DIVINE SAVIOR HEALTHCARE INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: DIVINE SAVIOR HEALTHCARE INC (EIN 39-0806250)
Tax period: 2020-07-01 to 2021-06-30
Filed: 2022-05-12
IRS object ID: 202211329349304501
Schema version: 2020v4.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-05-12T12:46:00-05:00	ReturnTs
Tax Period End	2021-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390758449	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WIPFLI LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1502 LONDON ROAD SUITE 200	AddressLine1Txt
City	DULUTH	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55812	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390806250	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DIVINE SAVIOR HEALTHCARE INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	DIVI	BusinessNameControlTxt
Phone	6087424131	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 387 2817 NEW PINERY ROAD	AddressLine1Txt
City	PORTAGE	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53901	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	SIDNEY C SCZYGELSKI	PersonNm
Person Title	CFO/SENIOR VP OF FINANCE	PersonTitleTxt
Phone	6087424131	PhoneNum
Signature	2022-05-06	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	SIDNEY	PersonFirstNm
Person Last	SCZYGELSKI	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MICHAEL J PETERSON CPA	PreparerPersonNm
PTIN	P01833529	PTIN
Phone	2187224705	PhoneNum
Preparation	2022-04-30	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	ASPIRUS DIVINE SAVIOR HOSPITAL & CLINICS INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	SIDNEY C SCZYGELSKI	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2200 WESTWOOD DRIVE	AddressLine1Txt
City	WAUSAU	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54401	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$132,629,897	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	ASPIRUS.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1917	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES.	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	9	VotingMembersIndependentCnt
Total Employee	1054	TotalEmployeeCnt
Total Volunteers	10	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$6,886,934	PYContributionsGrantsAmt
CY Contributions Grants	$532,314	CYContributionsGrantsAmt
PY Program Service Revenue	$92,114,615	PYProgramServiceRevenueAmt
CY Program Service Revenue	$93,624,074	CYProgramServiceRevenueAmt
PY Investment Income	$1,131,604	PYInvestmentIncomeAmt
CY Investment Income	$5,247,216	CYInvestmentIncomeAmt
PY Other Revenue	$276,595	PYOtherRevenueAmt
CY Other Revenue	$144,559	CYOtherRevenueAmt
PY Total Revenue	$100,409,748	PYTotalRevenueAmt
CY Total Revenue	$99,548,163	CYTotalRevenueAmt
PY Grants And Similar Paid	$6,000	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$60,132,487	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$56,203,421	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$41,157,871	PYOtherExpensesAmt
CY Other Expenses	$43,709,075	CYOtherExpensesAmt
PY Total Expenses	$101,296,358	PYTotalExpensesAmt
CY Total Expenses	$99,912,496	CYTotalExpensesAmt
PY Revenues Less Expenses	-$886,610	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$364,333	CYRevenuesLessExpensesAmt
Total Assets BOY	$144,456,917	TotalAssetsBOYAmt
Total Assets EOY	$146,404,206	TotalAssetsEOYAmt
Total Liabilities BOY	$60,885,613	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$60,304,271	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$83,571,304	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$86,099,935	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$38,208,209	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$72,233,262	RevenueAmt
Desc	ADS IS AN ACUTE CARE 73-BED HOSPITAL LOCATED IN PORTAGE, WI. INPATIENT SERVICES INCLUDED ADMISSIONS OF ADULTS AND PEDIATRIC PATIENTS WHICH TOTALED 4,730 PATIENT DAYS IN FISCAL YEAR 2021. ADS ALSO OFFERS A WIDE ARRAY OF OUTPATIENT SERVICES TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. EMERGENCY ROOM, URGENT CARE, SURGERY, AMBULANCE, RENAL DIALYSIS, AND REHABILITATION SERVICES ARE AMONG MANY OF THE OUTPATIENT SERVICES PROVIDED. KEY OUTPATIENT SERVICE STATISTICS IN FISCAL YEAR 2021 INCLUDED 12,460 EMERGENCY ROOM VISITS, 3,265 URGENT CARE VISITS (CLOSED FOR A PORTION OF YEAR DUE TO COVID), 20,601 X-RAYS AND 3,007 INFUSION THERAPY VISITS WERE AMONG MANY OF THE PATIENT SERVICES AS NOTED. ADS ALSO PROVIDES SPECIALIZED HOME CARE SERVICES TO INDIVIDUALS WHO NEED CARE WITHIN THEIR OWN HOME. THESE PERSONALIZED SERVICES INCLUDE SKILLED NURSING SERVICES, HOME HEALTH AIDES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, IV THERAPY, AND PALLIATIVE CARE FOR TERMINAL ILLNESS.ADS PROMISES TO THE COMMUNITY TO PROVIDE HEALTHCARE SERVICES TO THOSE IN NEED REGARDLESS OF THEIR ABILITY TO PAY AS DEFINED IN THE HOSPITAL'S CHARITY AND COMMUNITY CARE POLICIES AND PROGRAMS. DURING FISCAL YEAR 2021, ADS'S CHARITY CARE PROGRAM AWARDED APPROXIMATELY $1,036,189 IN GROSS CHARGES FOR FINANCIAL ASSISTANCE TO PATIENTS WHO COULD NOT OTHERWISE AFFORD CARE.IN ADDITION TO INPATIENT AND OUTPATIENT HOSPITAL SERVICES, ADS ALSO PROVIDES EDUCATIONAL AND PREVENTATIVE SERVICES AT FREE OR REDUCED COSTS TO COMMUNITY MEMBERS. SOME OF THESE EVENTS OFFERED TO THE PUBLIC INCLUDE:LOW COST EXERCISE CLASSES, FREE BLOOD PRESSURE SCREENINGS, LOW COST CHOLESTEROL SCREENINGS, LOW COST CHILDBIRTH EDUCATION CLASSES, BLOOD DRIVES, FREE BREASTFEEDING WORKSHOPS, SUPPORT GROUPS, AND LOW-COST CPR AND FIRST AID CLASSES.IN FISCAL YEAR 2016, ADS OPENED A MEDICALLY INTEGRATED FITNESS CENTER IN RESPONSE TO THE COMMUNITY NEEDS ASSESSMENT PERFORMED.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$14,744,859	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$13,861,315	RevenueAmt
