2023-05-12T13:11:59-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 390873606 THE HOWARD YOUNG MEDICAL CENTER INC HOWA 7153568000 240 MAPLE STREET WOODRUFF WI 54568 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 7158472250 2023-05-12 1 SIDNEY SCZYGELSKI 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-05-12 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 40641253 0 X WWW.ASPIRUS.ORG X 1948 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 10 7 227 80 0 0 1636396 7930584 29571874 29379803 -9074 3076154 472010 254712 31671206 40641253 3652 24000 0 0 16023537 19294016 0 0 0 28590821 23285769 44618010 42603785 -12946804 -1962532 105216633 83126047 8319347 21802020 96897286 61324027 WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 32993839 24000 29379803 THE HOWARD YOUNG MEDICAL CENTER, INC. IS A 42-BED HOSPITAL CAMPUS PROVIDING SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2022, THE HOWARD YOUNG MEDICAL CENTER. TREATED 1,012 ADULTS AND CHILDREN FOR A TOTAL OF 4,249 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR 31,543 OUTPATIENT VISITS, WHICH INCLUDED 404 OUTPATIENT SURGERIES AND 6,431 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS. 32993839 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 44 0 227 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 ERIC ANDERSON BOARD MEMBER/SVP-PATIENT EXPERIENCE 2.00 50.00 X 0 495034 104300 JESSE G TISCHER VICE CHAIR/SVP & PRES.-REG. MARKETS 2.00 50.00 X 0 644385 101649 JUDY SMOLAREK RN CHAIR 1.00 4.00 X X 0 0 0 RAY BURGAN VICE CHAIR (THRU JULY 2021) 1.00 4.00 X X 0 0 0 STEVE LAKING SECRETARY/TREASURER 1.00 4.00 X 0 0 0 HOLLY BEEDE-MCKINNEY NP BOARD MEMBER/NURSE PRACTITIONER 2.00 50.00 X 0 143770 6028 SISTER ELIZABETH AMMAN OP BOARD MEMBER 1.00 4.00 X 0 0 0 KELLY COURT BOARD MEMBER 1.00 4.00 X 0 0 0 KATE FERREL BOARD MEMBER 1.00 4.00 X 0 0 0 FATHER JIM FOSDICK BOARD MEMBER 1.00 4.00 X 0 0 0 ARTHUR C HELGERSON DDS BOARD MEMBER 1.00 4.00 X 0 0 0 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 2.00 50.00 X 0 915379 141626 MATTHEW HEYWOOD PRESIDENT & CEO-ASPIRUS 2.00 50.00 X 0 2684221 266094 TERESA THEILER PRESIDENT-ASPIRUS NORTH DIVISION 2.00 50.00 X 0 215035 23842 WADE CARROLL VP-INFORMATION TECHNOLOGY 2.00 50.00 X 0 306056 43153 BENJAMIN BARSOTTI VP-CHIEF MEDICAL INFORMATION OFFICER 2.00 50.00 X 0 462446 50766 BRETT DAVIS PRESIDENT-ASPIRUS HEALTH PLAN 2.00 50.00 X 0 394127 62857 JAMES MATHESON SVP & CHIEF STRATEGY OFFICER 2.00 50.00 X 0 452729 89948 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-AMG 2.00 50.00 X 0 572454 92664 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 751984 56650 JON HARDESTY VP-CORPORATE HUMAN RESOURCES 2.00 50.00 X 0 325937 43270 LISA ROWE-PEPLINSKI VP-CARE QUALITY & PATIENT SAFETY 2.00 50.00 X 0 367202 18878 MATTHEW BREWER VP-OPERATIONS 2.00 50.00 X 0 313780 42259 MICHAEL HOLZHUETER SVP & GENERAL COUNSEL 2.00 50.00 X 0 449756 89333 PAUL VAN DEN HEUVEL VP-NETWORKS STRATEGY 2.00 50.00 X 0 340811 45098 RENEE SMITH EXECUTIVE DIRECTOR-ANI 2.00 50.00 X 0 460002 93775 RUTH RISLEY-GRAY SVP & SYSTEM CNO 2.00 50.00 X 0 329902 52673 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 516494 97286 WENDY ANGELO VP-CMO - POPULATION HEALTH 2.00 50.00 X 0 363857 42762 CATHERINE MARSH PHARMACIST 40.00 X 63025 99153 20499 JUSTIN CEBERY REGISTERED NURSE 40.00 X 70840 84073 36359 SHARON KRAUSE PHARMACIST 40.00 X 62091 90183 17043 ROBERT ANDERSON PHARMACIST 40.00 X 62222 91524 19106 GINA KASPER PHARMACIST 40.00 X 55351 83587 8819 313529 11953881 1666737 0 0 1 0 TOTAL MSP LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 MEDICAL STAFFING 1194465 EAGLE TELEMED HOLDINGS LLC 280 INTERSTATE NORTH CIR SE SUITE ATLANTA GA 303392453 TELEMEDICINE SERVICES 1172889 COMPASS GROUP USA INC PO BOX 102289 ATLANTA GA 303682289 FOOD SERVICES STAFFING SERVICES 385415 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 MEDICAL STAFFING 351614 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 54868 MEDICAL STAFFING 310693 5 5631083 2299501 7930584 PATIENT SERVICE REVENUE 621990 28520260 28520260 CONTRACTED SERVICE REVENUE 900099 361597 361597 LAB REVENUE 900099 88000 88000 PHARMACY REVENUE 446110 3405 3405 406541 406541 29379803 3076154 3076154 157280 0 