2023-05-12T15:09:03-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 391390638 ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS ASPI 7153612000 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 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 189959379 0 X WWW.ASPIRUS.ORG X 1981 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 10 7 620 17 0 0 2858985 2969186 147536646 186677096 -27546 12230 297538 289351 150665623 189947863 164281 3234 0 0 59889762 95892047 0 0 0 90453199 104036314 150507242 199931595 158381 -9983732 78779146 127420805 51272831 83063990 27506315 44356815 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 153974491 3234 186507897 ASPIRUS RHINELANDER HOSPITAL IS A 63-BED HOSPITAL CAMPUS, AND ASPIRUS TOMAHAWK HOSPITAL IS A 15-BED CAMPUS, BOTH OF WHICH PROVIDE SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2022, ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS SERVICED THE COMMUNITY THROUGH A TOTAL OF APPROXIMATELY 12,232 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR APPROXIMATELY 101,146 OUTPATIENT VISITS, WHICH INCLUDED APPROXIMATELY 3,700 OUTPATIENT SURGERIES AND APPROXIMATELY 15,633 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.BEGINNING IN DECEMBER OF 2021, THE VARIOUS ASPIRUS CLINICS IN THE REGION WERE ALL REORGANIZED SO THAT THEY WERE INCLUDED UNDER ASPIRUS RHINELANDER HOSPITAL. 153974491 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 68 0 1 620 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 SVP-SERVICE LINE & PATIENT EXP. 2.00 50.00 X X 0 495034 104300 JESSE TISCHER VICE CHAIR-SVP & PRESIDENT-REGIONAL MARKETS 2.00 50.00 X X 0 644385 101649 JUDY SMOLAREK RN CHAIR 1.00 4.00 X X 0 0 0 STEVE LAKING SECRETARY/TREASURER 1.00 4.00 X X 0 0 0 SISTER ELIZABETH AMMAN OP BOARD MEMBER 1.00 4.00 X 0 0 0 HOLLY BEEDE-MCKINNEY NP BOARD MEMBER/NURSE PRACTITIONER 2.00 50.00 X 0 143770 6028 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 MATTHEW HEYWOOD PRESIDENT & CEO-ASPIRUS 2.00 50.00 X 0 2684221 266094 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 2.00 50.00 X 0 915379 141626 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 & PAT. 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 CHRISTOPER KOENIGS CLINICAL MEDICAL PHYSICIST 40.00 X 80491 115116 38130 DENAE BACHMEIER MANAGER-PHARMACY 40.00 X 72828 110551 21996 MICHELLE LANGHEIM PHARMACIST 40.00 X 62524 101632 22687 BRADLEY JAMISON SUPERVISOR-PHARMACY 40.00 X 72854 94123 11956 ELIZABETH MIKULA PHARMACIST 40.00 X 59060 85491 26316 347757 12012274 1685996 0 0 1 0 STAFFENCY LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACT LABOR 2346738 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 PHYSICIAN SERVICES 1125357 HAYES HEALTHCARE LLC PO BOX 88122 CHICAGO IL 606801122 PHYSICIAN SERVICES 649608 DELTA HEALTHCARE PLACEMENT LLC PO BOX 202940 DALLAS TX 753202940 CONTRACT LABOR 361644 RADIATION ONCOLOGY SPECIALISTS SC PO BOX 1790 BROOKFIELD WI 53008 ONCOLOGY SERVICES 337000 8 2843880 125306 2969186 PATIENT SERVICE REVENUE 621990 172917311 172917311 LAB REVENUE 621500 8418571 8418571 PHARMACY REVENUE 446110 4186314 4186314 CONTRACT SERVICE REVENUE 900099 985700 985700 169200 169200 186677096 12230 12230 105459 0 105459 105459 105459 -717 11516 -12233 -12233 CAFETERIA/VENDING REVENUE 900099 196125 196125 196125 189947863 186507896 0 470781 X 1500 1500 1734 1734 78258354 72722436 5535918 2275393 2035908 239485 10962471 9080602 1881869 4395829 4013752 382077 11557 11557 20794870 15975307 4819563 2660 2660 245739 188442 57297 116448 61746 