Desc	ADS OWNS AND OPERATES PHYSICIAN PRACTICES IN PORTAGE, OXFORD AND PARDEEVILLE, WI (CLOSED SINCE 2020 DUE TO COVID). TOTAL CLINIC VISITS FOR FISCAL YEAR 2021 WERE 64,804. THESE CLINICS PROVIDE FAMILY PRACTICE, INTERNAL MEDICINE, PHYSIATRY, OB, ORTHOPEDICS AND SURGICAL SERVICES, AMONG MANY OTHER CLINICAL SERVICES OFFERED TO PATIENTS IN THE COMMUNITY, AND WORK TOGETHER WITH THE HOSPITAL SERVICES OF ADS IN AN EFFORT TO COORDINATE HOSPITAL AND CLINICAL CARE TO PROVIDE CONVENIENT, COST-EFFECTIVE CARE TO MEMBERS OF THE COMMUNITY. THE RURAL OXFORD CLINIC IS IN A HEALTH SHORTAGE AREA TO BETTER MEET THE RESIDENTS OF THIS COMMUNITY CLOSER TO THEIR HOMES.THE CLINICS SERVICE A LARGE PORTION OF ELDERLY, DISABLED, AND LOW-INCOME PATIENTS WHO ARE COVERED UNDER THE MEDICARE AND WISCONSIN MEDICAL ASSISTANCE PROGRAMS. THE CLINICS ARE OFTEN REIMBURSED FROM THESE PROGRAMS AT RATES WELL BELOW THE COST OF CARING FOR THESE PATIENTS, HOWEVER, IT IS ADS'S MISSION IN THE COMMUNITY TO PROVIDE CARE TO THESE PATIENTS.PATIENTS OF THE ADS CLINICS ARE ALSO ELIGIBLE FOR THE ORGANIZATION'S CHARITY AND COMMUNITY CARE PROGRAMS WHICH PROVIDE FREE OR REDUCED CARE TO INDIVIDUALS AND FAMILIES BASED ON INCOME AND ASSET GUIDELINES. THE FIGURES PRESENTED IN STATEMENT 4A OF THE HOSPITAL PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE CHARITY CARE AMOUNTS PROVIDED TO CLINIC PATIENTS AS WELL. ADDITIONAL INFORMATION ON THE CHARITY CARE POLICIES CAN ALSO BE FOUND IN SCHEDULE H (HOSPITALS) OF THE FORM 990.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$4,686,231	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$7,529,497	RevenueAmt
Desc	ADS OWNS AND OPERATES AN 83-BED EXTENDED CARE FACILITY AND 40-BED ASSISTED LIVING FACILITY. THE EXTENDED CARE FACILITY OFFERS SKILLED AND INTERMEDIATE CARE NURSING FOR RESIDENTS WHO REQUIRE SHORT-TERM REHABILITATION PROGRAMS OR LONG-TERM CARE. THE FACILITY ALSO OFFERS MEDICATION MANAGEMENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, IV THERAPY, AND NUTRITION SERVICES, AS WELL AS ACCESS TO OTHER HEALTHCARE AND HOSPITAL SERVICES OFFERED BY ADS'S HOSPITAL PROGRAMS. IN 2021, 20,627 RESIDENT DAYS OF CARE AND 10,893 ASSISTED LIVING DAYS WERE PROVIDED BY THE EXTENDED CARE FACILITY. A MAJORITY OF THE RESIDENTS RECEIVE CARE UNDER THE WISCONSIN MEDICAL ASSISTANCE OR FAMILY CARE PROGRAMS. ADS RECOGNIZES THAT THE COST OF CARING FOR THESE INDIVIDUALS OFTEN EXTENDS BEYOND THE AMOUNT THAT IS PAID TO THE FACILITY BY THE MEDICAL ASSISTANCE PROGRAM. RESIDENTS OF THE EXTENDED CARE FACILITY AT ADS WHO HAVE EXHAUSTED ALL OTHER PROGRAMS SUCH AS MEDICAL ASSISTANCE OR THE WISCONSIN FAMILY CARE PROGRAM ARE ALSO ABLE TO APPLY FOR DISCOUNTED OR FREE CARE FOR HOSPITAL OR CLINICAL SERVICES UNDER THE ORGANIZATION'S CHARITY AND COMMUNITY CARE PROGRAMS AS DESCRIBED EARLIER NOTING THE HOSPITAL AND CLINIC PROGRAM SERVICE ACCOMPLISHMENTS. SINCE MOST EXTENDED CARE CHARGES ARE COVERED UNDER WISCONSIN MEDICAL ASSISTANCE PROGRAMS WHEN INCOME LEVELS ARE BELOW ESTABLISHED GOVERNMENT STANDARDS, THESE PROGRAMS ARE MOST OFTEN UTILIZED AS A SOURCE OF PAYMENTS FOR MANY RESIDENTS. IF THESE MEDICAL ASSISTANCE PROGRAMS ARE NOT AVAILABLE DUE TO A UNIQUE CIRCUMSTANCE, THE RESIDENT'S STAY MAY BE EVALUATED FOR CHARITY OR COMMUNITY CARE ON A CASE BY CASE BASIS BY ADMINISTRATION OF THE ORGANIZATION.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$57,639,299	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	90	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	1054	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	9	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	SIDNEY C SCZYGELSKI	PersonNm
Phone	7158472250	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2200 WESTWOOD DRIVE	AddressLine1Txt
City	WAUSAU	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54401	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	OfficerOfficerInd	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
JOSHUA POGORELEC
PHYSICIAN	40.00	Yes (X)	$713,862	$0	$54,686
JOHN HEISLER
BOARD MEMBER/CHIEF HR OFFICER	1.00	Yes (X)	$0	$571,823	$43,247	40.00	Yes (X)
JESSE TISCHER
BOARD MEMBER/SVP & PRESIDENT	1.00	Yes (X)	$0	$551,417	$54,420	40.00	Yes (X)
TRAVIS HAMELE
CHAIRPERSON	3.00	Yes (X)	$0	$0	$0		Yes (X)
JUDY WARMUTH PHD
VICE CHAIRPERSON	2.50	Yes (X)	$0	$0	$0		Yes (X)
LOUIS HEITKE DDS
SECRETARY	2.50	Yes (X)	$0	$0	$0		Yes (X)
PETE WELSH
TREASURER	2.50	Yes (X)	$0	$0	$0		Yes (X)
BOB CRAWFORD
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
ROBIN KVALO
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
KRISTEN SKOLARZ
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
CHAD STEVENSON
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
LYNN VOGT
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0	1.00
SUSAN KRECKMAN
BOARD MEMBER/PHYSICIAN	40.00	Yes (X)	$365,900	$0	$53,443
MATTHEW HEYWOOD
PRESIDENT & CEO ASPIRUS	1.00		$0	$1,316,596	$71,205	50.00	Yes (X)
SIDNEY SCZYGELSKI
SR. VP OF FINANCE/CFO	1.00		$0	$861,658	$62,993	50.00	Yes (X)
MICHAEL DECKER
CEO	40.00		$658,019	$0	$102,851		Yes (X)
NANCY ROTH-MALLEK
VP FINANCE	40.00		$0	$221,008	$45,855		Yes (X)
MARLIN NELSON
VP FINANCE (THRU JULY)	40.00		$353,494	$0	$60,934		Yes (X)
RENEE SMITH
EXECUTIVE DIRECTOR ANI	1.00		$0	$506,661	$49,619	50.00		Yes (X)
ERIC ANDERSON
SVP- SERVICE LINE & PATIENT EXP.	1.00		$0	$475,604	$56,304	50.00		Yes (X)
JENNIFER REDMAN-SCHELL
SVP & PRESIDENT- ASPIRUS CLINICS	1.00		$0	$481,240	$39,357	50.00		Yes (X)
TODD RICHARDSON
SVP & CHIEF INFORMATION OFFICER	1.00		$0	$455,671	$52,263	50.00		Yes (X)
RUTH RISLEY-GRAY
SVP & SYSTEM CHIEF NURSING OFFICER	1.00		$0	$419,745	$45,966	50.00		Yes (X)
MICHAEL MCGRAIL
SVP & SYSTEM CHIEF MEDICAL OFFICER	1.00		$0	$426,022	$0	50.00		Yes (X)
RICK NEVERS
SVP- REGIONAL OPERATIONS SIO	1.00		$0	$371,883	$30,050	50.00		Yes (X)
MICHAEL WALTERS
VP PHYSICIAN & CLINICAL SERVICES	40.00		$502,475	$0	$55,063			Yes (X)
DOUGLAS ARNOLD
PHYSICIAN	40.00		$724,838	$0	$54,619				Yes (X)
BRAD ROGOWSKI
PHYSICIAN	40.00		$517,406	$0	$51,104				Yes (X)
ANGELA MOREAU
PHYSICIAN	40.00		$463,088	$0	$36,803				Yes (X)
BRENDA JENKIN
PHYSICIAN	40.00		$417,652	$0	$17,319				Yes (X)
JAMES SELF
ORTHOPEDIC SURGEON	40.00		$396,643	$0	$26,676				Yes (X)
CARI LOGEMANN
SVP & GEN. COUNSEL (THRU JUNE)	1.00		$0	$437,354	$22,668	50.00				Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$5,113,377	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$7,096,682	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,087,445	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	71	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
JACKSON & COKER LOCUMTENENS