157280 157280 157280 CAFETERIA/VENDING REVENUE 900099 97432 97432 97432 40641253 29379803 0 3330866 X 24000 24000 15592180 14567900 1024280 415348 394015 21333 2368752 2168294 200458 917736 859679 58057 11925 11925 322641 322641 7198623 6405322 793301 750 595 155 32935 17995 14940 44707 44707 928116 87736 840380 79492 62296 17196 433780 433780 2738405 2218925 519480 92141 92141 CORPORATE ALLOCATIONS 4166178 108076 4058102 MEDICAL SUPPLIES 3761087 3486880 274207 HOSPITAL TAX 863824 863824 REPAIRS AND MAINTENANCE 792411 535067 257344 1818754 1531138 287616 42603785 32993839 9609946 0 1552 1702 -14756 3804017 5065473 1246631 1262793 175220 47691 24666502 2550618 23159677 22115884 62364981 54126797 12380 0 14452175 520463 105216633 83126047 2831848 2942776 0 355636 0 17799376 5487499 704232 8319347 21802020 X 34532306 7463831 62364980 53860196 96897286 61324027 105216633 83126047 X -1962532 -11161417 -22449310 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11925 11925 0 PART II-B, LINE 1: MEMBERSHIP DUES ARE PAID TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). A PORTION OF THOSE DUES ARE COMMITTED TO LOBBYING PURPOSES. WHA INVOICE STATES 15.3% OF $35,571 ($5,442) GOES FOR LOBBYING ON INVOICE COVERING THE PERIOD OF 1/1/22-12/31/22. SIMILARLY, AHA DUES COMMITTED TO LOBBYING WAS 26.47% OF $24,491 ($6,483). 62364981 -5286593 2606290 345301 54126797 49930019 15137220 2393442 308816 62364981 51085092 1388115 2296766 246422 49930019 50942861 2954250 2595594 216425 51085092 48746796 4592173 2201258 194850 50942861 0.00000 1.00000 0.00000 1 0 2560000 2560000 18188771 1567810 16620961 3860104 982808 2877296 57627 57627 22115884 HYMC TRUST INDENTURE 54126797 F 54126797 LONG TERM INSURANCE LIABILITY 186887 DUE TO AFFILIATES 496683 DEFERRED COMPENSATION 20662 704232 X PART V, LINE 4: THE HOWARD YOUNG TRUST WAS ESTABLISHED BY S. HOWARD YOUNG IN 1975 AS A MECHANISM TO ENSURE THE HOSPITAL CONTINUES TO HAVE ACCESS TO FUNDING FOR CAPITAL NEEDS, MEDICAL SERVICE CONTINUATION AND SERVICE GROWTH TO MEET THE COMMUNITY'S NEEDS. PART X, LINE 2: ASPIRUS HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND CONCLUDED THAT NO MATERIAL LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS AT JUNE 30, 2022. 1 1 X 1 X 1 X 1 1 1 1 0 412288 412288 0.00990 7020802 2508674 4512128 0.10800 7433090 2508674 4924416 0.11790 86659 86659 0.00210 4817 4817 0.00010 1825 1825 0.00000 93301 93301 0.00220 7526391 2508674 5017717 0.12010 24000 24000 0.00060 24000 24000 0.00060 1 434442 0 7050415 12092349 -5041934 X 1 1 1 1 THE HOWARD YOUNG MEDICAL CENTER 240 MAPLE STREET WOODRUFF WI 54568 WWW.ASPIRUS.ORG/FIND-A-LOCATION/HOWARD 201 X X X THE HOWARD YOUNG MEDICAL CENTER 1 0 1 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X HTTPS://WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 THE HOWARD YOUNG MEDICAL CENTER PART V, SECTION B, LINE 2: A HOSPITAL ORGANIZATION THAT ACQUIRES A HOSPITAL FACILITY (THROUGH MERGER OR ACQUISITION) MUST MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO THE ACQUIRED HOSPITAL FACILITY BY THE LAST DAY OF THE ORGANIZATION'S SECOND TAXABLE YEAR BEGINNING AFTER THE DATE ON WHICH THE HOSPITAL FACILITY WAS ACQUIRED. THE FILING HOSPITAL WAS ACQUIRED BY A NEW PARENT (ASPIRUS INC - 45-3358926) ON 08/01/2021 (TAX YEAR 2021). THE CHNA WILL BE DUE THE LAST DAY OF THE SECOND TAXABLE YEAR WHICH WILL BE 06/30/2024.THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT EFFORTS IN FY22 WERE SIGNIFICANTLY IMPACTED BY A NUMBER OF FACTORS, INCLUDING: THE TRANSITION OF THE HOSPITAL FROM ASCENSION HEALTH TO ASPIRUS HEALTH IN AUGUST 2021; THE SUBSEQUENT CHANGES IN PROCESSES, TEAM STRUCTURE AND RELATED IMPACTS; COVID-19 AND ITS RIPPLE EFFECT ON COMMUNITY OUTREACH AND PUBLIC EVENTS / PROGRAMS.HOWARD YOUNG IS IN RURAL NORTHERN WISCONSIN. BECAUSE OF THAT SETTING, COMMUNITY HEALTH EFFORTS ARE FREQUENTLY COMPLETED WITH OTHER REGIONAL PARTNERS, INCLUDING OTHER ASPIRUS HOSPITALS. THE FOLLOWING DESCRIPTIONS ARE REFLECTIVE OF ASPIRUS RHINELANDER, ASPIRUS EAGLE RIVER AND HOWARD YOUNG MEDICAL CENTER (ALSO WITH ASPIRUS) UNLESS OTHERWISE INDICATED. MENTAL HEALTH AND SUBSTANCE USE IN PART DUE TO THE KNOWLEDGE AND CAPACITY THAT THE RHINELANDER-BASED KOELLER BEHAVIORAL HEALTH UNIT (PART OF