2022-02-11T07:21:07-06:00 2021-03-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156352111 1280 CHANDLER DRIVE SPOONER WI 54801 MICHAEL D SCHAFER CHIEF EXECUTIVE OFFICER 7156352111 2022-02-10 1 MICHAEL SCHAFER 999009999 RYAN STRUSZ P01604381 6123764500 2022-02-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MICHAEL D SCHAFER 1280 CHANDLER DRIVE SPOONER WI 54801 30564168 0 X WWW.SPOONERHEALTH.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 7 7 176 40 0 0 1144364 5972634 25327558 23584083 580389 817608 123187 183335 27175498 30557660 7000 10000 0 0 10936739 11387602 0 0 0 14181384 13170786 25125123 24568388 2050375 5989272 55814008 69652889 22430466 27186563 33383542 42466326 X TO PROVIDE HIGH QUALITY HEALTHCARE. 0 1 20011962 10000 23272771 SPOONER HEALTH SYSTEM IS A 25 BED CRITICAL ACCESS HOSPITAL THAT PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, REHABILITATION, DIAGNOSTIC, HOSPICE AND WOUND CARE. FOR THE FISCAL YEAR ENDING 3/31/2021, THERE WERE 1,520 INPATIENT DAYS, 330 INPATIENT DISCHARGES, 19,867 OUTPATIENT VISITS, 5,930 EMERGENCY ROOM VISITS, AND 296 SURGERIES ALONG WITH 337 SCOPE PROCEDURES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS SUCH AS MEDICARE AND MEDICAID AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM, WHICH INCLUDES FEE DISCOUNTS AS WELL AS 100% FREE CARE, IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES. 720072 0 311312 THE HOME HEALTH AGENCY PROVIDES ESSENTIAL NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/2021, THERE WERE 2,152 HOME HEALTH VISITS SERVING 221 PATIENTS, 91 ADMITTED CASES, AND 86 DISCHARGED CASES. 20732034 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 176 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X REBECCA BUSCH CFO 7159391732 1280 CHANDLER DRIVE SPOONER WI 54801 JAMIE MORALES BOARD PRESIDENT 1.00 X X 0 0 0 TIM REEDY BOARD VICE PRESIDENT 1.00 X X 0 0 0 ADAM LEIGL BOARD TREASURER 1.00 X X 0 0 0 MARK VAN ETTEN MD BOARD SECRETARY/MEDICAL DIRECTOR 5.00 X X 0 0 0 BRIAN GASKILL MD BOARD MEMBER/CHIEF OF STAFF 1.00 X 0 0 0 SUE CHURCHILL BOARD MEMBER 1.00 X 0 0 0 NICOLE TIMMS BOARD MEMBER 1.00 X 0 0 0 MICHAEL SCHAFER CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 REBECCA BUSCH CHIEF FINANCIAL OFFICER 40.00 X 127481 0 24802 PATRICK MCCANN MD ER MEDICAL DIRECTOR 40.00 X 187487 0 44230 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 40.00 X 182997 0 44117 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 40.00 X 169862 0 43716 TIMOTHY BASSETT PHARMACY DIRECTOR 40.00 X 156930 0 13800 THERESA HUTZLER APNP 40.00 X 149268 0 35280 974025 0 205945 6 0 1 0 WAPITI MEDICAL GROUP-WOOD RIVER LLC 107 FLYNN DR STE 600 MILBANK SD 57252 ER PHYSICIAN COVERAGE 1603786 ARAMARK 27310 NETWORK PLACE CHICAGO IL 60673 CULINARY/LAUNDRY 1163872 ESSENTIA HEALTH 1180 CHANDLER DRIVE SPOONER WI 54801 CONTRACTED LABOR 916948 HEALTHTECH MANAGEMENT SERVICES 5110 MARYLAND WAY STE 200 BRENTWOOD TN 37027 