3000 OLD ALABAMA RD STE 119-608	ALPHARETTA	GA	30022	JOB SEARCH/STAFF	$124,958
FRANK WALTER
S4202 WHISPERING PINES DR	BARABOO	WI	53913	PHYSICIAN SERVICES	$117,513
ADP LLC
PO BOX 842875	BOSTON	MA	00284	PAYROLL SERVICES	$104,341

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	3	CntrctRcvdGreaterThan100KCnt
Government Grants	$529,175	GovernmentGrantsAmt
All Other Contributions	$3,139	AllOtherContributionsAmt
Total Contributions	$532,314	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE	621990	$70,824,528	$70,824,528
CLINIC REVENUE	623000	$13,861,315	$13,861,315
EXTENDED CARE FACILITY REVENUE	621110	$7,529,497	$7,529,497

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,408,734	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,408,734	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$93,624,074	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,033,732	TotalRevenueColumnAmt
Exclusion	$1,033,732	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$43,395	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$43,395	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$43,395	TotalRevenueColumnAmt
Exclusion	$43,395	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$37,295,218	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$33,002,833	SecuritiesAmt
Other	$78,901	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$4,292,385	SecuritiesAmt
Other	-$78,901	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,213,484	TotalRevenueColumnAmt
Exclusion	$4,213,484	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA REVENUE	Desc
Business	722514	BusinessCd
Total Revenue Column	$101,164	TotalRevenueColumnAmt
Exclusion	$101,164	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$101,164	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$99,548,163	TotalRevenueColumnAmt
Related Or Exempt Func Income	$93,624,074	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$5,391,775	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$661,128	TotalAmt
Management And General	$661,128	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$44,864,342	TotalAmt
Program Services	$36,546,142	ProgramServicesAmt
Management And General	$8,318,200	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,684,226	TotalAmt
Program Services	$1,071,404	ProgramServicesAmt
Management And General	$612,822	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$6,049,626	TotalAmt
Program Services	$2,309,666	ProgramServicesAmt
Management And General	$3,739,960	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,944,099	TotalAmt
Program Services	$2,314,616	ProgramServicesAmt
Management And General	$629,483	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$291,736	TotalAmt
Program Services	$291,736	ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$18,400	TotalAmt
Management And General	$18,400	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$400	TotalAmt
Management And General	$400	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$1,329	TotalAmt
Management And General	$1,329	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$6,126,368	TotalAmt
Program Services	$4,645,626	ProgramServicesAmt
Management And General	$1,480,742	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$160,542	TotalAmt
Program Services	$295	ProgramServicesAmt
Management And General	$160,247	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$390,833	TotalAmt
Program Services	$14,746	ProgramServicesAmt
Management And General	$376,087	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$223,134	TotalAmt
Program Services	$55,190	ProgramServicesAmt
Management And General	$167,944	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,574,965	TotalAmt
Program Services	$2,158	ProgramServicesAmt
Management And General	$1,572,807	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$194,417	TotalAmt
Program Services	$145,760	ProgramServicesAmt
Management And General	$48,657	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$711,380	TotalAmt
Management And General	$711,380	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$5,336,027	TotalAmt
Program Services	$262,070	ProgramServicesAmt
Management And General	$5,073,957	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$186,666	TotalAmt
Program Services	$56,183	ProgramServicesAmt
Management And General	$130,483	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$11,078,507	$7,796,044	$3,282,463
CORPORATE ALLOCATIONS	$7,199,393	$854	$7,198,539
BAD DEBT EXPENSE	$5,151,683	$449,425	$4,702,258
REPAIRS AND MAINTENANCE	$2,569,703	$1,495,718	$1,073,985

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,493,592	TotalAmt
Program Services	$181,666	ProgramServicesAmt
Management And General	$2,311,926	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$99,912,496	TotalAmt
Program Services	$57,639,299	ProgramServicesAmt
Management And General	$42,273,197	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$4,720,124	BOYAmt
EOY	$2,645,741	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$10,003,254	BOYAmt
EOY	$9,225,742	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$10,544,595	BOYAmt
EOY	$12,178,537	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,850,158	BOYAmt
EOY	$1,727,368	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,896,983	BOYAmt
EOY	$530,955	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$140,018,584	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$68,325,254	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$68,343,634	BOYAmt
EOY	$71,693,330	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$43,161,984	BOYAmt
EOY	$43,285,229	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$3,936,185	BOYAmt
EOY	$5,117,304	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$144,456,917	BOYAmt
EOY	$146,404,206	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$8,229,795	BOYAmt
EOY	$9,033,497	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$435,646	BOYAmt
EOY	$1,240,856	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$39,728,898	BOYAmt
EOY	$37,324,876	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$12,491,274	BOYAmt
EOY	$12,705,042	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$60,885,613	BOYAmt