54702 2728444 531053 2197391 249136 193968 55168 1652215 415521 1236694 6179000 3487984 2691016 250755 1012 249743 CORPORATE ALLOCATIONS 28899062 5592502 23306560 MEDICAL SUPPLIES 27685085 27222633 462452 BAD DEBT 6718397 6718397 REPAIRS AND MAINTENANCE 2571447 1178204 1393243 5931499 4549130 1382369 199931595 153974491 45957104 0 4884 9400 1071337 452313 11544 0 18617572 28297904 2389454 4148773 100500 352038 101220765 9547507 46302458 91673258 0 164807 90931 0 10190466 2322312 78779146 127420805 7774428 11676942 0 419936 0 68647572 43498403 2319540 51272831 83063990 X 27337920 44192008 168395 164807 27506315 44356815 78779146 127420805 X -9983732 26834232 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 11557 11557 0 PART II-B, LINE 1: ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND WHA HAVE NOTIFIED THE HOSPITAL THAT APPROXIMATELY $11,557 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 8597016 8597016 76507623 3016207 73491416 17944 4871 13073 15611579 6526429 9085150 486603 486603 91673258 ASBESTOS LIABILTY 246000 DUE TO AFFILIATES 907001 ESTIMATED THIRD PARTY PAYOR PAYABLES 383400 DEFERRED COMPENSATION 168961 OPERATING LEASE LIABILITY 582178 LONG TERM INSURANCE LIABILITY 32000 2319540 X 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 0 1 1 1378003 1378003 0.00710 27625888 19367530 8258358 0.04270 29003891 19367530 9636361 0.04980 101451 1332 100119 0.00050 23298 23298 0.00010 648 648 0.00000 125397 1332 124065 0.00060 29129288 19368862 9760426 0.05040 1 449 449 0.00000 1 449 449 0.00000 1 2588545 0 25436068 31928015 -6491947 X 1 1 2 1 ASPIRUS RHINELANDER HOSPITAL 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 WWW.ASPIRUS.ORG/FIND-A-LOCATION /ASPIR 138 X X X 2 ASPIRUS TOMAHAWK HOSPITAL 401 WEST MOHAWK DRIVE TOMAHAWK WI 54487 WWW.ASPIRUS.ORG/FIND-A-LOCATION /ASPIR 1016 X X X X ASPIRUS RHINELANDER HOSPITAL 1 0 1 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X 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 ASPIRUS TOMAHAWK HOSPITAL 2 0 1 1 X X X X X X X X X 20 1 1 1 1 X HTTPS://WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X 1 20 1 HTTPS://WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X 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 ASPIRUS RHINELANDER HOSPITAL 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 2022). 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.ASPIRUS RHINELANDER 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 ASPIRUS RHINELANDER HOSPITAL, COMMUNITY HEALTH IMPROVEMENT STAFF ORGANIZED HOSPITAL AND CLINIC VOLUNTEERS FOR THE LOCAL FOOD PANTRY. 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. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 2: THE HOSPITAL WAS ACQUIRED BY ASPIRUS INC DURING THE FISCAL YEAR. MORE DETAILS ARE PROVIDED THROUGHOUT THE FORM 990. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 5: RECOGNIZING ITS VITAL IMPORTANCE IN UNDERSTANDING THE HEALTH NEEDS AND ASSETS OF THE COMMUNITY, THE HOSPITAL INVITED THE INPUT OF COMMUNITY MEMBERS-AT-LARGE AS WELL AS A RANGE OF PUBLIC HEALTH AND SOCIAL SERVICE PROVIDERS THAT REPRESENT THE BROAD INTERESTS OF LINCOLN COUNTY. A CONCERTED EFFORT WAS MADE TO ENSURE THAT THE INDIVIDUALS AND ORGANIZATIONS REPRESENTED THE NEEDS AND PERSPECTIVES OF: 1) PUBLIC HEALTH PRACTICE; 2) INDIVIDUALS WHO ARE MEDICALLY UNDERSERVED, HAVE LOW INCOME, OR ARE CONSIDERED AMONG THE MINORITY POPULATIONS SERVED BY THE HOSPITAL; AND 3) THE BROADER COMMUNITY AT LARGE AND THOSE WHO REPRESENT THE BROAD INTERESTS AND NEEDS OF THE COMMUNITY