2023-05-12T12:55:13-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 382908586 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC ASPI 9069322525 N10561 GRAND VIEW LANE IRONWOOD MI 49938 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 9069322525 2023-05-12 1 SIDNEY SCZYGELSKI 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-05-12 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 74400615 0 X WWW.ASPIRUS.ORG X 1989 MI WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 14 7 403 35 0 0 5084027 1629638 68196849 71966385 751240 680371 228903 124221 74261019 74400615 2182 772 0 0 29040235 29500198 0 0 0 33741905 37653051 62784322 67154021 11476697 7246594 77443317 72385424 36289526 32871936 41153791 39513488 X WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 0 0 49716174 772 72000385 ASPIRUS IRONWOOD HOSPITAL AND CLINICS IS A 25-BED CRITICAL ACCESS HOSPITAL WHICH PROVIDES HEALTH CARE SERVICES TO RESIDENTS OF IRONWOOD, MICHIGAN AND ITS SURROUNDING COMMUNITIES. SOME OF THE SERVICES PROVIDED BEYOND TRADITIONAL INPATIENT HOSPITALIZATIONS INCLUDE SURGERY, EMERGENCY CARE, RADIOLOGY, LABORATORY, THERAPIES, EYE CARE, ONCOLOGY, SLEEP LAB, AND CARDIOLOGY, AMONG VARIOUS OTHER HEALTH CARE SERVICES.ASPIRUS IRONWOOD HOSPITAL AND CLINICS PROVIDES HEALTH CARE SERVICES TO ALL PEOPLE, REGARDLESS OF THEIR ABILITY TO PAY. FOR THOSE INDIVIDUALS UNABLE TO PAY FOR THEIR HEALTH CARE NEEDS, ASPIRUS IRONWOOD HOSPITAL AND CLINICS OFFERS SERVICES FOR FREE OR AT A REDUCED PRICE THROUGH THE FINANCIAL AID DISCOUNT POLICY. PLEASE REFER TO SCHEDULE H OF THE FORM 990 FOR ADDITIONAL INFORMATION ON THE COST OF FINANCIAL AID DISCOUNTS PROVIDED TO PATIENTS DURING FISCAL YEAR 2022.ASPIRUS IRONWOOD HOSPITAL AND CLINICS ALSO PROVIDES HEALTH CARE SERVICES TO INDIVIDUALS COVERED UNDER GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID WHICH OFTEN REIMBURSE THE HOSPITAL AT AMOUNTS SUBSTANTIALLY LOWER THAN THE USUAL AND CUSTOMARY CHARGE. THOSE PEOPLE COVERED BY THESE TYPES OF PROGRAMS NEED ACCESS TO HEALTH CARE BUT ARE OFTEN TIMES UNABLE TO TRAVEL LONG DISTANCES TO RECEIVE THIS CARE. ASPIRUS IRONWOOD HOSPITAL AND CLINICS PROVIDES THIS LOCAL, QUALITY HEALTH CARE TO MANY ELDERLY AND LOW-INCOME INDIVIDUALS THAT ARE IN NEED OF HEALTH CARE. DURING FISCAL YEAR 2022, MORE THAN 69.5% OF THE HOSPITAL'S GROSS PATIENT SERVICE REVENUE WAS FROM BENEFICIARIES OF MEDICARE AND MEDICAID. 49716174 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 40 0 403 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 JESSE TISCHER SVP & PRESIDENT-REG. MARKETS 1.00 50.00 X 0 644385 101649 DANIEL LUKES BOARD MEMBER/PHYSICIAN 1.00 X 0 669993 44505 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-AMG 1.00 50.00 X X 0 572454 92664 JONATHAN BRUEGGEMAN BOARD MEMBER/PHYSICIAN 1.00 50.00 X 0 443961 50805 CHRISTINE HARFF BOARD MEMBER(THRU 10/21)/PRES.