EOY	$60,304,271	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$83,537,524	BOYAmt
EOY	$86,067,056	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$33,780	BOYAmt
EOY	$32,879	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$83,571,304	BOYAmt
EOY	$86,099,935	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$144,456,917	BOYAmt
EOY	$146,404,206	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$364,333	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$549,662	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$3,442,626	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	0	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$8,076	OtherActivitiesAmt
Total Lobbying Expenditures	$8,076	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	ADS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE WHA HAS NOTIFIED ADS THAT APPROXIMATELY $2,540 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. ADS IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, ADS PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT APPROXIMATELY $2,217 OF THE FEES PAID BY DIVINE SAVIOR HEALTHCARE IN FISCAL YEAR 2021 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. ADS PAID AHA DUES OF $12,963 OF WHICH 25.6% IS FOR LOBBYING OR $3,319.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,041,760	OtherCostOrOtherBasisAmt
Book Value	$5,041,760	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$94,930,083	OtherCostOrOtherBasisAmt
Depreciation	$42,846,868	DepreciationAmt
Book Value	$52,083,215	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$32,192,142	OtherCostOrOtherBasisAmt
Depreciation	$25,478,386	DepreciationAmt
Book Value	$6,713,756	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$7,854,599	OtherCostOrOtherBasisAmt
Book Value	$7,854,599	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$71,693,330	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDesc	AmtAmt
LONG TERM INSURANCE	$1,001,601
MEDICARE ACCELERATED PAYMENTS	$7,771,862
RELATED PARTY PAYABLES	$1,976
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS	$1,480,000
DEFERRED COMPENSATION	$905,604
LONG TERM FICA	$1,543,999

Field	Value	IRS element (for citing)
Total Liability	$12,705,042	TotalLiabilityAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$423,630	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$64,708	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$358,922	NetCommunityBenefitExpnsAmt
Total Expense	0.00380	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,232,129	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,915,689	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,316,440	NetCommunityBenefitExpnsAmt
Total Expense	0.05610	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,655,759	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,980,397	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,675,362	NetCommunityBenefitExpnsAmt
Total Expense	0.05990	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$260	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$260	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$51,808	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$51,808	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$52,068	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$52,068	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,707,827	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,980,397	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,727,430	NetCommunityBenefitExpnsAmt
Total Expense	0.06040	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense	$2,105,124	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$11,633,618	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$17,323,926	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$5,690,308	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DIVINE SAVIOR HEALTHCARE INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2817 NEW PINERY ROAD	AddressLine1Txt
City	PORTAGE	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53901	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.ASPIRUS.ORG	WebsiteAddressTxt
State License	80	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	DIVINE SAVIOR HEALTHCARE INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	SEE PART V, SECTION C, LINE 7D	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	SEE PART V, SECTION C, LINE 7D	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare	Yes (X)	LookBackMedicareInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, ADS'S BOARD OF DIRECTORS APPOINTED A TASK FORCE CONSISTING OF REPRESENTATIVES FROM ADS'S BOARD OF DIRECTORS, EMPLOYEES AND MANAGEMENT OF ADS, AND COMMUNITY MEMBERS AND LEADERS IN ORDER TO HAVE A WIDE PERSPECTIVE OF NEEDS AND INFORMATION BEING REPRESENTED IN THE COMMUNITY TO ACHIEVE BENEFICIAL RESULTS FOR THE CHNA FOR THE HOSPITAL IN PLANNING FOR THE FUTURE. QUANTITATIVE DATA INCLUDING STATISTICS AND DEMOGRAPHIC INFORMATION WERE OBTAINED FROM COUNTY HEALTH STUDIES OF COMMUNITY HEALTH NEEDS BY THE TWO COUNTIES IN ADS'S PRIMARY SERVICE AREA (COLUMBIA AND MARQUETTE COUNTIES) AS WELL AS PATIENT STATISTICS AND TRENDS FROM ADS'S OWN INTERNAL RECORDS. OTHER PUBLISHED SOURCES OF INFORMATION WERE ALSO REFERENCED FOR STATISTICAL AND INFORMATIONAL PURPOSES WHEN NEEDED THROUGHOUT THE PROCESS.INTERVIEWS WERE CONDUCTED WITH COMMUNITY MEMBERS AND INDIVIDUALS WHO WERE REGARDED AS HAVING EXPERTISE IN PUBLIC HEALTH, INDIVIDUALS EMPLOYED WITH GOVERNMENT AGENCIES WITH COMMUNITY HEALTH NEEDS INFORMATION, INDIVIDUALS REPRESENTING COMMUNITY EMPLOYERS, AND INDIVIDUALS WHO WOULD BE ABLE TO ACCESS HEALTH NEEDS INFORMATION FROM A WIDE DEMOGRAPHIC MAKE-UP OF THE POPULATION. DURING INTERVIEWS, PARTICIPANTS FROM THE COMMUNITY WERE ASKED FOR THEIR INPUT REGARDING BOTH HEALTH NEEDS AND POSSIBLE SOLUTIONS TO IDENTIFIED NEEDS. THIS INFORMATION WAS GATHERED, ALONG WITH THE QUANTITATIVE INFORMATION NOTED ABOVE, AND WAS SUMMARIZED FOR THE BOARD OF DIRECTORS OF THE ORGANIZATION TO REVIEW AND SUMMARIZE IN TERMS OF A PRIORITY SETTING EXERCISE. FROM THIS EXERCISE, KEY OR PRIORITY NEEDS WERE IDENTIFIED TO BE ADDRESSED AS A RESULT OF THE INFORMATION GATHERED ON HEALTH NEEDS IN THE COMMUNITY AND PRIMARY SERVICE AREA OF ADS.