SERVED. TWO METHODS WERE USED TO GATHER COMMUNITY INPUT: A COMMUNITY SURVEY AND KEY INFORMANT INTERVIEWS. THE PROCESS AND RESULTS ARE OUTLINED BELOW. COMMUNITY SURVEY: AN ELECTRONIC/ONLINE SURVEY WAS CREATED AND DISTRIBUTED VIA EMAIL THROUGH LOCAL NETWORKS IN AUGUST-OCTOBER 2020. INITIAL DISTRIBUTION WAS CONDUCTED THROUGH COMMUNITY COALITION MEMBERS, THE HEALTH DEPARTMENT, THE HOSPITAL FOUNDATIONS AND EXISTING COMMUNITY MEMBER EMAIL LISTS OF THE HOSPITALS' COMMUNITY HEALTH IMPROVEMENT ASSOCIATES. THE SURVEY ASKED COMMUNITY MEMBERS ABOUT THEIR OPINION OF THE COMMUNITY'S TOP HEALTH ISSUES ACROSS MULTIPLE CATEGORIES OF HEALTH FACTORS. MORE THAN 270 INDIVIDUALS RESPONDED. DATA WERE ANALYZED AS A WHOLE AS WELL AS BY HOUSEHOLD INCOME (UNDER $50K ANNUALLY) AND ETHNICITY.KEY INFORMANT INTERVIEWS: ELEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED VIRTUALLY INOCTOBER AND NOVEMBER 2020. RESPONDENTS REPRESENTED THE FOLLOWING ORGANIZATIONS:LINCOLN COUNTY HEALTH DEPARTMENT (COUNTY-WIDE)AGING AND DISABILITY RESOURCE CENTER (COUNTY-WIDE)COMMUNIDAD HISPANA (COUNTY-WIDE)*COMMUNITY ACTION PROGRAM (CAP) SERVICES (COUNTY-WIDE)*UW EXTENSION (COUNTY-WIDE)KINSHIP (TOMAHAWK)TOMAHAWK SCHOOL DISTRICTHEAD START (TOMAHAWK)*SENIOR DINING SITE (TOMAHAWK)ST. VINCENT DE PAUL (MERRILL)*MERRILL COMMUNITY FOOD PANTRY** REPRESENTED INDIVIDUALS WHO ARE MEDICALLY UNDERSERVED, HAVE LOW-INCOME, OR ARE CONSIDERED AMONG THE MINORITY POPULATIONS SERVED BY THE HOSPITAL.INTERVIEWEES WERE ASKED TO REVIEW THE COMMUNITY SURVEY, BE PREPARED TO SPEAK TO THEIR PERCEPTIONS OF THE COMMUNITY'S TOP HEALTH ISSUES AND DESCRIBE THEIR REASONING. THE INTERVIEWS WERE CONDUCTED BY TWO HOSPITAL ASSOCIATES AND ONE STATEWIDE (ASPIRUS WISCONSIN) ASSOCIATE WHO LEAD COMMUNITY HEALTH IMPROVEMENT EFFORTS. A QUALITATIVE REVIEW AND RESULTING SUMMARY WAS CONDUCTED BY TWO STATEWIDE (ASCENSION WISCONSIN) COMMUNITY HEALTH IMPROVEMENT ASSOCIATES.COMMUNITY INPUT SUMMARY: THE RESULTS OF THE COMMUNITY SURVEY AND THE KEY INFORMANT INTERVIEWS WERE COMBINED INTO A GRID TO IDENTIFY SIMILARITIES, DIFFERENCES AND PATTERNS. NOTE SOME DATA IS SEPARATED BY INCOME AND BY ETHNICITY AS A WAY TO BETTER UNDERSTAND DIFFERING PRIORITIES. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:- ASPIRUS MERRILL HOSPITAL ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 11: 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.NUTRITION AND HEALTHY FOOD ASPIRUS TOMAHAWK PARTICIPATED IN THE LINCOLN COUNTY NUTRITION COALITION. 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. THE HOSPITAL OFFERED 'FIT FOR LIFE' EXERCISE CLASSES IN A SUPERVISED SETTING FOR CARDIAC REHAB PATIENTS WHO HAVE COMPLETED THEIR TREATMENT PLAN. THE HOSPITAL OFFERS THE CLASSES AT A REDUCED RATE, INCURRING LOSSES ON THE OFFERING.ORAL HEALTH NO ORAL HEALTH ACTIVITIES WERE CONDUCTED. MENTAL HEALTH AND ALCOHOL AND OTHER DRUG USEAS PART OF THE COALITION, ASPIRUS TOMAHAWK HELPED PROMOTE PUBLIC AWARENESS AND SOCIAL NORMS CAMPAIGNS (E.G., HOPELINE, SMALL TALKS, KNOW METH, ADVERSE CHILDHOOD EXPERIENCES [ACES], PARENT PACT, SOCIAL HOST AWARENESS). THE HOSPITAL ALSO HELPED PROMOTE PRESENTATIONS AND INFORMATIONAL MATERIALS AND SUPPORTED FAMILY FUN PACKS (A COVID-RESPONSE STRATEGY). 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. ADDITIONALLY, THE HOSPITAL SPENT TIME IMPROVING COMMUNITY SAFETY, INCLUDING A BIKE RODEO AND LAYING THE GROUNDWORK FOR SOME BICYCLE PATH SIGNAGE. ALL SIGNIFICANT NEEDS WERE PRIORITIZED BY THE HOSPITAL. ASPIRUS RHINELANDER HOSPITAL PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. ASPIRUS TOMAHAWK HOSPITAL PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. SCHEDULE H - PART V, SECTION B, LINE 2: RHINELANDER HOSPITAL - 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 2022). THE CHNA WILL BE DUE THE LAST DAY OF THE SECOND TAXABLE YEAR WHICH WILL BE 06/30/2024. 