-REG. UP 1.00 50.00 X 0 403040 91022 PATRICK TINCHER JR VP-FINANCE REGIONAL OPERATIONS 1.00 50.00 X 0 334332 52220 MARCUS SANTINI BOARD MEMBER/PHYSICIAN (THRU 9/21) 40.00 X 0 319936 53873 JENNIFER WEAVER BOARD MEMBER/NURSE PRACTITIONER 2.00 40.00 X 0 104166 20417 KRISTEN MESKE BOARD MEMBER/NURSE PRACTITIONER 2.00 40.00 X 0 108310 5597 JAMES LORENSON CHAIRPERSON (THRU 01/22) 1.00 X X 0 0 0 JOHN MATONICH CHAIRPERSON 1.00 X X 0 0 0 STEVEN TINTI TREASURER 1.00 X X 0 0 0 KATIE L CLARK SECRETARY 1.00 X X 0 0 0 RICHARD KOUBEK BOARD MEMBER 1.00 X 0 0 0 JAMES R RICHARDSON BOARD MEMBER 1.00 X 0 0 0 KIRK R SCHOTT BOARD MEMBER/CONTRACTED PHYSICIAN 40.00 1.00 X 0 0 0 WILLIAM W WOOD BOARD MEMBER 1.00 X 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 1.00 50.00 X 0 2684221 266094 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 1.00 50.00 X 0 915379 141626 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 751984 56650 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 516494 97286 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 495034 104300 RENEE SMITH EXECUTIVE DIRECTOR ANI 2.00 50.00 X 0 460002 93775 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 2.00 50.00 X 0 452729 89948 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 2.00 50.00 X 0 449756 89333 BRETT DAVIS PRESIDENT - ASPIRUS HEALTH PLAN 2.00 50.00 X 0 394127 62857 LISA ROWE-PEPLINSKI VP-CARE QUALITY & PAT. SAFETY 2.00 50.00 X 0 367202 18878 PAUL VAN DEN HEUVEL VP-NETWORKS STRATEGY 2.00 50.00 X 0 340811 45098 RUTH RISLEY-GRAY SVP & SYSTEM CNO 2.00 50.00 X 0 329902 52673 CASEY MADISON MANAGER-PHARMACY 40.00 X 143279 0 42771 TINA MARSHALL NURSE PRACTITIONER 40.00 X 160133 0 21824 CYNTHIA SIMMONS NURSING SUPERVISOR 40.00 X 122928 0 38101 SUSAN TICE REGISTERED NURSE - AIW MNA 40.00 X 135851 0 19733 JULIE MONVILLE DIR.-NURSE & REG. EMERG. SERVICES 40.00 X 138973 0 8305 MICHAEL MCGRAIL FORMER SVP & SYSTEM CMO 0.00 0.00 X 0 449085 0 701164 12207303 1762004 12 1 1 0 MICHIGAN EMERGENCY PHYSICIANS PO BOX 677979 DALLAS TX 752677979 ER PHYSICIAN COVERAGE 2029240 STAFFENCY LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACT LABOR 1310017 UPPER PENINSULA HEALTH CARE SOLUTIONS 853 W WASHINGTON ST MARQUETTE MI 498554330 MRI SERVICES 518397 WAPITI 107 FLYNN DRIVE WUITE 600 MILBANK SD 57252 CONTRACT PROVIDER 404341 TELEHEALTH SOLUTIONS PO BOX 1813 SPARTANBURG SC 29304 ELECTRONIC MEDICAL SERVICES 323490 10 1627381 2257 1629638 NET PATIENT SERVICE REVENUE 621990 68620993 68620993 PHARMACY 340B 446110 2449080 2449080 RELATED PARTY RENTAL 531120 167910 167910 728402 728402 71966385 479075 479075 14346 0 14346 14346 14346 200296 1000 0 0 200296 1000 201296 201296 CAFETERIA 722514 75875 75875 EHR INCENTIVE PAYMENTS 621990 34000 34000 109875 74400615 72000385 0 770592 X 772 772 24207654 21020015 3187639 942222 717540 224682 3388389 3088044 300345 961933 721939 239994 43955 43955 3682 3682 2195 2195 8863363 8596379 266984 30385 685 29700 124132 54170 69962 31540 23392 8148 599108 14556 584552 157443 104416 53027 566145 325 565820 2610179 1002145 1608034 422838 422838 DRUGS AND MEDICAL SUPPL 10151413 10117271 34142 CORPORATE ALLOCATIONS 9704877 3279933 6424944 QAAP EXPENSES 1723203 1723203 BAD DEBT EXPENSE 1127768 1127768 1490825 974592 516233 67154021 49716174 17437847 0 2911415 2642140 12208705 11465541 6828423 9973693 1175968 1696641 250348 207028 70269434 44747548 27126462 25521886 10434793 9800243 6230764 5171676 236607 236607 10039832 5669969 77443317 72385424 4473775 3981450 299922 1337883 14138098 14090621 17377731 13461982 36289526 32871936 X 40541124 38941153 612667 