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7A & 10A:WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 11: TOP IDENTIFIED HEALTH NEEDS BEING ADDRESSED:1. ACCESSIBILITY TO HEALTHCARE SERVICES 2. MANAGEMENT OF OBESITY AND OTHER CHRONIC CONDITIONS THESE STEPS HAVE BEEN TAKEN TO ADDRESSES ACCESS TO CARE:- CONTINUED TO PRIORITIZE ACCESS AND RECRUITMENT AS A KEY INITIATIVE AND HAVE SUCCESSFULLY RECRUITED IN THE AREAS OF OB/GYN, CARDIOLOGY, ORTHOPEDICS, PAIN MANAGEMENT AND ENDOCRINOLOGY- PEDIATRICS AND ORTHOPEDICS HAVE EXPANDED THEIR REACH TO SEE PATIENTS AT THE OXFORD CLINIC- TELEHEALTH VISITS & VIRTUAL CARE WERE OFFERED AS AN OPTION - PROVIDED ATHLETIC TRAINERS TO AREA SCHOOLS- PROVIDED TRAVEL VOUCHERS- UTILIZED INTERPRETER/TRANSLATION SERVICES- UTILIZED SPANISH SPEAKING PEDIATRICIAN TO IMPROVE COMMUNICATION WITH SPANISH SPEAKING PATIENTS - OFFERED WALK-IN ORTHOPEDIC VISITS- UTILIZED THE RESPIRATORY CARE CLINIC FOR COVID-19 RELATED NEEDS - STAFF CONDUCTED EDUCATIONAL PRESENTATIONS AT ORGANIZATIONS THROUGHOUT THE SERVICE AREA FOR FREE- PARTICIPATED IN HEALTH LITERACY INITIATIVES- UTILIZED THE ED2RECOVERY PROGRAM TO PROVIDE SUPPORT FOR DRUG AND ALCOHOL ADDICTION TO ADDRESS THE MANAGEMENT OF OBESITY AND CHRONIC CONDITIONS, THE FOLLOWING STEPS HAVE BEEN TAKEN:-INCREASED ACCESSIBILITY TO PERSONAL WELLNESS SERVICES THROUGH LA VITA, THE MEDICALLY INTEGRATED FITNESS FACILITY. OFFERED PAVE THE WEIGH AND OTHER TRANSITION PROGRAMS AT LA VITA, WITH REDUCED OR FREE MEMBERSHIP FEES. INCREASED HOURS AVAILABLE TO ACCESS THE FACILITY. - EXPANDED THE REACH OF THE MENTAL HEALTH NURSE PRACTITIONER BY OFFERING TELEHEALTH VISITS - OFFERED A FREE PROGRAM ON DIABETES PREVENTION & MANAGEMENT- FREE PRESENTATIONS OFFERED ON A VARIETY OF TOPICS RELATED TO OBESITY & CHRONIC CONDITIONS- OFFERED A FREE BREAST CANCER SUPPORT GROUP- STARTED A VERTICAL GARDEN AT THE ASSISTED LIVING FACILITY - SUPPORTED THE BOYS & GIRLS CLUB BY JOINING THE PLANNING COMMITTEE TO BRING A LOCAL CHAPTER TO THE AREA, AND OFFERING FINANCIAL SUPPORT- PROVIDED SUPPORT FOR THE DRUG AND ALCOHOL ABUSE PREVENTION COALITIONS AND RECOVERY CENTERS DUE TO COVID-19 RELATED ISSUES, SOME OF THE HOSPITAL'S OUTREACH ACTIVITIES AND SUPPORT GROUPS FOR CHRONIC CONDITIONS DID NOT OCCUR THIS YEAR. SEVERAL OF THE NEEDS IDENTIFIED WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE WITHIN THE PRIMARY SERVICE AREA, OR AT THE PRESENT TIME IT WAS DETERMINED THAT A PARTNER ORGANIZATION MAY BE NEEDED TO MAKE A NEW HEALTH SERVICE A FINANCIALLY VIABLE OPTION IN THE LOCAL COMMUNITY. TWO EXAMPLES OF THESE ITEMS WHICH WERE NOTED IN THE CHNA PROCESS WERE ACCESS TO CANCER CARE AND MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES. IT WAS DETERMINED THAT ASPIRUS DIVINE SAVIOR DOES NOT HAVE THE POPULATION BASE TO PROVIDE RADIATION ONCOLOGY SERVICES AS THIS WAS MOST EFFECTIVELY AND EFFICIENTLY PROVIDED IN THE MADISON, WISCONSIN AREA WHICH IS WITHIN 30 MINUTES OF THE HOSPITAL. SOME ONCOLOGY SERVICES, INCLUDING CHEMOTHERAPY AND FOLLOW-UP VISITS, ARE PROVIDED BY ASPIRUS DIVINE SAVIOR'S PRIMARY CARE PROVIDERS AS WELL AS VISITING SPECIALISTS, SO IT WAS DETERMINED THAT THE CANCER CARE IN THIS AREA WAS ADEQUATE AT THE CURRENT TIME FOR THE POPULATION. MENTAL HEALTH SERVICES AND ACCESSIBILITY OF ALCOHOL AND SUBSTANCE USE SERVICES WERE IDENTIFIED AS IMPORTANT ISSUES IN THE COMMUNITY. GIVEN ASPIRUS DIVINE SAVIOR'S RESOURCE CONSTRAINTS, AND THE EXISTENCE OF OTHER ORGANIZATIONS FOCUSED ON RESPONDING TO THOSE NEEDS, ASPIRUS DIVINE SAVIOR WILL SUPPORT THEIR EFFORTS THROUGH CONTINUED COLLABORATION WITH OTHER ORGANIZATIONS IN THE COMMUNITY WHO ARE CURRENTLY WORKING TO ADDRESS MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES. IT WAS IDENTIFIED THAT THERE IS A SIGNIFICANT GAP IN FUNDING AVAILABLE FOR MANY PATIENTS IN NEED OF THESE SERVICES; HOWEVER, THERE IS A PRIMARY CARE MENTAL HEALTH CLINIC IN THE COMMUNITY WHICH PROVIDES A SIGNIFICANT AMOUNT OF MENTAL HEALTH SERVICES TO AREA RESIDENTS. ASPIRUS DIVINE SAVIOR DETERMINED THAT DUE TO THE VAST FINANCIAL AND SOCIAL NEEDS OF MANY OF THE PATIENTS IN NEED OF THE MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAMS, THAT MANY GROUPS MAY NEED TO PARTNER TOGETHER IN THE FUTURE TO WORK ON PLANNING EFFORTS FOR THESE SERVICES IN THE FUTURE AS THIS IS A VERY COMPLEX ISSUE.SEVERAL OTHER NEEDS WERE NOT ADDRESSED AS ANOTHER ORGANIZATION WITHIN THE COMMUNITY ALREADY PROVIDES THESE SERVICES WHICH ARE NOT IN ASPIRUS DIVINE SAVIOR'S PRIMARY AREA OF HEALTHCARE EXPERTISE. ONE EXAMPLE OF THESE TYPES OF SERVICES IS A FREE DENTAL CLINIC TO PROVIDE ACCESS TO PATIENTS WHO ARE OTHERWISE UNABLE TO AFFORD PROPER DENTAL CARE. IN RECENT YEARS, A COMMUNITY GROUP HAS ORGANIZED A FREE DENTAL CLINIC TO PROCESS ACCESS TO DENTAL CARE FOR INDIVIDUALS WITH FINANCIAL NEEDS THAT LIMIT THEIR ACCESS TO DENTAL SERVICES.