MANAGEMENT FEES 630679 SHARED MEDICAL TECHNOLOGY INC 2020 W NEWTON ST RICE LAKE WI 54868 DIAGNOSTIC RADIOLOGY 406122 7 5966391 6243 5972634 PATIENT SERVICE REVENUE 621400 22879681 22879681 OTHER PATIENT REVENUE FROM JV 621400 704402 704402 23584083 454361 454361 36879 0 36879 36879 36879 369755 0 6508 369755 -6508 363247 363247 MISCELLANEOUS 900099 91914 91914 MEAL INCOME 900099 54542 54542 146456 30557660 23584083 0 1000943 10000 10000 147502 147502 8575825 7507903 1067922 341704 294094 47610 1702060 1464911 237149 620511 534055 86456 693692 693692 44054 44054 59342 59342 4832 4832 1973558 1815958 157600 202518 202518 220545 123064 97481 781127 233367 547760 1215458 1189789 25669 31249 31249 11796 11796 707529 707529 2439108 2439108 111468 111468 DRUGS 2479647 2479647 MEDICAL SUPPLIES 1183466 1163598 19868 BAD DEBT EXPENSE 646015 646015 MISCELLANEOUS 238660 1034 237626 126722 78917 47805 24568388 20732034 3836354 0 4233932 16527514 1432607 1456301 3776359 3273841 503129 607903 246179 255579 35337281 12455280 25012628 22882001 19636973 23403285 972201 1246465 55814008 69652889 3079265 3641734 5830767 18434201 17697062 917000 17000 22430466 27186563 X 33383542 42466326 33383542 42466326 55814008 69652889 5989272 3093512 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4832 4832 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, RURAL WISCONSIN HEALTH COOPERATIVE AND WISCONSIN HOSPITAL ASSOCIATION WERE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF SPOONER HEALTH SYSTEM AND OTHER MEMBERS. 1215671 1215671 20273644 5607287 14666357 815951 370501 445450 13032015 6477492 6554523 22882001 THIRD PARTY PAYOR PAYABLE 17000 17000 X 33005157 3093512 3093512 29911645 646015 646015 30557660 23922373 0 23922373 646015 646015 24568388 PART X, LINE 2: THE SYSTEM IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE SYSTEM FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE SYSTEM FOLLOWS THE ACCOUNTING STANDARD FOR INCOME TAXES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 646,015. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 646,015. 1 1 1 X 1 X 1 1 1 0 1 1 238 170592 170592 0.00710 3689525 2315163 1374362 0.05740 238 3860117 2315163 1544954 0.06450 7 4402 42225 10570 31655 0.00130 11 49 31815 31815 0.00130 2 247 719149 309541 409608 0.01710 22 50 28750 28750 0.00120 42 4748 821939 320111 501828 0.02090 42 4986 4682056 2635274 2046782 0.08540 15450 15450 0.00060 1 773 773 0.00000 1 272 272 0.00000 2 16495 16495 0.00060 1 646015 12326288 12340661 -14373 X 1 1 1 1 SPOONER HEALTH SYSTEM INC 1280 CHANDLER DRIVE SPOONER WI 54801 WWW.SPOONERHEALTH.COM 1024 X X X X HOME HEALTH AGENCY SPOONER HEALTH SYSTEM 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE PART V, PAGE 8 X 1 19 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X 1 X 0 X X X X 1 X 0 0 SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 5: SPOONER HEALTH SYSTEM (SH) WORKED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER (THE CENTER) OF DULUTH, MN TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT IN THE SUMMER OF 2018. COMMUNITY INPUT WAS GATHERED THROUGH A PUBLIC COMMUNITY SURVEY AND A SERIES OF KEY INFORMANT PHONE INTERVIEWS WITH INDIVIDUALS SELECTED BASED ON THE VARIOUS CONSUMER GROUPS OF LOCAL HEALTH SERVICES INCLUDING SENIOR CITIZENS, YOUNG PARENTS, HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. A NEWS RELEASE WAS SENT TO THE LOCAL PAPERS TO INFORM AND INVITE THE PUBLIC TO BE PART OF THE PROCESS. THE SURVEY WAS DEVELOPED TO ASSESS THE HEALTH CARE NEEDS AND PREFERENCES IN THE SERVICE AREA OF WASHBURN COUNTY. THE CENTER HELPED DEVELOP, DISTRIBUTE AND COLLATE THE SURVEY RESULTS. SURVEYS WERE MAILED TO A RANDOM STRATIFIED SAMPLE OF 800 COMMUNITY RESIDENCES. ADITIONALLY, THE SURVEY LINK WAS PUBLICIZED AND AVAILABLE ON THE SH WEBSITE. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 6B: SPOONER HEALTH SYSTEM CONTRACTED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER OF DULUTH, MN TO COMPLETE THEIR CHNA. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 11: DECREASE USE OF ALCOHOL, TOBACCO AND OTHER DRUG ABUSE: PROGRESS TOWARD THIS GOAL INCLUDES CONTINUED REPORTING OF OPIOID DISPENSING TO WISCONSIN VIA THE PRESCRIPTION DRUG MONITORING PROGRAM. SH HAS INCREASED THE AMOUNT OF INFORMATION ABOUT OPIOIDS THAT IS INCLUDED IN EVERY POST-DISCHARGE SUMMARY. SH PROVIDES REPRESENTATION ON SEVERAL COLLABORATIVE COMMUNITY GROUPS SUCH AS THE WASHBURN COUNTY COMMUNITY ALLIANCE FOR PREVENTION COMMITTEE AND THE DRUG ENDANGERED CHILDREN M-TEAM, WHICH IS A MULTI-DISCIPLINARY TEAM TO PROVIDE SERVICES FOR CHILDREN FOUND AT DRUG LAB SITES. THE SH PAIN MANAGEMENT CLINIC OPENED IN 2018 AND HAD 90 VISITS IN FISCAL YEAR 2021. THE CLINIC HELPS PEOPLE TAKE AN ACTIVE ROLE IN MANAGING CHRONIC PAIN WITH A COMBINATION OF THERAPIES RATHER THAN TURNING TO OTHER SUBSTANCES TO FIND RELIEF FROM PAIN. AN UPDATED LIST OF RESOURCES FOR PATIENTS IS AVAILABLE ON THE SH WEBSITE AND THROUGH OUR CAREGIVERS. INCREASE AWARENESS, UTILIZATION & ACCESS TO BEHAVIORAL HEALTH SERVICES: SH SUPPORTS A DEMENTIA FRIENDLY COMMUNITY THROUGH LEADING AND MANAGING THE APHASIA SUPPORT GROUP AND THE MEMORY CLINIC. THE APHASIA SUPPORT GROUP PROVIDES INDIVIDUALS TANGIBLE TOOLS TO ASSIST IN COPING WITH APHASIA AS WELL AS A FORUM TO SHARE SIMILAR EXPERIENCES WITH OTHERS. THE MEMORY CLINIC IS OFFERED TWICE A MONTH AND TREATED 26 PATIENTS THIS YEAR. SH ALSO PROVIDES REPRESENTATION ON THE MENTAL HEALTH TASK FORCE OF WASHBURN COUNTY, CREATED IN 2018 TO SUPPORT MENTAL HEALTH PREVENTION AND AWARENESS PROGRAMMING. AN UPDATED LIST OF RESOURCES FOR PATIENTS IS AVAILABLE ON THE SH WEBSITE AND THROUGH OUR CAREGIVERS. THESE SERVICES CAN BE INCORPORATED INTO DISCHARGE PLANNING AND CASE MANAGEMENT AS APPLICABLE AND WILL BE COMMUNICATED TO THE PUBLIC THROUGH THE SH WEBSITE, SOCIAL MEDIA AND COMMUNITY NEWSLETTER. COMMUNITY IS AWARE