572335 41153791 39513488 77443317 72385424 X 7246594 -2216919 -6669978 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 3682 3682 0 PART II-B, LINE 1: MEMBERSHIP DUES ARE PAID TO THE MICHIGAN HOSPITAL ASSOCIATION (MHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA). A PORTION OF THOSE DUES ARE COMMITTED TO LOBBYING PURPOSES. MHA INVOICE STATES 14.56% OF $11,042 ($1,608) GOES FOR LOBBYING ON INVOICE COVERING THE PERIOD OF 7/1/21-6/30/22. SIMILARLY, AHA DUES COMMITTED TO LOBBYING WAS 26.47% OF $7,835 ($2,074). 421754 421754 41191170 19958611 21232559 142644 87076 55568 27885832 24563290 3322542 628034 138571 489463 25521886 DEFERRED COMPENSATION PLAN ASSETS 4286300 F INVESTMENTS IN UNCONSOLIDATED AFFILIATES 885376 F 5171676 CSV LIFE INSURANCE 229479 OPERATING LEASE ROU ASSET 194832 RELATED PARTY RECEIVABLE 5245658 5669969 DEFERRED COMPENSATION 4297747 LONG-TERM INSURANCE LIABILITY 257946 DUE TO OTHER -9553 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3825000 FINANCE LEASE LIABILITY 111021 OPERATING LEASE LIABILITY 194832 MEDICARE REFUNDABLE ADVANCES 4784989 13461982 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 489575 489575 0.00740 13548209 7027854 6520355 0.09870 14037784 7027854 7009930 0.10610 14394 400 13994 0.00020 2112390 2068272 44118 0.00070 7500 7500 0.00010 2134284 2068672 65612 0.00100 16172068 9096526 7075542 0.10710 1 392634 0 15441375 15232011 209364 X 1 1 1 WESTERN UPPER MICHIGAN EYE CARE LLC EYE CLINIC 0.51000 0.00000 0.49000 1 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS N10561 GRAND VIEW LANE IRONWOOD MI 49938 WWW.ASPIRUS.ORG 270022 X X X X ASPIRUS IRONWOOD HOSPITAL & CLINICS INC 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 21 1 SEE PART V, SECTION C, LINE 7D 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 ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: THROUGHOUT THE PLANNING AND PRODUCTION OF THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT, A STEERING COMMITTEE OF COMMUNITY LEADERS AND SUBJECT MATTER EXPERTS MET REGULARLY TO DIRECT THE REPORTING PROCESS, WHICH INCLUDED THE CREATION AND DISTRIBUTION OF A SURVEY TO A RANDOM SELECTION OF RESIDENTS. FOR ASPIRUS IRONWOOD, THIS INCLUDES INPUT FROM THE WESTERN UPPER PENINSULA HEALTH DEPARTMENT AS WELL AS OTHER ASPIRUS UP HOSPITALS. REPRESENTATIVES FROM EACH ORGANIZATION COMMUNICATED IN REGULAR MEETINGS. THE KEY DATA ELEMENT IN THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT IS THE COMMUNITY SURVEY, WHICH IDENTIFIED IMPORTANT ISSUES REGARDING QUALITY OF LIFE THAT HAD NOT BEEN MEASURED BEFORE THE SURVEY WAS CONDUCTED. THE SURVEY WAS MAILED TO THOUSANDS OF HOUSEHOLDS ACROSS THE ENTIRE UPPER PENINSULA, WITH NEARLY 5,000 RESPONSES BACK FROM RESIDENTS. THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT ALSO INCLUDES A SIGNIFICANT AMOUNT OF DATA INDICATORS ACROSS MULTIPLE CATEGORIES RELATING TO HEALTH AND HEALTH FACTORS. THIS DATA WAS COMPILED FROM A WIDE ARRAY OF PUBLISHED SOURCES AND FROM HEALTH CARE PROVIDERS. PUBLISHED SOURCES INCLUDED THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, AND STATISTICS COMPILED BY THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH, THE WISCONSIN DIVISION OF PUBLIC HEALTH, AND OTHER GOVERNMENT AND PRIVATE AGENCIES. ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:- ASPIRUS ONTONAGON HOSPITAL, INC.- U.P. HEALTH SYSTEM - BARAGA COUNTY MEMORIAL HOSPITAL- ASPIRUS KEWEENAW HOSPITAL- ASPIRUS IRON RIVER HOSPITAL- COPPER COUNTRY MENTAL HEALTH SERVICES- GOGEBIC COUNTY COMMUNITY MENTAL HEALTH- UPPER GREAT LAKES FAMILY HEALTH CENTER ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6B: WESTERN U.P. HEALTH DEPARTMENT ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A AND LINE 10A:HTTPS://WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: USING A SET OF CATEGORIES AND THE DATA WITHIN, ASPIRUS IRONWOOD, ALONG WITH THE OTHER 3 ASPIRUS UPPER MICHIGAN HOSPITALS, IDENTIFIED THREE MAJOR PRIORITY AREAS THAT IMPACT EACH OF THE UPPER PENINSULA COUNTIES AND IRON COUNTY, WI. FOR THE PURPOSES OF THE ASPIRUS IRONWOOD CHNA, AND TO FULFILL THE REQUIREMENTS SET FORTH BY THE PPACA, ASPIRUS IRONWOOD HAS TAKEN THE THREE OVERALL PRIORITIES AND WILL BE ADDRESSING THESE NEEDS AND LOOKING TO MAKE AN IMPACT ON THE FUTURE OF OUR COMMUNITIES. THE THREE MAJOR PRIORITY AREAS THAT WILL BE THE FOCUS ARE:1. MENTAL HEALTH ASPIRUS HOSPITALS IN THE U.P. PLAN TO ADDRESS MENTAL HEALTH THROUGH PREVENTION TRAININGS, ANTI-STIGMA CAMPAIGN, SENIOR WELLNESS PROGRAM, AND SUPPORT GROUPS THROUGH COLLABORATION WITH SEVERAL LOCAL MENTAL HEALTH AGENCIES AND RECOVERY CENTERS.2. SUBSTANCE ABUSE THE FOLLOWING STRATEGIES ARE PLANNED: EDUCATION AND OUTREACH, SELF-REFERRAL PROCESS, SUPPORT GROUPS, PROVISION OF SUBOXONE, AND PEER RECOVERY COACHING. PLANNED COLLABORATION WITH SEVERAL LOCAL MENTAL HEALTH AGENCIES AND RECOVERY CENTERS WILL ASSIST WITH THE PLAN.3. CHRONIC DISEASES - STRATEGIES ARE PLANNED FOR PREVENTION, PROMOTION, AND TREATMENT. PREVENTION/PROMOTION WILL INCLUDE FITNESS FACILITIES AND CLASSES, OUTREACH INCLUDING SCHOOLS, FOOD GLEANING, VERTICAL GARDENS, AND FOOD AS MEDICINE PROGRAM. TREATMENT WILL INCLUDE REFERRAL-BASED FITNESS PROGRAM, SUPPORT GROUPS (I.E. DIABETES), AND FRUIT AND VEGETABLE PRESCRIPTION PROGRAM.BASED ON THE CHNA, THE FOLLOWING ARE THE OTHER IDENTIFIED ISSUES NOT BEING ADDRESSED AND THE ASSOCIATED REASONS WHY: 1. HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES ASPIRUS PROVIDES FINANCIAL ASSISTANCE FOR PATIENTS WHO STRUGGLE TO AFFORD CARE. 2. LACK OF HEALTH INSURANCE ASPIRUS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE THE AVAILABILITY AND AFFORDABILITY OF HEALTH INSURANCE, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE.3. UNEMPLOYMENT, WAGES, AND ECONOMIC CONDITIONS ASPIRUS WORKS TO PAY FAIR WAGES AND PROVIDE REASONABLE BENEFITS PACKAGES. ASPIRUS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE ECONOMIC CONDITIONS, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 3 1 - ASPIRUS EYE CENTER E6112 BLUFF VIEW ROAD IRONWOOD MI 49938 EYE CLINIC 2 - ASPIRUS IRONWOOD CLINIC N10565 GRAND VIEW LANE IRONWOOD MI 49938 PROVIDER BASED CLINIC 3 - ASPIRUS HURLEY CLINIC 501 GRANITE STREET HURLEY WI 54534 PROVIDER BASED CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF 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 6A: ASPIRUS IRONWOOD HOSPITAL & CLINICS PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE MICHIGAN HOSPITAL ASSOCIATION (MHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC THROUGH MHA'S DATABASE AND WEBSITE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FROM THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT ASPIRUS IRONWOOD HOSPITAL & CLINICS INCLUDE THE OPERATION OF THE HOSPITAL'S INPATIENT MEDICAL/SURGICAL NURSING UNIT AS WELL AS THE INTENSIVE CARE UNIT. THE HOSPITAL INPATIENT AND INTENSIVE CARE UNITS OPERATE 24 HOURS PER DAY SEVEN DAYS PER WEEK AND ARE STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL INPATIENT AND INTENSIVE CARE UNITS COME FROM THE HOSPITAL'S EMERGENCY DEPARTMENT WHICH IS OPERATED TO PROVIDE EMERGENCY CARE TO PATIENTS OF THE COMMUNITY AND SURROUNDING AREAS. THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF ASPIRUS IRONWOOD HOSPITAL & CLINICS AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF ASPIRUS IRONWOOD HOSPITAL & CLINICS TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE INPATIENT UNIT REPORTED COMMUNITY BENEFIT COSTS OF $1,958,907 WITH DIRECT OFFSETTING REVENUE OF $1,917,995. THE INTENSIVE CARE UNIT REPORTED COMMUNITY BENEFIT COSTS OF $153,483 WITH DIRECT OFFSETTING REVENUE OF $150,277. PART I, LN 7 COL(F): IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $1,083,519 WAS EXCLUDED FROM THE DENOMINATOR. PART II, COMMUNITY BUILDING ACTIVITIES: AIW PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND, IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. AIW, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WOULD NOT BE AVAILABLE LOCALLY WITHOUT THE HOSPITAL. THE BOARD ALSO CONTAINS COMMUNITY REPRESENTATIVES. THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, NURSING HOME SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, ONCOLOGY, AND WOMEN'S SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. 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 IRONWOOD 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: PATIENT FINANCIAL SERVICES (PFS) PROACTIVELY IDENTIFIES UNINSURED PATIENTS AND UNDER-INSURED PATIENTS AND SCREENS THEM FOR FINANCIAL ASSISTANCE AND COUNSELING WITHOUT REGARD TO RACE, ETHNICITY, GENDER, RELIGION, OR NATIONAL ORIGIN. THESE SERVICES ARE PROVIDED AT NO CHARGE. PFS COUNSELORS WORK WITH UNINSURED AND UNDER-INSURED PATIENTS TO HELP THEM UNDERSTAND THE SYSTEM'S FINANCIAL ASSISTANCE/DISCOUNTING POLICIES AND HOW THEY CAN QUALIFY FOR ASSISTANCE AND/OR DISCOUNTS INCLUDING A REFERRAL TO PUBLIC AND PRIVATE PROGRAMS TO DETERMINE ELIGIBILITY. PART VI, LINE 2: ASPIRUS IRONWOOD HOSPITAL & CLINICS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY EXAMINING THE NEEDS OF THE PATIENT. THIS IS DONE THROUGH ANALYSIS OF PATIENT VOLUMES IN DEPARTMENTS, SPECIALISTS, AND THE DIFFERENT CLINIC LOCATIONS WITHIN THE ORGANIZATION'S AREAS OF SERVICE. INFORMATION IS ALSO GATHERED DIRECTLY FROM THE PATIENTS TO SEE WHAT AREAS THEY WOULD LIKE TO SEE ADDITIONAL SUPPORT. INFORMATION REGARDING THE NEEDS OF THE GENERAL COMMUNITY IS OBTAINED FROM THE MICHIGAN HOSPITAL ASSOCIATION AND THE WISCONSIN HOSPITAL ASSOCIATION AND ANALYZED FOR POTENTIAL NEW SERVICE AREAS. ASPIRUS IRONWOOD HOSPITAL & CLINICS HAS COLLABORATED WITH OTHER AREA HOSPITALS TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IS AN IMPORTANT TOOL IN IDENTIFYING THE