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 13H: THE CHARITABLE CARE POLICY OF ADS ALSO ALLOWS FOR AN ADMINISTRATIVE DETERMINATION FOR A PATIENT THAT MAY UNDERGO A CATASTROPHIC EVENT OR UNIQUE CIRCUMSTANCE. THIS ADDITIONAL PROVISION ALLOWS FOR ADMINISTRATION TO MAKE A DETERMINATION THAT MAY ASSIST A PATIENT IN A UNIQUE TIME OF FINANCIAL NEED.
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 20E: THE FINANCIAL ASSISTANCE POLICY IS POSTED IN EACH OF THE HOSPITAL'S PHYSICIAN CLINICS. FINANCIAL ASSISTANCE INFORMATIONAL CARDS ARE ALSO GIVEN TO ANYONE INDICATING FINANCIAL HARDSHIP, AND THEY ARE ENCOURAGED TO CONTACT A FINANCIAL COUNSELOR FOR FURTHER INFORMATION ON THE FINANCIAL ASSISTANCE POLICY.

Field	Value	IRS element (for citing)
Facility	5	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - ASPIRUS PORTAGE CLINIC
2817 NEW PINERY ROAD	PORTAGE	WI	53901	PHYSICIAN CLINIC
2 - ASPIRUS TIVOLI COMMUNITY
2805 HUNTERS TRAIL	PORTAGE	WI	53901	SKILLED NURSING FACILITY, ASSISTED LIVING FACILITY, AND HOME HEALTH PROGRAM
3 - ASPIRUS OXFORD CLINIC
N4390 CROSSROADS CLINIC ROAD	OXFORD	WI	53952	PHYSICIAN CLINIC
4 - ASPIRUS DIVINE SAVIOR WELLNESS CENTER
2815 NEW PINERY ROAD	PORTAGE	WI	53901	WELLNESS CENTER
5 - ASPIRUS PARDEEVILLE CLINIC
102 GILLETTE STREET	PARDEEVILLE	WI	53954	PHYSICIAN CLINIC

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	DIVINE SAVIOR HEALTHCARE, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S 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 HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING 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 THE FORM 990.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,151,682.
PART II, COMMUNITY BUILDING ACTIVITIES:	ADS PROVIDES SERVICES AND EDUCATIONAL OPPORTUNITIES EITHER FREE OF CHARGE OR AT A NOMINAL FEE IN AN ATTEMPT TO PROVIDE THESE OPPORTUNITIES TO THOSE MEMBERS OF THE COMMUNITIES WHO OTHERWISE MAY NOT BE ABLE TO AFFORD OR HAVE ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH SCREENINGS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS.
PART III, LINE 2:	THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
PART III, LINE 3:	MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL PATIENT ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.
PART III, LINE 4:	PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE FOR. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8:	THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE HOSPITAL 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, RADIOLOGY, AMBULANCE, AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, HOSPITALIST PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT DIVINE SAVIOR HEALTHCARE, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2021 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).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
PART III, LINE 9B:	UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENT'S ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORK QUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT.
PART VI, LINE 2:	ADS 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 COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. ADS, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, URGENT CARE, HOME CARE, RENAL DIALYSIS, INFUSION SERVICES, SWING BED SERVICES, NURSING HOME SERVICES, ASSISTED LIVING SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, WOMEN'S SERVICES, AND AMBULANCE SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED.
PART VI, LINE 3:	UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE ORGANIZATION'S FINANCIAL COUNSELORS EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY AND COMMUNITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.
PART VI, LINE 4:	THE PRIMARY SERVICE AREA FOR ADS ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30-MILE RADIUS OF THE HOSPITAL. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE PORTAGE, PARDEEVILLE, WISCONSIN DELLS, LAKE DELTON, BRIGGSVILLE, WYOCENA, POYNETTE, AND ARLINGTON, WISCONSIN, AMONG MANY OTHERS. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RESIDE IN THE ORGANIZATION'S EXTENDED AND LONG-TERM CARE FACILITIES OR PATIENTS WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION.