8 1 - ASPIRUS RHINELANDER CLINIC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 OUTPATIENT PHYSICIAN CLINIC 2 - ASPIRUS TOMAHAWK CLINIC 401 WEST MOHAWK TOMAHAWK WI 54487 OUTPATIENT PHYSICIAN CLINIC 3 - ASPIRUS CRANDON CLINIC 400 WEST GLEN STREET CRANDON WI 54520 OUTPATIENT PHYSICIAN CLINIC 4 - ASPIRUS WOODRUFF CLINIC 240 MAPLE STREET WOODRUFF WI 54568 OUTPATIENT PHYSICIAN CLINIC 5 - ASPIRUS EAGLE RIVER CLINIC 930 EAST WALL STREET EAGLE RIVER WI 54521 OUTPATIENT PHYSICIAN CLINIC 6 - ASPIRUS KOLLER BEHAVIORAL HEALTH CLINIC 1020 KABEL AVENUE RHINELANDER WI 54501 BEHAVIORAL HEALTH CLINIC 7 - ASPIRUS OUTPATIENT THERAPIES-RHINELANDER 2003 EAST WINNEBAGO STREET RHINELANDER WI 54501 OUTPATIENT REHABILITATION 8 - ASPIRUS OUTPATIENT THERAPIES - TOMAHAWK 202 W MOHAWK DRIVE TOMAHAWK WI 54487 OUTPATIENT REHABILITATION 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, SCHEDULE H 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 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 FOR FORM 990. 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 6,718,397. 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: 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. THE COSTING METHODOLOGY USED WAS THE PATIENT CARE COST TO CHARGE RATIO WHICH WAS DERIVED FROM THE CALCULATION ON IRS WORKSHEET 2. 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 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 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 V, SECTION B, LINE 7A - ST. MARY'S HOSPITAL HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/CHNAS/2021%20SACRED%20HEART%20HOSPITAL%20CHNA.PDF PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL USE 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. ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL UTILIZE 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: ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL PRIMARILY SERVE THE RESIDENTS OF LINCOLN COUNTY AND ONEIDA COUNTY AND SURROUNDING COUNTIES IN RURAL NORTHERN WISCONSIN.ASPIRUS RHINELANDER: THE POPULATION OF ONEIDA COUNTY IS APPROXIMATELY 37,800, WITH 7.9% OF RESIDENTS LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS NEARLY $56,800. APPROXIMATELY 5% OF INDIVIDUALS LIVING IN THE COUNTY ARE UNINSURED AND 15% RECEIVE MEDICAID. ONEIDA COUNTY INCLUDES DESIGNATED MENTAL HEALTH, DENTAL HEALTH AND PRIMARY CARE PROVIDER SHORTAGE AREAS. THERE ARE THREE HOSPITALS (ASPIRUS RHINELANDER HOSPITAL, HOWARD YOUNG MEDICAL CENTER, AND MARSHFIELD MEDICAL CENTER-MINOCQUA) IN ONEIDA COUNTY. ASPIRUS RHINELANDER HOSPITAL 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.)ASPIRUS TOMAHAWK HOSPITAL PRIMARILY SERVES THE RESIDENTS OF LINCOLN COUNTY AND SURROUNDING COUNTIES IN RURAL NORTH CENTRAL WISCONSIN. THE POPULATION IS APPROXIMATELY 28,000, WITH 9% LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS $56,600. SIX PERCENT OF INDIVIDUALS ARE UNINSURED AND 16% RECEIVE MEDICAID. LINCOLN COUNTY INCLUDES A DESIGNATED MENTAL HEALTH, DENTAL AND PRIMARY CARE SHORTAGE AREA. THERE ARE TWO HOSPITALS IN LINCOLN COUNTY; ASPIRUS MERRILL HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL. PART VI, LINE 5: THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING:(1) AS MENTIONED, THE ORGANIZATION PROVIDES SEVERAL SERVICES WHICH ARE NOT OTHERWISE AVAILABLE BEING IN A RURAL SETTING.