HEALTH NEEDS OF THE COMMUNITY AND RESULTS OF THE PROJECT ASSIST IN PRIORITIZING HEALTH NEEDS THAT LEAD TO THE ALLOCATION OF APPROPRIATE RESOURCES AND THE CREATION OF NEW PARTNERSHIPS TO IMPROVE THE HEALTH OF THE POPULATION. PART VI, LINE 3: A SUMMARY OF FINANCIAL ASSISTANCE CONTACT INFORMATION IS AVAILABLE IN THE FORM OF A BROCHURE IN THE WAITING AREAS THROUGHOUT ASPIRUS IRONWOOD HOSPITAL & CLINICS. PATIENT FINANCIAL SERVICES PERSONNEL ARE AVAILABLE TO DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE PROCEDURES AND PROGRAMS WITH PATIENTS. ASPIRUS IRONWOOD HOSPITAL & CLINICS ALSO HAS A SECTION ON ITS WEBSITE THAT PROVIDES CONTACT INFORMATION FOR FINANCIAL ASSISTANCE FOR THOSE HAVING DIFFICULTY MEETING THEIR FINANCIAL OBLIGATIONS. PART VI, LINE 4: THE COMMUNITIES THAT ASPIRUS IRONWOOD HOSPITAL & CLINICS SERVE COVER AN APPROXIMATE 50-MILE RADIUS SURROUNDING THE IRONWOOD, MICHIGAN AREA. THIS AREA INCLUDES PORTIONS OF THE UPPER PENINSULA GOGEBIC COUNTY, UP TO THE ONTONAGON COUNTY REGION, INTO WISCONSIN COVERING IRON COUNTY, PARTS OF ASHLAND COUNTY, AND PARTS OF VILAS COUNTY. THE GEOGRAPHIC AREA THAT ASPIRUS IRONWOOD HOSPITAL & CLINICS SERVE INCLUDES AN ECONOMICALLY DEPRESSED AREA THAT IS BASED ON A MAJORITY OF FAMILIES THAT DO NOT HAVE HEALTH INSURANCE, OR THAT ARE UTILIZING MEDICAID. PART VI, LINE 5: ASPIRUS IRONWOOD HOSPITAL & CLINICS HAVE NUMEROUS CONTINUING EDUCATION EVENTS THAT ARE SET UP TO HELP IMPROVE THE MEDICAL CARE AND KNOWLEDGE OF THE LOCAL POPULATION. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. ASPIRUS IRONWOOD HOSPITAL & CLINICS CONTINUE TO REINVEST IN EQUIPMENT, TRAINING, AND RESEARCH AREAS IN ORDER TO IMPROVE PATIENT CARE IN THE COMMUNITIES THAT IT SERVES, AS WELL AS PROVIDING RESEARCH TO HELP THE LOCAL COMMUNITIES. PART VI, LINE 6: ASPIRUS IRONWOOD HOSPITAL & CLINICS IS AN AFFILIATED HEALTH SYSTEM WHICH SERVES THE COMMUNITY SURROUNDING IRONWOOD, MICHIGAN. AFFILIATES OF ASPIRUS IRONWOOD HOSPITAL & CLINICS PROMOTE THE HEALTH OF THE COMMUNITY BY FULFILLING ASPIRUS' MISSION. ASPIRUS IRONWOOD HOSPITAL & CLINICS PROVIDES PHYSICIAN SERVICES IN AN OUTPATIENT CLINIC. ASPIRUS IRONWOOD HOSPITAL & CLINICS IS ALSO AN AFFILIATE OF ASPIRUS, INC. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTH CARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES DEDICATED TO IMPROVING THE HEALTH OF ALL WE SERVE. WE WORK COLLABORATIVELY WITH OTHERS WHO SHARE OUR PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. PART VI, LINE 7, REPORTS FILED WITH STATES MI X 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 SCZYGELSKI SR. 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 SVP & PRESIDENT-REG. MARKETS 0 501025 0 142821 0 539 0 11714 0 89935 0 746034 0 0 DANIEL LUKES BOARD MEMBER/PHYSICIAN 0 662071 0 600 0 7322 0 17346 0 27159 0 714498 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 JONATHAN BRUEGGEMAN BOARD MEMBER/PHYSICIAN 0 402125 0 41317 0 519 0 17346 0 33459 0 494766 0 0 CHRISTINE HARFF BOARD MEMBER(THRU 10/21)/PRES.