PART VI, LINE 6:	ADS IS 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	WI

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (23 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MATTHEW HEYWOOD
PRESIDENT & CEO ASPIRUS	$0	$992,466	$0	$321,290	$0	$2,840	$0	$17,196	$0	$54,009	$0	$1,387,801	$0	$0
SIDNEY SCZYGELSKI
SR. VP OF FINANCE/CFO	$0	$571,336	$0	$102,719	$0	$187,603	$0	$20,046	$0	$42,947	$0	$924,651	$0	$174,000
DOUGLAS ARNOLD
PHYSICIAN	$642,364	$0	$54,270	$0	$28,204	$0	$14,000	$0	$40,619	$0	$779,457	$0	$0	$0
JOSHUA POGORELEC
PHYSICIAN	$557,554	$0	$108,867	$0	$47,441	$0	$14,000	$0	$40,686	$0	$768,548	$0	$0	$0
MICHAEL DECKER
CEO	$644,962	$0	$0	$0	$13,057	$0	$72,707	$0	$30,144	$0	$760,870	$0	$64,118	$0
JOHN HEISLER
BOARD MEMBER/CHIEF HR OFFICER	$0	$339,009	$0	$66,240	$0	$166,574	$0	$17,196	$0	$26,051	$0	$615,070	$0	$152,214
JESSE TISCHER
BOARD MEMBER/SVP & PRESIDENT	$0	$458,373	$0	$92,613	$0	$431	$0	$11,473	$0	$42,947	$0	$605,837	$0	$0
BRAD ROGOWSKI
PHYSICIAN	$427,753	$0	$18,750	$0	$70,903	$0	$9,760	$0	$41,344	$0	$568,510	$0	$0	$0
MICHAEL WALTERS
VP PHYSICIAN & CLINICAL SERVICES	$435,611	$0	$44,202	$0	$22,662	$0	$12,002	$0	$43,061	$0	$557,538	$0	$0	$0
RENEE SMITH
EXECUTIVE DIRECTOR ANI	$0	$381,673	$0	$68,268	$0	$56,720	$0	$17,196	$0	$32,423	$0	$556,280	$0	$55,911
ERIC ANDERSON
SVP- SERVICE LINE & PATIENT EXP.	$0	$399,509	$0	$67,809	$0	$8,286	$0	$17,196	$0	$39,108	$0	$531,908	$0	$0
JENNIFER REDMAN-SCHELL
SVP & PRESIDENT- ASPIRUS CLINICS	$0	$411,201	$0	$69,616	$0	$423	$0	$17,196	$0	$22,161	$0	$520,597	$0	$0
TODD RICHARDSON
SVP & CHIEF INFORMATION OFFICER	$0	$341,475	$0	$67,414	$0	$46,782	$0	$17,196	$0	$35,067	$0	$507,934	$0	$43,823
ANGELA MOREAU
PHYSICIAN	$391,628	$0	$17,188	$0	$54,272	$0	$14,000	$0	$22,803	$0	$499,891	$0	$0	$0
RUTH RISLEY-GRAY
SVP & SYSTEM CHIEF NURSING OFFICER	$0	$309,508	$0	$60,518	$0	$49,719	$0	$20,046	$0	$25,920	$0	$465,711	$0	$41,695
CARI LOGEMANN
SVP & GEN. COUNSEL (THRU JUNE)	$0	$228,246	$0	$78,456	$0	$130,652	$0	$15,527	$0	$7,141	$0	$460,022	$0	$129,488
BRENDA JENKIN
PHYSICIAN	$332,619	$0	$65,336	$0	$19,697	$0	$6,206	$0	$11,113	$0	$434,971	$0	$0	$0
MICHAEL MCGRAIL
SVP & SYSTEM CHIEF MEDICAL OFFICER	$0	$0	$0	$0	$0	$426,022	$0	$0	$0	$0	$0	$426,022	$0	$425,671
JAMES SELF
ORTHOPEDIC SURGEON	$384,173	$0	$0	$0	$12,470	$0	$0	$0	$26,676	$0	$423,319	$0	$0	$0
SUSAN KRECKMAN
BOARD MEMBER/PHYSICIAN	$263,606	$0	$84,974	$0	$17,320	$0	$14,000	$0	$39,443	$0	$419,343	$0	$0	$0
MARLIN NELSON
VP FINANCE (THRU JULY)	$318,821	$0	$0	$0	$34,673	$0	$46,146	$0	$14,788	$0	$414,428	$0	$32,594	$0
RICK NEVERS
SVP- REGIONAL OPERATIONS SIO	$0	$263,896	$0	$64,103	$0	$43,884	$0	$17,172	$0	$12,878	$0	$401,933	$0	$39,905
NANCY ROTH-MALLEK
VP FINANCE	$0	$190,697	$0	$29,403	$0	$908	$0	$12,895	$0	$32,960	$0	$266,863	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 4B	FormAndLineReferenceDesc
Explanation	SCHEDULE J, PART I, LINE 4A - SEVERANCE PAY MICHAEL MCGRAIL RECEIVED SEVERANCE PAY TOTALING $426,022 FOR CALENDAR YEAR 2020. THE FOLLOWING OFFICERS AND HIGHEST COMPENSATED EMPLOYEES PARTICIPATED IN A NON-QUALIFIED 457(F) RETIREMENT PLAN AND REPORTED THE FOLLOWING INCREASE IN THEIR RESPECTIVE PLANS: MIKE DECKER: $64,118 MARLIN NELSON: $32,146 SCHEDULE J, PART I, LINE 4B RELATED PARTY INFORMATION - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $174,000 J. HEISLER $152,214 C. LOGEMANN $129,488 M. MCGRAIL $425,671 R. NEVERS $39,905 T. RICHARDSON $43,823 R. RISLEY-GRAY $41,695 R. SMITH $55,911 M. NELSON $32,594 M. DECKER $64,118 KEY EMPLOYEES OF THE RELATED 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: 9% FOR VICE PRESIDENT, 13% FOR SENIOR LEADERSHIP COUNCIL, AND 15% FOR THE CEO. 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; 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.	ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	391337855	BondIssuerEIN
Bond Issued	2020-06-29	BondIssuedDt
Issue Price	$39,808,745	IssuePriceAmt
Purpose	REFINANCE OF 2006, 2009, 2012, 2014, 2016, 2019 REVENUE BONDS	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$2,354,291	RetiredAmt
Total Proceeds	$39,808,745	TotalProceedsAmt
Issuance Costs From Proceeds	$139,675	IssuanceCostsFromProceedsAmt
Other Spent Proceeds	$39,808,745	OtherSpentProceedsAmt
Substantial Completion	2020	SubstantialCompletionYr
Refunding Tax Exempt Bonds	0	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	Yes (1)	RefundingTaxableBondsInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (1)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	Yes (1)	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART III, LINES 2, 3A, AND 3B:	ASPIRUS, INC., THE PARENT ORGANIZATION OF DIVINE SAVIOR HEALTHCARE, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW LEASE AGREEMENTS, MANAGEMENT, AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY.
PART III, LINE 9:	SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS.
PART VI:	THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY REVENUE BONDS, SERIES 2020 BONDS (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY DIVINE SAVIOR HEALTHCARE, INC. (EIN 39-0806250). THE PROCEEDS OF THE SERIES 2020 BONDS WERE USED TO REFINANCE THE DIVINE SAVIOR HEALTHCARE, INC., SERIES 2016 BONDS (REFINANCING OF SERIES 2006 BONDS) AND SERIES 2019 BONDS (REFINANCING OF SERIES 2009, 2012, 2014 BONDS). INFORMATION REGARDING THE SERIES 2020 BONDS IS REPORTED IN SCHEDULE K FOR THAT ORGANIZATION. FOR THE ENTITY THAT BORROWED FUNDS, THE INFORMATION REPORTED IN PART I, PART II AND PART III OF SCHEDULE K RELATES ONLY TO THE PORTION OF THE SERIES 2020 BONDS LOANED TO THE ORGANIZATION. FOR THE ENTITY THAT BORROWED FUNDS, THE INFORMATION REPORTED IN PART IV OF SCHEDULE K RELATES TO THE ENTIRE ISSUE OF THE SERIES 2020 BONDS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2	BOARD MEMBERS TRAVIS HAMELE AND CHAD STEVENSON HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6	THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	ASPIRUS, INC. HAS THE ABILITY TO ELECT AT LEAST 10 OF THE 11 BOARD MEMBERS AS DESCRIBED IN THE BYLAWS.