(2) BASED ON THE ORGANIZATION'S MISSION, EMERGENCY ROOMS ARE MADE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY.(3) THE ORGANIZATION ALSO PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS THROUGH INTERNSHIP PROGRAMS.ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL PARTICIPATE IN GOVERNMENT SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, TRICARE).ASPIRUS TOMAHAWK IS A CRITICAL ACCESS HOSPITAL IN TOMAHAWK, WISCONSIN AND ASPIRUS RHINELANDER IS A SOLE COMMUNITY HOSPITAL IN RHINELANDER, WISCONSIN. BOTH HOSPITALS AND HOSPITAL-BASED CLINICS SERVE POOR RURAL COMMUNITIES.ASPIRUS RHINELANDER PROVIDES INPATIENT AND OUTPATIENT MENTAL HEALTH AND AODA SERVICES AT A FINANCIAL LOSS TO THE ORGANIZATION WHICH IS SOMEWHAT UNIQUE TO SMALL RURAL COMMUNITIES. PERSONS IN NEED OF MENTAL HEALTH OR AODA SERVICES WOULD OTHERWISE HAVE TO TRAVEL SEVERAL HUNDRED MILES TO SEEK CARE.ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL SERVE FOUR NATIVE AMERICAN TRIBES IN SURROUNDING COMMUNITIES. TRIBAL SERVICES ARE PAID UNDER MEDICARE-LIKE RATE UNDER CONTRACT HEALTH SERVICES REIMBURSEMENT PROGRAM UNDER THE FEDERAL INDIAN HEALTHPROGRAM. THE ORGANIZATION ALSO PARTICIPATES IN GOVERNMENT SPONSORED HEALTH PROGRAMS SUCH AS MEDICARE, MEDICAID, AND CHAMPUS. THE ORGANIZATION STRIVES TO BE A LOW-COST PROVIDER BY CONTINUALLY REDUCING INTERNAL COSTS THROUGH EFFICIENCY MEASURES WHICH IN TURN, IS PASSED ON TO PATIENTS THROUGH MARKET-BASKET PRICES. THE UNINSURED MEMBERS OF THE COMMUNITY ACCESS HEALTHCARE THROUGH THE EMERGENCY DEPARTMENT AND MEDICAL CLINICS. ALL MEDICALLY NECESSARY MEDICAL SERVICES ARE PROVIDED IN AN INPATIENT, OUTPATIENT OR CLINIC SETTING FOR PERSONS IN NEED OF CARE REGARDLESS OF THEIR ABILITY TO PAY.ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL FUND A COMMUNITY LINK COORDINATOR WHO WORKS IN CONJUNCTION WITH OUR PATIENT FAMILY SERVICES DEPARTMENT IN MEETING THE SPECIAL NEEDS OF OUR COMMUNITY. THIS TEAM HELPS OUR COMMUNITY MEMBERS NAVIGATE THE VARIOUS GOVERNMENTAL PROGRAMS BY HELPING OUR UNINSURED POPULATION APPLY FOR STATE MEDICAID PROGRAMS AND THE ORGANIZATION'S OWN COMMUNITY CARE (CHARITY CARE) PROGRAM. THE COMMUNITY CARE PROGRAM PROVIDES FINANCIAL ASSISTANCE AND SLIDING SCALE DISCOUNTS TO PATIENTS WHO MEET CERTAIN INCOME AND ASSET CRITERIA, UP TO 300% OF THE FEDERAL POVERTY GUIDELINES. PART VI, LINE 6: ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL ARE PART OF THE ASPIRUS HEALTH SYSTEM. ASPIRUS, INC. IS A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL WORK 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 ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL 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 ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL 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. 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 TISCHER VICE CHAIR-SVP & PRESIDENT-REGIONAL 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 SVP-SERVICE LINE & PATIENT EXP. 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 & PAT. 