ASPIRUS) BRINGS TO THE AREA, THE HOSPITALS ARE A STRONG AND VALUED RESOURCE. STAFF EXPERTISE IS SHARED INTERNALLY AS WELL AS EXTERNALLY. THIS WORK INCLUDES: - TRAINING AND COACHING: STAFF EXPERTS PROVIDE TRAINING AND COACHING ON AN IN-KIND BASIS. IN FY22, STAFF TRAINED OR COACHED THE HUMAN SERVICE CENTER STAFF, CAMP COUNSELORS AND LEADERS, NEW HORIZONS HOME VISITING STAFF, 25-30 ASPIRUS WELLNESS STAFF. ASPIRUS STAFF ALSO PROVIDED QUESTION, PERSUADE, REFER (QPR) SUICIDE PREVENTION TRAINING FOR LOCAL HIGH SCHOOL STAFF AND GRADES 9-12 HEALTH CLASSES, AS WELL AS COACHED NEW QPR TRAINERS (WHICH IMPROVES THE ACCESSIBILITY OF QPR TRAININGS IN THE REGION). - COALITION: ASPIRUS STAFF PARTICIPATES IN THE COMMUNITY OUTREACH PREVENTION EDUCATION (COPE) COALITION, WHICH IS THE REGION'S MENTAL HEALTH PROMOTION AND SUBSTANCE USE PREVENTION COALITION. ASPIRUS STAFF LED THE COALITION'S SUB-COMMITTEE ON SUICIDE PREVENTION AND MENTAL HEALTH. INCLUDED IN THIS WORK WAS THE CREATION AND DISTRIBUTION OF STICKERS PROMOTING THE NEW 988 CRISIS LINE WITH THE QR CODE FOR MENTAL AND HEALTH AND SUBSTANCE USE/ABUSE SUPPORT AVAILABLE 24/7. - PUBLIC EDUCATION: ASPIRUS STAFF WERE FREQUENTLY ASKED TO PROVIDE PUBLIC SERVICE MESSAGES ABOUT MENTAL HEALTH ISSUES SUCH SEASONAL AFFECTIVE DISORDER AND TEEN MENTAL HEALTH. IN NOVEMBER, A NEWS INTERVIEW WAS COMPLETED ON "MOVEMEBER" TO BRING AWARENESS TO MEN'S MENTAL HEALTH. ASPIRUS HOSTED A FILM/PRESENTATION ON MILWAUKEE'S DANIEL HOAN MEMORIAL BRIDGE; MULTIPLE PEOPLE HAVE ATTEMPTED SUICIDE BY JUMPING OFF THE BRIDGE. THE PRESENTER ALSO SHARED WAYS TO REDUCE SUICIDE RISK. STAFF FROM KOLLER BEHAVIORAL HEALTH WERE AVAILABLE TO PROVIDE SUPPORT TO THOSE WHO MAY BE IN NEED AFTER THE PRESENTATION.- COMMUNITY RESPONSE: ASPIRUS STAFF RESPOND TO LOCAL, SPECIFIC MENTAL HEALTH CRISES (E.G., THE DEATH OF A CHILD) AND PARTICIPATE ON COUNTY DEATH REVIEW TEAMS.- INTERNAL SYSTEMS: ASPIRUS STAFF IDENTIFIED OPPORTUNITIES TO REDUCE THE RISK OF BEHAVIORAL HEALTH PATIENTS WHO DIED BY SUICIDE AFTER BEING DISCHARGED. ASPIRUS HEALTH CONTRACTS WITH AN OUTSIDE AGENCY TO PROVIDE RECOVERY COACHING SERVICES THROUGHOUT THE SYSTEM'S WISCONSIN FOOTPRINT. ASPIRUS IS WORKING TO BUILD RELATIONSHIPS AND STRUCTURES IN ALL WISCONSIN HOSPITALS TO SUPPORT HAVING A RECOVERY COACH AVAILABLE WITHIN AN HOUR OR TWO TO THOSE PATIENTS INTERESTED IN WORKING WITH A COACH. CHRONIC DISEASETHE HOSPITALS OFFERED 'FIT FOR LIFE' EXERCISE CLASSES IN A SUPERVISED SETTING FOR CARDIAC REHAB PATIENTS WHO HAVE COMPLETED THEIR TREATMENT PLAN. THE HOSPITALS OFFER THE CLASSES AT A REDUCED RATE, INCURRING LOSSES ON THE OFFERING.ASPIRUS HEALTH, PRIMARILY THROUGH CARE MANAGEMENT, IMPLEMENTS A FRUIT AND VEGETABLE PRESCRIPTION (FVRX) PROGRAM ACROSS THE SYSTEM. PATIENTS WITH CHRONIC DISEASE ARE SCREENED FOR FOOD INSECURITY AND 'PRESCRIBED' FRUITS AND VEGETABLES. THE FVRX CAN BE USED LIKE CASH AT THE LOCAL FARMERS MARKET. FOR THE PURPOSES OF THIS CHNA, THE HOSPITAL CHOSE TO FOCUS ITS EFFORTS ON THE PRIORITIES LISTED ABOVE (MENTAL HEALTH, AODA, CHRONIC DISEASE). IN THE PRIORITIZATION PROCESS, THE FOLLOWING HEALTH ISSUES WERE RANKED LOWER: CHILD ABUSE AND GRADUATION RATES. THESE WERE NOT NAMED AS PRIORITIES SO EFFORTS COULD BE FOCUSED ON THE TOP THREE SELECTED. IN ADDITION, IT WAS SUGGESTED THAT THE YOUTH COMPONENTS SHOULD BE WOVEN INTO THE SELECTED PRIORITIES WHEN POSSIBLE, WHICH COULD HAVE AN IMPACT ON CHILD ABUSE AND GRADUATION RATES. THE HOWARD YOUNG MEDICAL CENTER PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF THE FOLLOWING (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY): 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 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 EXPENSE, LESS MEDICAID PROVIDER TAXES DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $833,594. SCHEDULE H - GENERAL EXPLANATION IN AUGUST 2021, THE ORGANIZATION'S PARENT BECAME ASPIRUS INC, WHO IS THE SOLE PARENT MEMBER OF THE ORGANIZATIONS REPORTED ON SCHEDULE R ATTACHED. THE FIRST MONTH OF THE FISCAL YEAR (JULY) THE ORGANIZATION WAS A PART OF A RELATED PARTY STRUCTURE WITH THE OVERARCHING PARENT BEING ASCENSION HEALTH ALLIANCE (45-3358926). FURTHER DETAIL OF THIS IS PROVIDED IN SCHEDULE O AND SCHEDULE R OF THIS ACCOMPANYING 990. AT