OF AND ACCESSES HEALTH CARE SERVICES: SH OFFERS MANY SPECIALTY SERVICES AT ITS DESIGNATED OUTPATIENT CLINIC. PHYSICIANS HOLD CLINICS SEVERAL DAYS A WEEK INCLUDING SERVICES SUCH AS OPHTHALMOLOGY, PODIATRY, GASTROENTEROLOGY, PAIN MEDICINE, UROLOGY AND EAR, NOSE AND THROAT. SH RECOGNIZES THE NEED FOR LOCAL PATIENTS TO BE ABLE TO RECEIVE SPECIALTY CARE CLOSE TO HOME AND THE DIFFERENCE THIS CAN MAKE ON HEALTH OUTCOMES. THESE SERVICES ARE ADVERTISED THROUGH NEWSPAPERS, THE SH WEBSITE, NEWSLETTERS AND SOCIAL MEDIA POSTS AS WELL AS AN ELECTRONIC SIGN BOARD INSIDE THE HOSPITAL ENTRANCE SCROLLING UPCOMING CLINICS. SH MAKES INFORMATION ON FINANCIAL ASSISTANCE WIDELY AVAILABLE THROUGH OUR WEBSITE AND EMPLOYS A PATIENT FINANCIAL COUNSELOR TO WORK DIRECTLY WITH PATIENTS TO EDUCATE THEM ON AVAILABLE OPTIONS. SH CONTINUES FINANCIAL AND IN-KIND SUPPORT FOR THE RICE LAKE AREA FREE CLINIC AND THE LOCAL REGIONAL HOSPICE SERVICES, AS WELL AS FAITH IN ACTION WASHBURN COUNTY. SH HOLDS NUMEROUS FLU SHOT CLINICS AT VARIOUS LOCATIONS IN THE COMMUNITY. SH ORGANIZES AN ANNUAL HEALTH FAIR WHERE FREE LAB CHOLESTEROL SCREENINGS ARE PROVIDED ONSITE. IN FISCAL YEAR 2021, 48 PERSONS TOOK ADVANTAGE OF THE FREE LAB SCREENINGS AND THE HEALTH FAIR WAS HELD OUTDOORS DUE TO COVID. SH WILL CONTINUE TO ADVOCATE TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO REDEFINE THEIR MIXED-USE SPACE INTERPRETATION SO URGENT CARE CAN BE IMPLEMENTED AT THE SH FACILITY IN THE FUTURE.TWO COMMUNITY HEALTH NEEDS WERE IDENTIFIED IN THE 2018 CHNA PROCESS THAT SH HAS CHOSEN NOT TO FOCUS THEIR EFFORTS ON. 1. INCREASE AWARENESS OF PREVENTION AND MANAGEMENT OF CHRONIC DISEASE - THE TEAM DISCUSSED THAT THESE ARE ALREADY SERVICES INCORPORATED INTO THE CARE AT SH AND PREVENTION EFFORTS ARE LED DOMINANTLY BY LOCAL PUBLIC HEALTH. 2. IMPROVE UNDERSTANDING OF COMMUNITY RESOURCES REGARDING HEALTH CARE COSTS - THE TEAM DISCUSSED THAT THE HOSPITAL COULD HAVE ONLY A SMALL IMPACT ON THE COST OF HEALTH CARE AND INSURANCE COVERAGE. THE HOSPITAL WILL HOWEVER INCREASE AWARENESS OF FINANCIAL SUPPORT PROGRAMS AND OUTREACH TO BUILD RELATIONSHIPS WITH HEALTH INSURANCE COVERAGE NAVIGATORS IN THE LOCAL AREA. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE WEBSITE AT HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFORMATION/FINANCIAL-ASSISTANCE/. THE APPLICATION IS ON THE WEBSITE HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/09/395-100-FAP-ATTACHMENT-E-APPLICATION-2021.PDF. THE PLAIN LANGUAGE SUMMARY IS ON THE WEBSITE HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFORMATION/PLAIN-LANGUAGE-SUMMARY/. THE INFORMATION ON THE WEBSITES EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE AT REGISTRATION. A FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE. PART V, LINE 7A, CHNA REPORT HOSPITAL FACILITY'S WEBSITE: HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/08/SPOONER-CHNA-SURVEY-FINDINGS_FINAL.PDF (CHANGE CAPITAL LETTERS TO