUNT OF SALARY INCREASE BASED OFF OF AN ANNUAL EMPLOYEE EVALUATION. FOR ALL EXECUTIVES, A BONUS POOL IS ESTABLISHED AND CRITERIA IS DEVELOPED AND DETERMINED AT THE BOARD OF DIRECTORS LEVEL. THE BOARD THEN REVIEWS ANNUALLY THE PLAN AND DETERMINES IF A PAYOUT WILL BE PROVIDED. ALL COMPENSATION DECISIONS ARE DOCUMENTED THROUGH A COMPENSATION SUB-COMMITTEE OF THE BOARD OF DIRECTORS BY INDIVIDUALS WITHOUT CONFLICT. 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 IX, LINE 11G PROFESSIONAL FEES/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,721,517. MANAGEMENT AND GENERAL EXPENSES 688,386. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,409,903. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. KEWEENAW HEALTH FOUNDATION 205 OSCEOLA STREET LAURIUM MI 49913 352340440 DEVELOP RESOURCES TO IMPROVE THE HEALTH AND WELL BEING OF THE PEOPLE MI 501(C)(3) LINE 7 N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501(C)(3) LINE 3 ASPIRUS INC 0 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501(C)(3) LINE 9 ASPIRUS INC 0 ASPIRUS SPEACIALISTS IN 425 PINE RIDGE BLVD WAUSAU WI 54401 391945080 MEDICAL SPECIALIST SERVICES WI 501(C)(3) LINE 9 ASPIRUS INC 0 ASPIRUS EXTENDED SERVICES INC 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501(C)(3) LINE 9 ASPIRUS INC 0 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501(C)(3) LINE 9 ASPIRUS INC 0 ASPIRUS ONTONAGON HOSPITAL 601 SEVENTH STREET ONTONAGON MI 49953 260806447 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 0 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTHCARE SERVICES WI 501(C)(3) LINE 9 ASPIRUS INC 0 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 0 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501(C)(3) LINE 7 ASPIRUS INC 0 ASPIRUS GRAND VIEW N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 0 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 9 ASPIRUS GRAND VIEW 0 ASPIRUS GRAND VIEW SERVICE CORPORATION N 10561 GRAND VIEW LANE IRONWOOD MI 49938 383005582 PHYSICIAN SERVICES MI 501(C)(3) LINE 3 ASPIRUS GRAND VIEW 0 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE MANAGEMENT SYSTEM WI 501(C)(3) LINE 11B, II N/A 0 ASPIRUS KEWEENAW ENTERPRISES 205 OSCOLA ST LAURIUM MI 49913 383390273 PHARMACY MI ASPIRUS KEWEENAW HOSPITAL C 1.00000 0 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 0 ASPIRUS GRAND VIEW CARING CAREGIVERS N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382902754 PERSONAL NEEDS SERVICES MI N/A C 0 1 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 ASPIRUS KEWEENAW ENTERPRISES A 104280 ACTUAL ASPIRUS INC M 72000 ACTUAL ASPIRUS CLINICS INC K 51000 ACTUAL ASPIRUS ONTONAGON HOSPITAL INC L 444000 ACTUAL ASPIRUS GRANDVIEW L 342000 ACTUAL ASPIRUS WAUSAU HOSPITAL INC M 187000 ACTUAL KEWEENAW HEALTH FOUNDATION P 53443 ACTUAL