THE TIME OF THIS CHANGE, THERE WERE MANY CHANGES IMPLEMENTED THAT IMPACTED THE RESPONSES ON SCHEDULE H. FOR 11 OF THE 12 MONTHS, THE RESPONSES AS RECORDED ON SCHEDULE H WERE ACCURATE. FOR CONTEXT OF WHAT THE FIRST MONTH (JULY 2021) WAS, THE 2020 990 CAN PROVIDE MORE DETAIL, BUT SOME HIGHLIGHTS ARE BELOW OF WHAT RESPONSES WOULD BE DURING THAT ONE MONTH:SCHEDULE H, PART I, LINE 3A: 250%SCHEDULE H, PART I, LINE 3B: 400%SCHEDULE H, PART I, LINE 3C: SUBJECT TO THE OTHER PROVISIONS OF THIS FINANCIAL ASSISTANCE POLICY, A PATIENT WITH INCOME GREATER THAN 400% OF THE FPL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER A "MEANS TEST" FOR SOME DISCOUNT OF PATIENT'S CHARGES FOR SERVICES FROM THE ORGANIZATION BASED ON A PATIENT'S TOTAL MEDICAL DEBT. A PATIENT ELIGIBLE FOR THIS CATEGORY OF FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE THAN THE CALCULATED AGB CHARGES.THE HOSPITAL ALSO USES INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY AS FACTORS IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARESCHEDULE H, PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM: PRIOR TO AUGUST 2021, THE HOSPITAL WAS AFFILIATED WITH MINISTRY HEALTH AND ASCENSION HEALTH. PART III, LINE 2: CURRENT YEAR BAD DEBT EXPENSE IS MULTIPLIED BY THE RATIO OF PATIENT CARE TO COST CHARGES. PART III, LINE 3: THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLES ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES.BAD DEBT POLICY AND PROCEDURE:POLICY: I. ASPIRUS' FINANCIAL POLICY REQUIRES SETTLEMENT OF A PATIENT SELF-PAY BILL OR ACCOUNT WILL BE REFERRED FOR OUTSIDE COLLECTION. II. FAILURE TO MEET THESE REQUIREMENTS IN ASPIRUS POLICY WILL RESULT IN THE ACCOUNT BEING CONSIDERED FOR BAD DEBT ONCE ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. THE ACCOUNT WILL BE REMOVED FROM ACCOUNTS RECEIVABLE AND TURNED OVER TO AN OUTSIDE AGENCY OR LAW FIRM FOR COLLECTION. PRIOR TO THIS HAPPENING, THE FOLLOWING CRITERIA MUST BE MET: A. PATIENT FINANCIAL SERVICES STAFF WILL MAKE REASONABLE COLLECTION EFFORTS BY WAY OF: 1. MONTHLY STATEMENTS 2. COLLECTION LETTERS 3. COLLECTION PHONE CALLS III. ALL COLLECTION ACTIVITY AND PATIENT CONTACTS WILL BE DOCUMENTED ON THE INDIVIDUAL ACCOUNTS. IV. ALL COLLECTION ACCOUNTS ARE TO BE TREATED THE SAME REGARDLESS OF PAYOR TYPE: SELF-PAY, GENERAL INSURANCE, MEDICARE, OR MEDICAL ASSISTANCE. V. PATIENT FINANCIAL SERVICES STAFF WILL USE SOUND BUSINESS JUDGMENT WHEN WORKING WITH THE ACCOUNT. AT THE DISCRETION OF THE FINANCIAL COUNSELOR, CREDIT REPORTS WILL BE REQUESTED FROM THE CREDIT BUREAU AND PROPERTY VERIFICATION OBTAINED THROUGH THE COUNTY TREASURER'S OFFICE. PROCEDURE: VI. THE FINAL STEP IS TO SUBMIT THE ACCOUNT TO A COLLECTION AGENCY OR LAW FIRM. EACH ACCOUNT IS REVIEWED TO DETERMINE IF THE ACCOUNT HAS MET THE BAD DEBT CRITERIA. ONCE IT HAS BEEN DETERMINED THAT ALL REQUIREMENTS HAVE BEEN MET, THE ACCOUNT IS TRANSFERRED FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY THE FINANCIAL COUNSELOR. SPECIFIC PROCEDURES PERTAINING TO THE DETAILED PROCEDURAL STEPS FOR TRANSFERRING TO THE AGENCY CAN BE FOUND IN THE INTERNAL POLICY. A. ADDITIONAL INFORMATION REGARDING MEDICARE BAD DEBTS: 1. THE DEBT MUST BE RELATED TO COVERED SERVICES AND DERIVED FROM DEDUCTIBLE AND COINSURANCE AMOUNTS. 2. THE HOSPITAL MUST PROVIDE REASONABLE COLLECTION EFFORTS. 3. THE DEBT IS NOT COLLECTABLE (AT LEAST 120 DAYS OUTSTANDING FROM THE DATE OF THE FIRST BILLING TO THE PATIENT.) 4. SOUND BUSINESS JUDGMENT ESTABLISHES THAT THERE WAS NO LIKELIHOOD OF RECOVERY AT ANY TIME IN THE FUTURE. II. BAD DEBT RECOVERIES A. PAYMENTS ON MONTHLY REMITTANCE ADVICES FROM OUTSIDE COLLECTION AGENCIES WILL BE POSTED TO EACH INDIVIDUAL ACCOUNT. B. PAYMENTS MADE DIRECTLY TO ASPIRUS BUT INTENDED FOR COLLECTION ACCOUNTS WILL BE POSTED TO THE APPROPRIATE ACCOUNT AND REPORTED DAILY/WEEKLY TO COLLECTION AGENCIES FOR RECONCILIATION OF THEIR RECORDS. C. INVOICES FOR COMMISSIONS DUE TO COLLECTION AGENCIES WILL BE PROCESSED MONTHLY. INVOICE AND REMITTANCE ADVICE WILL BE REVIEWED BY THE FINANCIAL COUNSELOR TEAM LEAD AND APPROVED BY THE MANAGER/DIRECTOR, THEN SUBMITTED TO FISCAL SERVICES FOR CHECK PROCESSING AND PAYMENT TO AGENCIES FOR COMMISSIONS DUE. 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 THE HOWARD YOUNG MEDICAL CENTER, INC. 