LOWERCASE TO ACCESS) PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE: HTTPS://SPOONERHEALTH.WPENGINE.COM/WP-CONTENT/UPLOADS/2021/08/SPOONER-HEALTH-COMMUNITY-HEALTH-ASSESSMENT-ACTION-PLAN_WEBSITE.PDF PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED PRIMARILY ON HOUSEHOLD INCOME COMPARED TO FEDERAL POVERTY GUIDELINES. HOWEVER, QUALIFIED HOUSEHOLD ASSETS ARE ALSO CONSIDERED WHEN DETERMINING AN INDIVIDUAL'S ABILITY TO PAY FOR HEALTHCARE SERVICES. FINALLY, INSURANCE STATUS CAN IMPACT A PERSON'S ELIGIBILITY IF THEY HAVE ACCESS TO HEALTH INSURANCE, THIRD-PARTY REIMBURSEMENT OR GOVERNMENTAL ASSISTANCE BUT FAIL TO TAKE ADVANTAGE OF IT OR FAIL TO MAINTAIN ELIGIBILITY. PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7A-C WERE COMPUTED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H, IRS INSTRUCTIONS. THE AMOUNTS REPORTED IN LINES 7E-I WERE REPORTED BASED ON DIRECT COSTS INCURRED BY SH. PART I, LINE 7G: INCLUDED IN PART I, LINE 7G ARE THE MEMORY CLINIC, WHICH IS A PHYSICIAN CLINIC, AND THE HOME HEALTH AGENCY. BOTH SERVICES ARE LISTED AS SUBSIDIZED HEALTH SERVICES BECAUSE THEY ARE OPERATED BY SHS TO PROVIDE A SERVICE THAT IS NEEDED IN THE COMMUNITY BUT THAT CANNOT BE SUSTAINED ON THEIR OWN. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE HOME HEALTH AGENCY WAS $706,984 WITH DIRECT OFFSETTING REVENUE OF $299,437 RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $407,547. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $12,165 WITH DIRECT OFFSETTING REVENUE OF $10,104, RESULTING IN A NET COMMUNITY EXPENSE OF $2,061. PART I, LN 7 COL(F): THE HOSPITAL IS REPORTING $1,092,849 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24B. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $24,032,284. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: SPOONER HEALTH (SH) PROVIDES REPRESENTATION ON MANY COMMUNITY HEALTH RELATED BOARDS INCLUDING WASHBURN COUNTY COMMUNITY COORDINATED RESPONSE TEAM, WASHBURN COUNTY TRANSITIONS OF CARE COALITION, BURNETT COUNTY CRISIS OVERSIGHT COMMITTEE AND FAITH IN ACTION WASHBURN COUNTY. IN FISCAL YEAR 2021, ADMINISTRATIVE AND CLINICAL STAFF AT SH SPENT MANY HOURS ACTIVELY WORKING WITH THE STATE OF WI, WASHBURN COUNTY PUBLIC HEALTH, NEIGHBORING MEDICAL FACILITIES AND OTHER COMMUNITY PARTNERS TO PREVENT, PREPARE FOR AND RESPOND TO THE COVID PANDEMIC. IN A NORMAL YEAR, SH PROVIDES FREE MEETING ROOM SPACE TO MANY NON-PROFIT COMMUNITY GROUPS, HOWEVER DURING THE PANDEMIC THIS WAS NOT POSSIBLE. SH CONTINUES TO BE A COMMUNITY DROP OFF LOCATION FOR INFECTIOUS WASTE, WHICH IS ROUTINELY COLLECTED AND PROPERLY DISPOSED OF FOR ENVIRONMENTAL SAFETY IN THE REGION. ADDITIONAL ACTIVITIES RELATED TO COMMUNITY BUILDING ARE REPORTED IN THE COMMUNITY HEALTH IMPROVEMENT CATEGORY. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 3: A PORTION OF THE BAD DEBT EXPENSE REPORTED IN LINE 2 WOULD BE CONSIDERED CHARITY CARE IF THE PROPER PAPERWORK WAS COMPLETED BY THE PATIENTS, HOWEVER THIS AMOUNT CANNOT BE QUANTIFIED. PART III, LINE 4: FOR INFORMATION ABOUT BAD DEBT EXPENSE, SEE THE "PATIENT RECEIVABLES, NET" SECTION OF NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2021 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $14,373 SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THESE ARE THE COSTS OF PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE HOSPITAL DIDN'T PROVIDE THESE SERVICES, NO OTHER ORGANIZATION IN THE COMMUNITY WOULD. PART III, LINE 9B: AFTER FINANCIAL ASSISTANCE IS PROVIDED, SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. SPOONER HEALTH SYSTEM MAKES ALL REASONABLE ATTEMPTS TO CONFIRM THAT PATIENTS ARE NOT ELIGIBLE FOR OTHER ASSISTANCE PROGRAMS PRIOR TO COLLECTION AGENCY ASSIGNMENT. PRIOR TO TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND STATEMENTS AND COLLECTION LETTERS TO THE PATIENT AT THE ADDRESS PROVIDED BY THE PATIENT. STATEMENTS AND COMMUNICATIONS WILL INFORM THE PATIENT OF THEIR FINANCIAL RESPONSIBILITY AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN. PART VI, LINE 2: THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT REPORTED IN PART V, SECTION B WAS THE ONLY ASSESSMENT OF THE COMMUNITY'S HEALTH NEEDS CONDUCTED DURING THE FISCAL YEAR. PART VI, LINE 3: PATIENTS WITHOUT INSURANCE ARE GIVEN THE FINANCIAL ASSISTANCE (FA) APPLICATION. OUR FINANCIAL COUNSELOR CALLS THEM AFTER DISCHARGE AND EXPLAINS WHAT ASSISTANCE (FROM THE GOVERNMENT OR SHS) MAY BE AVAILABLE TO THEM. SHE ASKS THEM TO FILL IT OUT AND MAKES AN APPOINTMENT WITH THEM IN THE OFFICE IF THEY NEED ASSISTANCE WITH THE FA APPLICATION OR GOING TO WWW.ACCESS.WISCONSIN.GOV TO APPLY FOR GOVERNMENTAL ASSISTANCE. WHEN THEY COME IN, SHE WILL ASSIST THEM WITH THE APPLICATION PROCESS AS MUCH AS SHE CAN. IF THEY NEED FURTHER ASSISTANCE, ARE OF RETIREMENT AGE, OR IF THERE IS A DISABILITY INVOLVED, SHE REFERS THEM TO THE WASHBURN COUNTY AGING AND DISABILITY RESOURCE CENTER WHERE THEY WILL HELP THE PATIENTS IN GETTING ADDITIONAL ASSISTANCE. OUR FINANCIAL COUNSELOR ALSO REFERS PATIENTS TO THE COUNTY'S PUBLIC HEALTH DEPARTMENT IF THEY NEED FAMILY OR WOMEN'S HEALTH ASSISTANCE. WE ALSO PUBLICIZE THE AVAILABILITY OF FA IN OUR ANNUAL REPORT TO THE COMMUNITY THAT IS SENT OUT TO EVERY ADDRESS IN OUR PRIMARY SERVICE AREA. PART VI, LINE 4: SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURNCOUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 30TH LARGESTCOUNTY BY LAND AREA IN WISCONSIN WITH AN ESTIMATED POPULATION OF 16,623 (PER APRIL 2020 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $50,280 WITH 12.8% OF PERSONS BELOW POVERTY LEVEL (PER 2014-2018 DATA). WASHBURN COUNTY HAD A 2.4% UNEMPLOYMENT RATE IN OCTOBER 2021 PER THE WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT. PART VI, LINE 6: SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 HIGH SCHOOL STUDENT SCHOLARSHIPS 6 8000 EMPLOYEE TUITION ASSISTANCE 1 