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, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 AND THE 990-T ARE 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 PURPOSES OF DETERMINING COMPENSATION, DIVINE SAVIOR HEALTHCARE, INC. RELIES 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 AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	UNRESTRICTED NET ASSET TRANSFERS - AWH 6,689,889. UNRESTRICTED NET ASSET TRANSFERS - AI -3,481,531. UNRESTRICTED NET ASSET TRANSFERS - ACI 211,929. UNRESTRICTED NET ASSET TRANSFERS - AOH 7. UNRESTRICTED NET ASSET TRANSFERS - VNA 928. UNRESTRICTED NET ASSET TRANSFERS - AIR -125. UNRESTRICTED NET ASSET TRANSFERS - ARH 21,809. UNRESTRICTED NET ASSET TRANSFERS - AKH -280.
FORM 990, PART XII, LINE 3B	THE ORGANIZATION IS REQUIRED TO BE INCLUDED IN A SINGLE AUDIT FOR THE YEAR ENDED 06/30/2021. THE DEADLINE FOR THIS FILING FALLS AFTER THE DEADLINE FOR THE 990 FOR THE SAME FISCAL YEAR END. THE SINGLE AUDIT WILL NOT BE FINALIZED AT THE TIME OF THIS SUBMISSION.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
ASPIRUS INC
425 PINE RIDGE BLVD	WAUSAU	WI	54401	391328331	HEALTH CARE SYSTEM MANAGEMENT	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		Yes (1)	ASPIRUS INC
ASPIRUS BUILDINGS INC
333 PINE RIDGE BLVD	WAUSAU	WI	54401	391406537	PROPERTY LEASING	WI	501(C)(3)	LINE 10		Yes (1)	ASPIRUS INC
ASPIRUS EXTENDED SERVICES INC
425 PINE RIDGE BLVD	WAUSAU	WI	54401	390782130	NURSING HOME SERVICES	WI	501(C)(3)	LINE 10		0	ASPIRUS INC
ASPIRUS MEDICAL GROUP INC
425 PINE RIDGE BLVD	WAUSAU	WI	54401	391670223	MEDICAL SERVICES	WI	501(C)(3)	LINE 10		Yes (1)	ASPIRUS INC
ASPIRUS ONTONAGON HOSPITAL INC
601 SEVENTH STREET	ONTONAGON	MI	49953	260806477	HOSPITAL	MI	501(C)(3)	LINE 3		Yes (1)	ASPIRUS INC
ASPIRUS VNA HOME HEALTH INC
520 N 32ND AVENUE	WAUSAU	WI	54401	390808511	HOME HEALTHCARE SERVICES	WI	501(C)(3)	LINE 10		Yes (1)	ASPIRUS INC
ASPIRUS VNA EXTENDED CARE INC
520 N 32ND AVENUE	WAUSAU	WI	54401	391597350	PERSONAL CARE SERVICES	WI	501(C)(3)	LINE 10		Yes (1)	ASPIRUS VNA HOME HEALTH INC
ASPIRUS IRON RIVER HOSPITAL & CLINICS INC
1400 W ICE LAKE RD	IRON RIVER	MI	49935	383236977	HOSPITAL	MI	501(C)(3)	LINE 3		Yes (1)	ASPIRUS INC
ASPIRUS HEALTH FOUNDATION INC
425 PINE RIDGE BLVD	WAUSAU	WI	54401	391256656	CHARITABLE FOUNDATION	WI	501(C)(3)	LINE 7		Yes (1)	ASPIRUS INC
ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC
410 DEWEY STREET	WISCONSIN RAPIDS	WI	54494	390868982	HOSPITAL	WI	501(C)(3)	LINE 3		Yes (1)	ASPIRUS INC
ASPIRUS KEWEENAW HOSPITAL
205 OSCEOLA STREET	LAURIUM	MI	49913	381443361	HOSPITAL	MI	501(C)(3)	LINE 3		Yes (1)	ASPIRUS INC
ASPIRUS IRONWOOD HOSPITAL & CLINICS INC
N10561 GRAND VIEW LANE	IRONWOOD	MI	49938	382908586	HOSPITAL	WI	501(C)(3)	LINE 3		Yes (1)	ASPIRUS INC

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
THE WESTWOOD CONFERENCE CENTER LLC
333 PINE RIDGE BLVD	WAUSAU	WI	54401	571184256	CONFERENCE CENTER	WI	N/A	0	0
WESTERN UPPER MICHIGAN EYE CARE LLC
131 W GENESEE STREET	IRON RIVER	MI	49935	272324957	EYE CARE SERVICES	MI	N/A	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
ASPIRUS NETWORK INC
3000 WESTHILL DRIVE 202	WAUSAU	WI	54401	391931679	HEALTH CARE NETWORK	WI	N/A	C	0
ASPIRUS KEWEENAW ENTERPRISES
205 OSCEOLA STREET	LAURIUM	MI	49913	383390273	PHARMACY	MI	N/A	C	0
ASPIRUS HEALTH VENTURES
3000 WESTHILL DRIVE 303	WAUSAU	WI	54401	474925640	HEALTH INSURANCE PLAN	WI	N/A	C	0
ASPIRUS ARISE HEALTH PLAN OF WI INC
3000 WESTHILL DRIVE 303	WAUSAU	WI	54401	364832569	HEALTH INSURANCE PLAN	WI	N/A	C	0
ASPIRUS ARISE HEALTH PLAN OF MI INC
3000 WESTHILL DRIVE 303	WAUSAU	WI	54401	475448266	HEALTH INSURANCE PLAN	MI	N/A	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (9 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
ASPIRUS INC
M	$5,486,849	COST
ASPIRUS INC
O	$24,542,351	COST
ASPIRUS INC
P	$4,264,512	COST
ASPIRUS INC
Q	$569,677	COST
ASPIRUS VNA
O	$93,034	COST
ASPIRUS WAUSAU HOSPITAL INC
M	$122,288	COST
ASPIRUS WAUSAU HOSPITAL INC
O	$289,013	COST
ASPIRUS WAUSAU HOSPITAL INC
P	$169,124	COST
ASPIRUS WAUSAU HOSPITAL INC
Q	$338,996	COST

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE R, PART V, LINE 1D:	FormAndLineReferenceDesc
Explanation	ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.	ExplanationTxt