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, 2022 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).MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: UPON A PATIENTS APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENTS ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORK QUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT. PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, THE HOWARD YOUNG MEDICAL CENTER, INC. USES BOTH HOSPITAL DATA AND RELIABLE, THIRD PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THESE REPORTS PROVIDE INFORMATION ABOUT KEY HEALTH, SOCIOECONOMIC, AND DEMOGRAPHIC INDICATORS THAT POINT TO AREAS OF NEED. THE HOWARD YOUNG MEDICAL CENTER, INC. UTILIZES THIS INFORMATION TO DETERMINE AND DEVELOP PROGRAMS AND SERVICES TO BE PROVIDED FOR THE COMMUNITY. THESE NEEDS AND INITIATIVES ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE CONSIDERED IN DEVELOPING THE ORGANIZATION'S STRATEGY, POLICY DEVELOPMENT, AND INTERNAL FINANCIAL AND OPERATIONAL DECISIONS. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATION AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: THE HOWARD YOUNG MEDICAL CENTER, INC. PRIMARILY SERVES THE RESIDENTS OF ONEIDA COUNTY AND SURROUNDING COUNTIES IN RURAL NORTHERN WISCONSIN. THE POPULATION OF ONEIDA COUNTY IS APPROXIMATELY 37,800, WITH 7.9% OF RESIDENTS LIVING AT OR BELOW THE FEDERAL POVERTYTHRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS NEARLY $56,800. APPROXIMATELY 5% OF INDIVIDUALS LIVING IN THE COUNTY ARE UNINSURED AND 15% RECEIVE MEDICAID. THERE ARE THREE HOSPITALS (ASPIRUS RHINELANDER, HOWARD YOUNG MEDICAL CENTER, AND MARSHFIELD MEDICAL CENTER MINOCQUA) IN ONEIDA COUNTY. THE HOWARD YOUNG MEDICAL CENTER IS A DISPROPORTIONATE SHARE HOSPITAL. (DISPROPORTIONATE SHARE HOSPITALS SERVE A SIGNIFICANTLY DISPROPORTIONATE NUMBER OF LOW-INCOME PATIENTS AND RECEIVE PAYMENTS FROM THE CENTERS FOR MEDICAID AND MEDICARE SERVICES TO COVER THE COSTS OF PROVIDING CARE TO UNINSURED PATIENTS.) ONEIDA COUNTY INCLUDES DESIGNATED MENTAL HEALTH, DENTAL HEALTH AND PRIMARY CARE PROVIDER SHORTAGE AREAS. PART VI, LINE 5: THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING:(1) THE ORGANIZATION'S GOVERNING BOARD CONSISTS PRIMARILY OF PERSONS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. THEY ARE NOT EMPLOYEES OF THE ORGANIZATION.(2) AS MENTIONED, THE ORGANIZATION PROVIDES SEVERAL SERVICES WHICH ARE NOT OTHERWISE AVAILABLE BEING IN A RURAL SETTING.(3) BASED ON THE ORGANIZATION'S MISSION, EMERGENCY ROOMS ARE MADE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY.(4) THE ORGANIZATION ALSO PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS THROUGH INTERNSHIP PROGRAMS. THE HOWARD YOUNG MEDICAL CENTER, INC. IS ALSO INVOLVED IN THE FOLLOWING EFFORTS WHICH FURTHER ITS TAX-EXEMPT STATUS:- THE HOSPITAL PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, TRICARE).- THE FACILITY STRIVES TO BE A LOW-COST/LOW-CHARGE PROVIDER BY UTILIZING THE LEAN SIX SIGMA APPROACH TO IMPROVE PATIENT SAFETY, PATIENT QUALITY OF SERVICES AND PATIENT SATISFACTION.- CHARITY CARE IS AVAILABLE TO ALL IN THE COMMUNITY BASED ON NEED AND IS SUBJECT TO SLIDING SCALE DISCOUNTS.- THE HOWARD YOUNG MEDICAL CENTER, INC. HAS A VOLUNTEER SERVICES PROGRAM WHERE COMMUNITY MEMBERS UTILIZE THE HOSPITAL AS A VEHICLE TO CONNECT WITH AND CONTRIBUTE TO INDIVIDUALS AND THE OVERALL COMMUNITY THROUGH VOLUNTEERING.- THE HOWARD YOUNG MEDICAL CENTER, INC. ENCOURAGES THEIR MANAGEMENT TEAM TO PARTICIPATE IN THE LOCAL GOOD PANTRY'S DISTRIBUTION DAY. NUTRITIONISTS ARE AVAILABLE TO DISCUSS HEALTHY FOOD CHOICES, CLINICAL SERVICES SUCH AS BLOOD PRESSURE CHECKS AND CHOLESTEROL SCREENING ALONG WITH EDUCATIONAL SESSIONS HAVE BEEN DEVELOPED. THEY ALSO HAVE NETWORKED WITH A LOCAL OPTOMETRY OFFICE TO PROVIDE EYE CARE SCREENINGS AND EYEGLASS ASSISTANCE. PART VI, LINE 6: HOWARD YOUNG MEDICAL CENTER IS PART OF THE ASPIRUS HEALTH SYSTEM. ASPIRUS, INC. IT IS A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. HOWARD YOUNG MEDICAL CENTER WORKS WITH ASPIRUS TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES THEY SERVE. AS NOTED PREVIOUSLY IN THE FORM 990, A NUMBER OF REPRESENTATIVES FROM ASPIRUS HAVE ROLES ON THE BOARD OF DIRECTORS OF HOWARD YOUNG MEDICAL CENTER AND TOGETHER PROMOTE THE MISSION OF ASPIRUS. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTHCARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES TO IMPROVING THE HEALTH OF ALL IT SERVES. ASPIRUS WORKS COLLABORATIVELY WITH OTHERS WHO SHARE ITS PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. ASPIRUS AND HOWARD YOUNG MEDICAL CENTER WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE PROVIDE HIGH QUALITY CARE TO MEMBERS OF COMMUNITIES WHICH OTHERWISE WITHOUT THE EFFORTS OF A COMBINED PARTNERSHIP MAY NOT HAVE ACCESS TO THIS CARE LOCALLY. 1 TOWN OF WOODRUFF PO BOX 560 WOODRUFF WI 54568 GOV 24000 0 MUNICIPAL SERVICES DONATION 1 0 X 1 1 0 1 0 0 0 0 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO-ASPIRUS 0 1051076 0 1629342 0 3803 0 17346 0 248748 0 2950315 0 0 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 0 610115 0 177495 0 127769 0 20196 0 121430 0 1057005 0 112143 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 0 289961 0 426149 0 35874 0 13626 0 43024 0 808634 0 25179 JESSE G TISCHER VICE CHAIR/SVP & PRES.-REG. MARKETS 0 501025 0 142821 0 539 0 11714 0 89935 0 746034 0 0 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-AMG 0 405520 0 113119 0 53815 0 17346 0 75318 0 665118 0 51368 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 0 357568 0 105424 0 53502 0 17346 0 79940 0 613780 0 50634 ERIC ANDERSON BOARD MEMBER/SVP-PATIENT EXPERIENCE 0 382299 0 111001 0 1734 0 17346 0 86954 0 599334 0 0 RENEE SMITH EXECUTIVE DIRECTOR-ANI 0 315463 0 89914 0 54625 0 17346 0 76429 0 553777 0 53547 JAMES MATHESON SVP & CHIEF STRATEGY OFFICER 0 322706 0 94649 0 35374 0 16347 0 73601 0 542677 0 26065 MICHAEL HOLZHUETER SVP & GENERAL COUNSEL 0 399152 0 25600 0 25004 0 8700 0 80633 0 539089 0 0 BENJAMIN BARSOTTI VP-CHIEF MEDICAL INFORMATION OFFICER 0 367202 0 65298 0 29946 0 17346 0 33420 0 513212 0 23406 BRETT DAVIS PRESIDENT-ASPIRUS HEALTH PLAN 0 260587 0 127333 0 6207 0 16557 0 46300 0 456984 0 0 WENDY ANGELO VP-CMO - POPULATION HEALTH 0 316829 0 44644 0 2384 0 7418 0 35344 0 406619 0 0 LISA ROWE-PEPLINSKI VP-CARE QUALITY & PATIENT SAFETY 0 287310 0 55655 0 24237 0 17283 0 1595 0 386080 0 22695 PAUL VAN DEN HEUVEL VP-NETWORKS STRATEGY 0 302649 0 31790 0 6372 0 11252 0 33846 0 385909 0 0 RUTH RISLEY-GRAY SVP & SYSTEM CNO 0 213913 0 91534 0 24455 0 17417 0 35256 0 382575 0 19718 JON HARDESTY VP-CORPORATE HUMAN RESOURCES 0 249182 0 49445 0 27310 0 10120 0 33150 0 369207 0 21288 MATTHEW BREWER VP-OPERATIONS 0 241222 0 47427 0 25131 0 9318 0 32941 0 356039 0 24855 WADE CARROLL VP-INFORMATION TECHNOLOGY 0 235726 0 45609 0 24721 0 10403 0 32750 0 349209 0 23743 TERESA THEILER PRESIDENT-ASPIRUS NORTH DIVISION 0 170897 0 43000 0 1138 0 11310 0 12532 0 238877 0 0 JUSTIN CEBERY REGISTERED NURSE 70826 81026 0 50 14 2997 2112 4838 13166 16243 86118 105154 0 0 CATHERINE MARSH PHARMACIST 62980 99089 0 0 45 64 1460 6500 5402 7137 69887 112790 0 0 ROBERT ANDERSON PHARMACIST 61290 90596 0 0 932 928 1865 5733 5492 6016 69579 103273 0 0 SHARON KRAUSE PHARMACIST 60401 89910 0 0 1690 273 952 5071 5405 5615 68448 100869 0 0 PART I, LINE 1A PAUL VAN DEN HEUVEL ($4,050) HAD A TAXABLE HOUSING ALLOWANCE. PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE HOWARD YOUNG MEDICAL CENTER, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUAL: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGESLSKI $112,143 W. CARROLL $23,743 B. BARSOTTI $23,406 J. MATHESON $26,065 J. REDMAN-SCHELL $51,368 J. HEISLER $25,179 J. HARDESTY $21,288 L. ROWE-PEPLINSKI $22,695 M. BREWER $24,855 R. SMITH $53,547 R. RISLEY-GRAY $19,718 T. RICHARDSON $50,634 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: 13% FOR SENIOR VICE PRESIDENT OR PRESIDENT, 15% FOR SVP & CHIEF FINANCIAL OFFICER, AND 20% FOR THE PRESIDENT & CHIEF EXECUTIVE OFFICER. 