2012-11-14T16:38:09-06:00 2012-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2011-07-01 391972671 ASPIRUS DOCTORS CLINIC INC ASPI 7158472250 2031 PEACH STREET WISCONSIN RAPIDS WI 54494 SIDNEY C SCZYGELSKI 7158472250 2012-11-14 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2012-11-14 2011 2016-02-24 21:20:13Z DUANE L ERWIN 333 PINE RIDGE BLVD WAUSAU WI 54401 3811697 0 X WWW.ASPIRUS.ORG X 2005 WI TO PROVIDE HEALTH CARE AND EDUCATION SERVICES TO PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. X 6 0 127 0 0 0 1500000 0 14299351 3811510 -24136 187 0 0 15775215 3811697 18431 825000 0 0 10905909 3697204 0 0 0 5002562 379098 15926902 4901302 -151687 -1089605 2234382 88284 1061786 5293 1172596 82991 X ASPRIUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTHCARE SYSTEM, WHICH LEADS BY ADVANCING INTIATIVES DEDICATED TO IMPROVING THE HEALTH OF ALL WE SERVE. WE WORK COLLABORATIVELY, WITH OTHERS WHO SHARE OUR PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. 0 1 4848173 825000 3811510 TO PROVIDE HEALTH CARE AND EDUCATION SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE COMPANY PROVIDES HEALTHCARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS COMMUNITY CARE POLICY. SEE SCHEDULE N TO THE FORM 990 FOR ADDITIONAL INFORMATION ON THE OPERATIONS OF ASPIRUS DOCTORS CLINIC, INC. IN FISCAL YEAR 2012. 4848173 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 13 0 1 127 1 0 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X SIDNEY C SCZYGELSKI 7158472250 333 PINE RIDGE BLVD WAUSAU WI 54401 X THOMAS A VOELKER 40.00 X X 270100 0 43594 LAWRENCE LEIBERT 40.00 X X 346964 0 42855 F DEAN DANNER 1.00 X X 0 289118 40202 BRAD BOETTCHER 40.00 X 253437 0 39034 SCOTT DICKMAN 40.00 X 361741 0 42522 TIMOTHY WOGAHN 40.00 X 297542 0 45468 LISA HAMILTON 1.00 X X 0 118293 27828 DUANE L ERWIN 1.00 X 0 750625 126367 SIDNEY C SCZYGELSKI 1.00 X 0 377724 76760 DONG JOON CHUNG 40.00 X 347010 0 46026 FLOYD DAUENHAUER 40.00 X 343701 0 38591 SEAN CASHIN 40.00 X 310777 0 41507 JEFFREY KOSZCZUK 40.00 X 305170 0 45590 BRENT FLETCHER 40.00 X 294779 0 46694 3131221 1535760 703038 28 0 1 0 RIVERVIEW HOSPITAL ASSOCIATION 410 DEWEY ST PO BOX 8080 WISCONSIN RAPIDS WI 54495 LAB AND HOUSEKEEPING SERVICES 300000 1 OTHER OPERATING REV 621110 3702513 3702513 NET PATIENT REVENUE 621110 108997 108997 3811510 187 187 3811697 3811510 0 187 825000 825000 871629 871629 2270233 2270233 555342 555342 23758 23758 1500 1500 308693 308693 6375 6375 118 118 273 273 COLLECTION EXPENSES 27871 27871 OTHER 8542 8542 EQUIPMENT RENTAL/MAINTE 1412 1412 DUES AND SUBSCRIPTIONS 556 556 4901302 4848173 53129 0 223412 87810 1057734 474 7793 0 945443 0 2234382 88284 203896 857890 5293 1061786 5293 X 1172596 82991 1172596 82991 2234382 88284 -1089605 0 X X 0 1 1 X 0 X 1200000 1500000 2700000 13268203 12957950 14107502 14299351 3881510 58514516 13268203 12957950 15307502 15799351 3881510 61214516 1200000 1500000 3701816 6401816 0 1200000 1500000 3701816 6401816 54812700 43129 11497 1742 101 187 56656 43129 11497 1742 101 187 56656 13311332 12969447 15309244 15799452 3881697 61271172 0.89460 0.96390 0.00090 0.00160 X 0 DUE TO AFFILIATES 5293 5293 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES (OR CURRENT ACCOUNTING GUIDANCE OR GAAP) REQUIRES ASPIRUS DOCTORS CLINIC, INC. TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TEHNICAL 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 THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. ASPIRUS DOCTORS CLINIC, INC. POLICY IS TO RECOGNIZE INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEAR ENDED JUNE 30, 2012, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY ASPIRUS DOCTORS CLINIC IN THE FINANCIAL STATEMENTS. ASPIRUS DOCTORS CLINIC, INC. RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS UNRECONGIZED TAX BENEFITS IN 2012. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. 1 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 501(C)3 825000 N/A N/A EQUITY TRANSFER 1 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDES BOARD APPROVED CONTRIBUTIONS TO RELATED ENTITIES; NO FORMAL MONITORING IS REQUIRED. X X X 1 1 X X X X 0 1 0 0 1 0 0 0 0 THOMAS A VOELKER 261795 0 0 0 8305 0 17056 0 26538 0 313694 0 0 0 LAWRENCE LEIBERT 338890 0 0 0 8074 0 17056 0 25799 0 389819 0 0 0 F DEAN DANNER 0 206433 0 57789 0 24896 0 15557 0 24645 0 329320 0 0 BRAD BOETTCHER 245358 0 0 0 8079 0 17056 0 21978 0 292471 0 0 0 SCOTT DICKMAN 353914 0 0 0 7827 0 17056 0 25466 0 404263 0 0 0 TIMOTHY WOGAHN 289697 0 0 0 7845 0 17056 0 28412 0 343010 0 0 0 DUANE L ERWIN 0 544700 0 191221 0 14704 0 10193 0 116174 0 876992 0 0 SIDNEY C SCZYGELSKI 0 292917 0 79742 0 5065 0 13428 0 63332 0 454484 0 0 DONG JOON CHUNG 324164 0 15000 0 7846 0 17056 0 28970 0 393036 0 0 0 FLOYD DAUENHAUER 335261 0 0 0 8440 0 17056 0 21535 0 382292 0 0 0 SEAN CASHIN 276384 0 0 0 34393 0 17056 0 24451 0 352284 0 0 0 JEFFREY KOSZCZUK 296730 0 0 0 8440 0 17056 0 28534 0 350760 0 0 0 BRENT FLETCHER 286339 0 0 0 8440 0 17056 0 29638 0 341473 0 0 0 PART I, LINE 1A TRAVEL AND HEALTH INSURANCE GROSS UPS, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. HEALTH INSURANCE GROSS-UP PAYMENTS - S. CASHIN $3,165 - INCLUDED IN INCOME; HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - F. DANNER $1,078 - INCLUDED IN INCOME. PART I, LINE 4B: 457F PLAN DISTRIBUTION ADMINISTERED BY A RELATED ORGANIZATION - F. DANNER $18,844 PART I, LINE 5 THE ORGANIZATION'S PHYSICIANS RECEIVE A PORTION OF THEIR COMPENSATION BASED ON WORK RVU'S EARNED AT ASPIRUS CLINICS, INC. MULTIPLIED BY A PHYSICIAN COMPENSATION CONVERSION FACTOR WHICH IS CALCULATED QUARTERLY. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS DOCTORS CLINIC, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH 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. ALL ASSETS AND LIABILITES RELATED TO ADC EMPLOYEES AND CLINIC OPERATIONS 2011-07-01 130233 NET BOOK VALUE 391670223 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 501(C)(3) EQUITY TRANSFER OF CASH BALANCE 2012-02-01 700000 BOOK VALUE 391328331 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 501(C)(3) EQUITY TRANSFER OF CASH BALANCE 2012-04-02 125000 BOOK VALUE 391328331 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 501(C)(3) 0 1 0 0 PART II, LINE 2E: LAWRENCE LEIBERT WAS A DIRECTOR, F. DEAN DANNER, AND SIDNEY C. SCZYGELSKI WERE OFFICERS OF ASPIRUS CLINICS, INC. PRIOR TO ASPIRUS DOCTORS CLINIC, INC.'S DECISION TO TRANSFER ASSETS TO THE RELATED PARTY.THE PHYSICIAN EMPLOYEES OF ASPIRUS DOCTORS CLINIC, INC. TRANSFERRED EMPLOYMENT TO ASPIRUS CLINICS, INC. DURING FISCAL YEAR 2012. ASPIRUS CLINICS, INC. IS A RELATED PARTY UNDER THE COMMON CONTROL OF ASPIRUS, INC. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 ASPIRUS DOCTORS CLINIC, INC. TRANSFERRED OPERATIONS OF THE CLINIC ON JUNE 6, 2011 TO ASPIRUS CLINICS, INC. (AN AFFILIATED ORGANIZATION). THE TRANSFER OF OPERATIONS OF THE NEW CLINIC WAS DONE IN CONJUNCTION WITH OPENING AND MOVING TO A NEW MODERN CLINIC FACILITY IN WISCONSIN RAPIDS, WI IN AN EFFORT TO PROVIDE MORE COORDINATED CARE AND SERVICES TO PATIENTS WITHIN THE ASPIRUS SYSTEM AND IN THE COMMUNITY. TNE NEW CLINIC ALSO PROVIDES SERVICES THAT WERE NOT OFFERED AT THE OLD CLINIC SUCH AS ADVANCED DIAGNOSTIC MRI SERVICES AND INHOUSE SURGICAL SERVICES. 