-REG. 0 312209 0 87267 0 3564 0 15384 0 75638 0 494062 0 0 BRETT DAVIS PRESIDENT - ASPIRUS HEALTH PLAN 0 260587 0 127333 0 6207 0 16557 0 46300 0 456984 0 0 MICHAEL MCGRAIL FORMER SVP & SYSTEM CMO 0 0 0 0 0 449085 0 0 0 0 0 449085 0 449085 PATRICK TINCHER JR VP-FINANCE REGIONAL OPERATIONS 0 262964 0 52409 0 18959 0 16349 0 35871 0 386552 0 7837 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 MARCUS SANTINI BOARD MEMBER/PHYSICIAN (THRU 9/21) 0 300734 0 3078 0 16124 0 17346 0 36527 0 373809 0 0 CASEY MADISON MANAGER-PHARMACY 134070 0 6424 0 2785 0 7590 0 35181 0 186050 0 0 0 TINA MARSHALL NURSE PRACTITIONER 156608 0 600 0 2925 0 8314 0 13510 0 181957 0 0 0 CYNTHIA SIMMONS NURSING SUPERVISOR 117959 0 2600 0 2369 0 6014 0 32087 0 161029 0 0 0 SUSAN TICE REGISTERED NURSE - AIW MNA 128420 0 5600 0 1831 0 6506 0 13227 0 155584 0 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 FILING ORGANIZATION, ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $112,143 J. REDMAN-SCHELL $51,368 P. TINCHER $7,837 J. MATHESON $26,065 J. HEISLER $25,179 L. ROWE-PEPLINSKI $22,695 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 WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 97710B7X4 2013-04-12 2998547 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 B WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 97712DC53 2017-11-02 12000000 NEW CONSTRUCTION 0 0 0 A 2998547 35270 2963277 2015 0 0 1 1 B 12000000 113564 11866436 2016 0 0 1 1 A 0 0 1 0 0 0.00700 0.00700 0 0 1 B 0 0 1 0 0 0.00300 0.00300 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WI HEALTH & EDUCATION FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/05/2018 SCHEDULE K, PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2013 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (EIN 39-0964813); ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. (EIN 38-2908586); AND LANGLADE HOSPITAL HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN (EIN 39-0806429). INFORMATION REGARDING THE SERIES 2013 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2013 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2013 BONDS.] SCHEDULE K, PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2017 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. (EIN 38-2908586); AND ASPIRUS ONTONAGON HOSPITAL, INC. (EIN 26-0806477). INFORMATION REGARDING THE SERIES 2017 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 2017 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2017 BONDS.] PART III, LINES 3A AND 3B: ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS IRONWOOD HOSPITAL & CLINICS, 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. 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 6 THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THERE SHALL BE A MINIMUM OF 11 VOTING DIRECTORS ALLOCATED AS FOLLOW. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN FIVE INDEPENDENT COMMUNITY CLASS DIRECTORS, FOUR ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., TWO PROVIDER CLASS DIRECTOR 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 OFFICER; 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 IS 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 ANNUALLY, BOARD MEMBERS ARE REQUIRED TO DISCLOSE CONFLICTS TO THE BOARD. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER FINANCIAL INTEREST TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS. AN INTERESTED PERSON IS A DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST. AFTER DISCLOSURE, THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING MEMBERS SHALL DECIDE IF A CONFLICT EXISTS. THE MEMBER WILL ABSTAIN FROM VOTING ON THIS ISSUE IF A CONFLICT OF INTEREST IS DISCOVERED. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS; COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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 LAB SERVICES: PROGRAM SERVICE EXPENSES 1,052,995. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,052,995. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 839,385. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 839,385. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 165,122. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,122. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 6,703,999. MANAGEMENT AND GENERAL EXPENSES 101,862. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,805,861. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFERS - AWH 341,080. INTERCOMPANY TRANSFERS - AI -7,248,369. INTERCOMPANY TRANSFERS - ACI -86,652. INTERCOMPANY TRANSFERS - AOH 17,157. INTERCOMPANY TRANSFERS - VNA -32,087. INTERCOMPANY TRANSFERS - AIR 115,148. INTERCOMPANY TRANSFERS - ARH -18,795. INTERCOMPANY TRANSFERS - ADS -972. INTERCOMPANY TRANSFERS - AKH 156,130. INTERCOMPANY TRANSFERS - ASP 3,586. INTERCOMPANY TRANSFERS - ARN 4,250. INTERCOMPANY TRANSFERS - HYMC 1,432. INTERCOMPANY TRANSFERS - PNW BB -1,011. CHANGE IN NCI -40,330. OTHER CHANGES IN NET ASSETS 119,455. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF ASPIRUS, INC., THE PARENT ORGANIZATION, ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE CONSOLIDATED AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE IN THIS PROCESS IN THE PAST YEAR. ASPIRUS 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 HOSPITAL INC 601 SEVENTH STREET ONTONAGON MI 49953 260806477 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME 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 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 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 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391965593 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI ASPIRUS IRONWOOD HOSPITAL & CLINICS INC RELATED -20452 6849 0 1 0.51000 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 391931679 HEALTH CARE NETWORK WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 ASPIRUS HEALTH VENTURES 3000 WESTHILL DRIVE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 3000 WESTHILL DRIVE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 3000 WESTHILL DRIVE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 1 ASPIRUS CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 842513742 ASSOCIATION WI N/A C 0 0 1 0 0 0 0 0 0 1 1 0 1 0 0 1 1 1 0 0 ASPIRUS INC B 4152629 COST ASPIRUS INC I 72947 COST ASPIRUS INC L 9771653 COST ASPIRUS INC O 29821853 COST ASPIRUS INC Q 12289452 COST ASPIRUS WAUSAU HOSPITAL INC I 80986 COST ASPIRUS WAUSAU HOSPITAL INC O 167128 COST ASPIRUS WAUSAU HOSPITAL INC P 162735 COST ASPIRUS WAUSAU HOSPITAL INC Q 55069 COST ASPIRUS MEDICAL GROUP INC J 90228 COST ASPIRUS MEDICAL GROUP INC O 107520 COST ASPIRUS KEWEENAW HOSPITAL INC O 189669 COST