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; 24 MONTHS FROM 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 WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTH 391337855 97712JDN0 2021-11-10 17990909 REVENUE BONDS SERIESE 2021 0 0 0 A 17990909 128165 2018 0 0 1 1 A 0 0 1 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2021 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL & CLINICS, INC. (EIN 39-1138241); ASPIRUS BUILDINGS, INC. (EIN 39-1406537); ASPIRUS STEVENS POINT HOSPITAL & CLINICS, INC. (EIN 39-0808443); ASPIRUS STANLEY HOSPITAL & CLINICS, INC. (EIN 39-0807065); ASPIRUS MERRILL HOSPITAL & CLINICS, INC. (EIN 39-0808503); ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS, INC. (EIN 39-1390638); ASPIRUS EAGLE RIVER HOSPITAL & CLINICS, INC. (EIN 39-0985690); AND THE HOWARD YOUNG MEDICAL CENTER, INC. (EIN 39-0873606). INFORMATION REGARDING THE SERIES 2021 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 2021 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2021 BONDS.] PART III, LINES 3A AND 3B: ASPIRUS, INC., THE PARENT ORGANIZATION OF THE HOWARD YOUNG MEDICAL CENTER INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW LEASE AGREEMENTS, 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. FORM 990, PART VI, SECTION A, LINE 4 IN AUGUST 2021, THE ORGANIZATION'S PARENT BECAME ASPIRUS INC, WHO IS THE SOLE PARENT MEMBER OF THE ORGANIZATIONS REPORTED ON SCHEDULE R ATTACHED. THE FIRST MONTH OF THE FISCAL YEAR (JULY) THE ORGANIZATION WAS A PART OF A RELATED PARTY STRUCTURE WITH THE OVERARCHING PARENT BEING ASCENSION HEALTH ALLIANCE (45-3358926). THE DIRECT PARENT BEING MINISTRY HEALTH CARE INC. (39-1490371) WHO IS OWNED BY ASCENSION HEALTH (31-1662309) WHICH IS OWNED BY ASCENSION HEALTH ALLIANCE (45-3358926). THE BYLAWS AND ARTICLES WERE AMENDED TO REFLECT THIS CHANGE. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE AUGUST 1, 2021, THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. PRIOR TO THAT, MINISTRY HEALTH CARE INC WAS THE CORPORATE MEMBER. FURTHER DETAILS ARE PROVIDED THROUGHOUT THE FORM. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS IS COMPRISED OF TEN DIRECTORS. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS MEMBER CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS, CONSISTING OF THREE NOMINATED BY THE NOMINATING COMMITTEE AND THREE NOMINATED BY ASPIRUS, INC. WITH CONSIDERATION TO INPUT FROM THE CORPORATION'S BOARD, AND ELECTED BY ASPIRUS, INC., TWO ASPIRUS MEMBER CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTOR FROM EACH HOSPITAL, CONSISTING OF PHYSICIANS IN THE ACTIVE CATEGORY OF THE MEDICAL STAFF AT THE HOSPITAL, NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE 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, STRATEGIC AND LONG-RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 INFORMATION. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS 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 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 NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS, INC. 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 IX, LINE 11G OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,265,440. MANAGEMENT AND GENERAL EXPENSES 698,814. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,964,254. LAB SERVICES: PROGRAM SERVICE EXPENSES 234,654. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 234,654. CONTRACT NURSING AND OTHER SERVICES: PROGRAM SERVICE EXPENSES 4,856,233. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,856,233. MEDICAL DIRECTORS FEES: PROGRAM SERVICE EXPENSES 47,112. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,112. FOOD SERVICE FEES: PROGRAM SERVICE EXPENSES 1,883. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,883. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 94,487. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,487. FORM 990, PART XI, LINE 9: RESTATEMENT OF NET ASSETS DUE TO MERGER -22,449,310. FORM 990, PART XII, LINE 2C: THE HOSPITAL RELIED ON THEIR NEW PARENT MEMBER, ASPIRUS INC, IN THE SELECTION OF THE INDEPENDENT AUDITORS. THEY WERE INCLUDED IN THEIR CONSOLIDATED AUDIT. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE 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 333 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS MEDICAL GROUP INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS ONTONAGON 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 HEALTH CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS VNA HOME HEALTH INC 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTGAGE WI 53901 390806250 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD HOSPITAL & CLINICS INC 135 S GIBSON STREET MEDFORD WI 54451 390964813 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD FOUNDATION INC 135 S GIBSON STREET MEDFORD WI 54451 391777081 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL & CLINICS INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 390808443 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL FOUNDATION INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 391657410 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS STANLEY HOSPITAL & CLINICS INC 1120 PINE STREET STANLEY WI 54768 390807065 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL & CLINICS INC 601 S CENTER AVENUE MERRILL WI 54452 390808503 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL FOUNDATION INC 601 S CENTER AVENUE MERRILL WI 54452 391627755 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS INC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391390638 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS EAGLE RIVER HOSPITAL & CLINICS INC 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 HOWARD YOUNG HEALTH CARE INC 240 MAPLE STREET WOODRUFF WI 54568 391499115 HEALTHCARE WI 501 (C) 3 LINE 12B, II ASPIRUS INC 1 ASPIRUS MEDICAL GROUP - NORTHERN WISCONSIN 2200 WESTWOOD DRIVE WAUSAU WI 54401 391965593 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 MINISTRY HEALTH CARE INC C/O TAX DEPARTMENT PO BOX 45998 ST LOUIS MO 631455998 391490371 PARENT (FORMER) MO 501 (C) 3 LINE 12A, I ASCENSION HEALTH 1 ASCENSION HEALTH C/O TAX DEPARTMENT PO BOX 45998 ST LOUIS MO 631455998 311662309 NATIONAL HEALTH SYSTEM MO 501 (C) 3 LINE 12A, I ASCENSION HEALTH ALLIANCE 1 ASCENSION HEALTH ALLIANCE C/O TAX DEPARTMENT PO BOX 45998 ST LOUIS MO 631455998 453358926 NATIONAL HEALTH SYSTEM MO 501 (C) 3 LINE 12A, I N/A 0 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI N/A 0 0 THE WESTWOOD CONFERENCE CENTER LLC 333 PINE RIDGE BLVD WAUSAU WI 54401 571184256 REAL ESTATE INVESTMENT WI N/A 0 0 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 0 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 0 ASPIRUS HEALTH VENTURES 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 0 ASPIRUS ARISE HEALTH PLAN OF WI INC 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 0 ASPIRUS ARISE HEALTH PLAN OF MI INC 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 0 ASPIRUS CAMPUS PROPERTY CONDOMINIUM OWNERS ASSOCIATION INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 842513742 ASSOCIATION WI N/A C 0 0 0 0 1 1 0 0 0 1 1 0 0 1 0 1 1 1 1 1 ASPIRUS WAUSAU HOSPITAL I 121258 COST ASPIRUS WAUSAU HOSPITAL O 302802 COST ASPIRUS WAUSAU HOSPITAL P 72402 COST ASPIRUS INC M 4267078 COST ASPIRUS INC O 16931405 COST ASPIRUS INC P 84778577 COST ASPIRUS MEDICAL GROUP Q 91263 COST ASPIRUS STEVENS POINT HOSPITAL I 157802 COST ASPIRUS STEVENS POINT HOSPITAL P 128766 COST ASPIRUS STANLEY HOSPITAL I 162768 COST ASPIRUS MERRILL HOSPITAL I 127697 COST ASPIRUS MERRILL HOSPITAL Q 171505 COST ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL O 89316 COST ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL P 88793 COST ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL I 61232 COST ASPIRUS EAGLE RIVER L 62000 COST ASPIRUS EAGLE RIVER O 160288 COST ASPIRUS EAGLE RIVER Q 260919 COST SCHEDULE R, PART II, PART III AND PART IV: IN AUGUST 2021, THE ORGANIZATION'S PARENT BECAME ASPIRUS INC, WHO IS THE SOLE PARENT MEMBER OF THE ORGANIZATIONS REPORTED ON SCHEDULE R ATTACHED. THE FIRST MONTH OF THE FISCAL YEAR (JULY) THE ORGANIZATION WAS A PART OF A RELATED PARTY STRUCTURE WITH THE OVERARCHING PARENT BEING ASCENSION HEALTH ALLIANCE (45-3358926). THE DIRECT PARENT BEING MINISTRY HEALTH CARE INC. (39-1490371) WHO IS OWNED BY ASCENSION HEALTH (31-1662309) WHICH IS OWNED BY ASCENSION HEALTH ALLIANCE (45-3358926). THE RELATED PARTY STRUCTURE OF ASCENSION HEALTH ALLIANCE/ASCENSION HEALTH/MINISTRY HEALTH CARE CAN BE PROVIDED UPON REQUEST. ALL COMPENSATION FROM BOTH RELATED PARTY STRUCTURES HAS BEEN REPORTED ON THE FORM 990. TRANSACTIONS AS REPORTED ON SCHEDULE R, PART V, LINE 2 TRANSACTIONS ARE NOT INCLUDING TRANSACTIONS WITH ASCENSION HEALTH ENTITIES FOR THE ONE MONTH OF RELATIONSHIP.