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 FORM 990, PART VI, LINE 7B FOR EXPLANATION 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 OFFICERS; 4) CHANGE THE FORMULA OR METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION; 5) APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS, IN ADDITION TO APPROVAL OF STRATEGIC AND LONG RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE ORGANIZATION'S MANAGEMENT. THE FORM 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS 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 ORGANIZATION'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 THE ORGANIZATION HAD AN INDEPENDENT AUDIT FOR EXECUTIVE COMPENSATION WHICH INCLUDED BASE SALARY, INCENTIVE PLANS, AND BENEFITS FOR ALL OFFICERS AND EXECUTIVE POSITIONS. THE REVIEW WAS COMMISSIONED BY THE COMPENSATION COMMITTEE OF THE BOARD AND WAS CONDUCTED BY AN INDEPENDENT CONSULTING FIRM. THE MARKET ANALYSIS WAS COMPLETED IN JUNE AND JULY OF 2009 AND PRESENTED TO THE COMPENSATION COMMITTEE OF THE BOARD IN AUGUST 2009 FOR FINAL COMPENSATION DETERMINATION. THE ORGANIZATION CONTINUES TO USE THESE RECOMMENDATIONS IN FISCAL YEAR 2012 AND EXECUTIVE COMPENSATION ADJUSTMENTS FOR NEW AND EXISTING EMPLOYEES MUST BE APPROVED BY THE BOARD OF DIRECTORS. 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. EXPLANATION FOR HOURS WORKED FORM 990, PART VII, LINE 1A DUANE L. ERWIN, SIDNEY C. SCZYGELSKI, AND LISA HAMILTON ARE EMPLOYED BY ASPIRUS, INC., A RELATED ORGANIZATION. ASPIRUS, INC.'S PURPOSE IS TO SERVE AS A SUPPORTING ORGANIZATION TO MULTIPLE SUBSIDIARY TAX EXEMPT ENTITIES. DUANE L. ERWIN, SIDNEY C. SCZYGELSKI, AND LISA HAMILTON DEVOTE THEIR TIME PROVIDING MANAGEMENT SERVICES TO THE RELATED TAX EXEMPT ENTITIES. F. DEAN DANNER DEVOTES APPROXIMATELY 43 HOURS PER WEEK AS FOLLOWS: ASPIRUS CLINICS, INC. - 40 HOURS ASPIRUS GENERAL CLINIC LLC. - 1 HOUR ASPIRUS SPECIALISTS, INC. - 1 HOUR ASPIRUS DOCTORS CLINIC, INC. - 1 HOUR THOMAS VOELKER DEVOTES APPROXIMATELY 42 HOURS PER WEEK AS FOLLOWS: ASPIRUS CLINICS, INC. - 40 HOURS ASPIRUS DOCTORS CLINIC, INC. - 1 HOUR ASPIRUS, INC. - 1 HOUR ASPIRUS WAUSAU HOSPITAL - 1 HOUR LAWRENCE LEIBERT DEVOTES APPROXIMATELY 41 HOURS PER WEEK AS FOLLOWS: ASPIRUS CLINICS, INC. - 40 HOURS ASPIRUS DOCTORS CLINIC, INC. - 1 HOUR 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 SELECTIONS OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE TO THIS PROCESS IN THE PAST YEAR. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE SYSTEM MANAGEMENT WI 501(C)(3) LINE 11B, II N/A 0 ASPIRUS WAUSAU HOSPITAL 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 SPECIALISTS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391945080 MEDICAL SPECIALIST SERVICES WI 501(C)(3) LINE 9 ASPIRUS INC 0 ASPIRUS EXTENDED SERVICES 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 INC 601 SEVENTH STREET ONTONAGON MI 49953 260806477 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 0 ASPIRUS VNA HOME HEALTH 520 N32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTHCARE SERVICES WI 501(C)(3) LINE 9 ASPIRUS INC 0 ASPIRUS VNA EXTENDED CARE INC 520 N32ND 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 49932 382908536 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 0 GRAND VIEW HOSPITAL AUXILIARY N 10561 GRAND VIEW LANE IRONWOOD MI 49932 237178363 LIFELINE EMERGENCY SYSTEM MI 501(C)(3) LINE 9 ASPIRUS GRAND VIEW 0 ASPIRUS GRAND VIEW SERVICE CORP N 10561 GRAND VIEW LANE IRONWOOD MI 49932 383005582 PHYSICIAN SERVICES MI 501(C)(3) LINE 3 ASPIRUS GRAND VIEW 0 ASPIRUS NETWORK INC 3000 WESTHILL DR 202 WAUSAU WI 54401 391931679 HEALTH CARE NETWORK WI N/A C ASPIRUS GRAND VIEW CARING CAREGIVERS N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382902754 PERSONAL NEEDS SERVICES MI N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0