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 CHRISTOPER KOENIGS CLINICAL MEDICAL PHYSICIST 80416 115001 0 0 75 115 2373 6654 13462 15641 96326 137411 0 0 DENAE BACHMEIER MANAGER-PHARMACY 72478 105016 0 5000 350 535 1120 7273 5778 7825 79726 125649 0 0 MICHELLE LANGHEIM PHARMACIST 62454 93684 0 0 70 7948 1041 3983 8461 9202 72026 114817 0 0 BRADLEY JAMISON SUPERVISOR-PHARMACY 68212 94003 0 0 4642 120 2125 6129 1234 2468 76213 102720 0 0 ELIZABETH MIKULA PHARMACIST 59020 85430 0 0 40 61 1736 3086 10528 10966 71324 99543 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, ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS & CLINICS, 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 69386269 REVENUE BONDS SERIES 2021 0 0 0 A 69386269 494301 68891968 2017 0 0 1 1 A 0 1 0 0 0 0 1 A 0 0 1 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 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS, INC., 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. 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 THERE SHALL BE A MINIMUM OF 10 VOTING DIRECTORS ALLOCATED AS FOLLOWS. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN SIX INDEPENDENT COMMUNITY CLASS DIRECTORS, TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., AND TWO PROVIDER CLASS DIRECTORS 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 CONTRACT NURSING AND OTHER LABOR: PROGRAM SERVICE EXPENSES 9,032,301. MANAGEMENT AND GENERAL EXPENSES 1,633,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,666,059. FOOD SERVICE FEES: PROGRAM SERVICE EXPENSES 5,225. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,225. HOUSEKEEPING FEES: PROGRAM SERVICE EXPENSES 468,936. MANAGEMENT AND GENERAL EXPENSES 236,041. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 704,977. INTERPRETER FEES: PROGRAM SERVICE EXPENSES 5,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,167. LAB FEES: PROGRAM SERVICE EXPENSES 3,522,928. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,522,928. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 92,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,278. OTHER FEES: PROGRAM SERVICE EXPENSES 2,623,955. MANAGEMENT AND GENERAL EXPENSES 2,949,764. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,573,719. PHARMACY FEES: PROGRAM SERVICE EXPENSES 224,517. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 224,517. FORM 990, PART XI, LINE 9: NET ASSET ADJUSTMENT FROM ACQUISITION OF NEW PARENT 26,834,232. 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 EAGLE RIVER HOSPITAL & CLINICS INC 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 THE HOWARD YOUNG MEDICAL CENTER INC 240 MAPLE STREET WOODRUFF WI 54568 390873606 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 CONDOMINIUM OWNERS ASSOCIATION INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 842513742 ASSOCIATION WI N/A C 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 ASPIRUS MEDICAL GROUP INC O 925378 COST ASPIRUS MEDICAL GROUP INC Q 357465 COST ASPIRUS MEDICAL GROUP INC P 4638625 COST ASPIRUS MEDICAL GROUP INC I 95340 COST ASPIRUS MERRILL HOSPITAL INC Q 56259 COST ASPIRUS STANLEY HOSPITAL INC P 98768 COST ASPIRUS STEVENS POINT HOSPITAL INC M 359794 COST ASPIRUS STEVENS POINT HOSPITAL INC O 1902152 COST ASPIRUS STEVENS POINT HOSPITAL INC P 1905619 COST ASPIRUS WAUSAU HOSPITAL INC G 1323532 COST ASPIRUS WAUSAU HOSPITAL INC P 1369905 COST ASPIRUS WAUSAU HOSPITAL INC O 520217 COST ASPIRUS WAUSAU HOSPITAL INC L 147953 COST ASPIRUS WAUSAU HOSPITAL INC K 341553 COST ASPIRUS WAUSAU HOSPITAL INC Q 1264317 COST ASPIRUS WAUSAU HOSPITAL INC I 1168866 COST ASPIRUS INC P 3772704 COST ASPIRUS INC Q 71124 COST ASPIRUS INC O 83640120 COST ASPIRUS INC M 27024191 COST ASPIRUS INC K 113138 COST ASPIRUS INC I 12080376 COST HOWARD YOUNG MEDICAL CENTER Q 88793 COST HOWARD YOUNG MEDICAL CENTER I 61232 COST HOWARD YOUNG MEDICAL CENTER O 89316 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.