2000 PART I, LINE 2: SPOONER HEALTH SYSTEM AWARDS SCHOLARSHIPS TO HIGH SCHOOL SENIORS WHO ARE GOING ON TO COLLEGE IN A HEALTH CARE FIELD. THE FUNDS ARE PAID DIRECTLY TO THE COLLEGE TO ENSURE THEY ARE USED FOR THE PURPOSE OF TUITION. SPOONER HEALTH SYSTEM ALSO OFFERS TUITION ASSISTANCE FOR EMPLOYEES THAT ARE FURTHERING THEIR EDUCATION TO ENHANCE THEIR JOB RELATED SKILLS, KNOWLEDGE AND IMPROVE THEIR POTENTIAL FOR PROMOTION OR CAREER DEVELOPMENT OPPORTUNITIES. TO RECEIVE TUITION REIMBURSEMENT FROM THE HOSPITAL, AN EMPLOYEE MUST SUBMIT A TUITION ASSISTANCE IN EXCHANGE FOR SERVICE FROM THE HUMAN RESOURCES DEPARTMENT ALONG WITH THE APPROPRIATE DOCUMENTATION. THIS INCLUDES WRITTEN PROOF OF SUCCESSFUL COMPLETION OF THE COURSE PER THE COURSE REQUIREMENTS AND ITEMIZED BILLS, RECEIPTS OR STATEMENTS WITH PROOF OF PAYMENT FOR EXPENSES. X X X 0 0 0 0 0 0 0 0 0 PATRICK MCCANN MD ER MEDICAL DIRECTOR 187487 0 0 0 0 0 9900 0 34330 0 231717 0 0 0 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 182997 0 0 0 0 0 9681 0 34436 0 227114 0 0 0 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 169862 0 0 0 0 0 9084 0 34632 0 213578 0 0 0 THERESA HUTZLER APNP 149268 0 0 0 0 0 0 0 35280 0 184548 0 0 0 TIMOTHY BASSETT PHARMACY DIRECTOR 156930 0 0 0 0 0 8030 0 5770 0 170730 0 0 0 REBECCA BUSCH CHIEF FINANCIAL OFFICER 127481 0 0 0 0 0 6633 0 18169 0 152283 0 0 0 A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-10-23 21200000 CONSTRUCTING REPLACEMENT HOSPITAL 0 0 0 A 3080000 21240408 21240408 2016 0 0 1 1 A 0 1 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/13/2019 FORM 990, PART III, LINE 3 WE NOW STAFF OUR OWN CARDIAC REHAB PROGRAM, PRIOR TO 10/1/2020 IT WAS STAFFED BY ESSENTIA. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 SPOONER HEALTH SYSTEM CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. INCLUDED IN THE FEES PAID TO HEALTHTECH MANAGEMENT SERVICES IS THE COMPENSATION FOR THE CEO. DURING 2020, THE CEO RECEIVED $244,877 OF TAXABLE PAY, $10,860 OF NONTAXABLE DEFERRED COMPENSATION AND $23,695 OF OTHER NONTAXABLE BENEFITS FROM HEALTHTECH MANAGEMENT SERVICES FOR HIS SERVICES TO SPOONER HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 WAS REVIEWED WITH BOARD MEMBERS WHO APPROVED IT. THE 990 WAS THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ANY OFFICER, BOARD MEMBER, OR KEY EMPLOYEE OF THE ORGANIZATION ON AN ANNUAL BASIS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE PERSON WITH THE CONFLICT SHALL LEAVE MEETINGS DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A MICHAEL SCHAFER, CEO, IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION, INCLUDING COMPENSATION SURVEYS, TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL, WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. ALL OFFICERS AND KEY EMPLOYEES' COMPENSATION IS REVIEWED ON AN ANNUAL BASIS AND COMPARED TO MARKET DATA GATHERED BY THE HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.