2022-05-12T12:42:55-05:00 2021-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2020-07-01 390868982 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC ASPI 7154229292 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 7154229292 2022-05-06 1 SIDNEY SCZYGELSKI 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-04-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SIDNEY C SCZYGELSKI 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 191756381 0 X WWW.ASPIRUS.ORG X 1912 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 12 6 753 192 259969 0 5000378 5159052 149926655 154137095 3078879 5755598 322783 560346 158328695 165612091 62500 425 0 0 58680770 59078431 0 0 0 75174663 77001852 133917933 136080708 24410762 29531383 210052304 202900701 77413866 62928981 132638438 139971720 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 109760578 425 154043363 ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. OWNS AND OPERATES THE FOLLOWING ENTITIES: (1) ASPIRUS RIVERVIEW HOSPITAL, ESTABLISHED IN 1912; (2) THE OUTPATIENT ASPIRUS RIVERVIEW THERAPIES; (3) ASPIRUS RIVERVIEW CLINICS - THIS SERVICE INCLUDES CLINICS IN WISCONSIN RAPIDS, NEKOOSA, THE ROME-LAKES AREA, ADAMS CLINIC, AND THE MARSHFIELD CLINIC ESTABLISHED IN 2021; (4) THE ASPIRUS CANCER CARE WISCONSIN RAPIDS; (5) ASPIRUS RIVERVIEW DENTAL CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THIS CLINIC IN 2009 TO SERVE RESIDENTS OF SOUTH WOOD COUNTY WHO ARE COVERED BY BADGER CARE/MEDICAID; (6) ASPIRUS RIVERVIEW WOUND AND HYPERBARIC CENTER. THE CENTER OPENED IN 2010 AND IS MANAGED BY HEALOGICS; (7) ASPIRUS HEART & VASCULAR CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THE CLINIC IN 2016, STAFFING IT WITH A FULL-TIME CARDIOLOGIST AND NURSE PRACTITIONER; (8) ASPIRUS DOCTORS CLINIC WAS PURCHASED AS OF 1/1/17. (9) ASPIRUS RIVERVIEW BEHAVIORAL HEALTH CLINIC WAS ESTABLISHED IN 2018. IT PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AND IS STAFFED BY PSYCHIATRISTS, NURSE PRACTITIONERS AND LICENSED CLINICAL SOCIAL WORKERS.ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT, AND IT PROVIDES MEASURABLE IMPROVEMENT IN HEALTH ACCESS, HEALTH STATUS, AND THE USE OF HEALTH CARE RESOURCES. IN ADDITION, THE PROGRAMS AND SERVICES CONSIDERED COMMUNITY BENEFITS SHOULD MEET ONE OR MORE OF THE FOLLOWING CRITERIA: *SUPPORTS THE ORGANIZATION'S COMMUNITY-BASED MISSION *TARGETS THE PROBLEMS OF THE POOR OR MEDICALLY UNDERSERVED *IMPACTS THE HEALTH STATUS OF THE IDENTIFIED COMMUNITY *REDUCES COMMUNITY HEALTH COSTS *IS ACCESSIBLE TO THE ENTIRE TARGET COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY *STIMULATES EXTERNAL COMMUNITY PARTNERSHIPS *IMPROVES THE ACCESS TO NEEDED HEALTH CARE SERVICESFONEMED IS A FREE, CONFIDENTIAL TELEPHONE SERVICE THE COMMUNITY CAN CALL AFTER THE CLINICS ARE CLOSED TO GET ROUTINE HEALTH ADVICE OR GENERAL HEALTH INFORMATION FROM A REGISTERED NURSE. APPROXIMATELY 1,748 PERSONS BENEFITED FROM THIS PROGRAM.ASPIRUS RIVERVIEW DENTAL CLINIC IN WISCONSIN RAPIDS IS OPEN TO PATIENTS WHO HAVE MEDICAID OR BADGER CARE INSURANCE COVERAGE. THIS INSURANCE IS NOT TYPICALLY ACCEPTED BY INDEPENDENT DENTAL CLINICS. THERE WERE APPROXIMATELY 2,085 VISITS FROM THIS PROGRAM IN 2021. THE LIFELINE PROGRAM IS A 24 HOUR A DAY PERSONAL RESPONSE SYSTEM. A LIFELINE UNIT IS INSTALLED IN THE "SUBSCRIBER'S" HOME AND OPERATES THROUGH THEIR PHONE LINE. HE/SHE WEARS A "PERSONAL HELP BUTTON", WHICH THEY USE TO ALERT LIFELINE SIMPLY BY PRESSING THE BUTTON. THERE IS ALSO AN AUTO ALERT PERSONAL HELP BUTTON, WHICH ALERTS LIFELINE AUTOMATICALLY IF THE SUBSCRIBER FALLS. A LIFELINE "MONITOR" ANSWERS THE CALL THROUGH THE LIFELINE UNIT, AND THEY CALL THE SUBSCRIBER. AFTER THEY DETERMINE WHAT KIND OF HELP IS NEEDED, THEY CALL THE SUBSCRIBER'S "RESPONDERS", WHICH ARE FRIENDS, NEIGHBORS, OR RELATIVES THAT CAN CHECK ON THE SUBSCRIBER, OR IF THE SUBSCRIBER NEEDS MORE PROFESSIONAL HELP THE MONITOR WILL CALL FOR IT IMMEDIATELY. THE LIFELINE PROGRAM HELPS PEOPLE THAT WOULD OTHERWISE BE UNABLE TO REMAIN IN THEIR HOMES. IT PROVIDES THEM WITH FREEDOM AND SECURITY TO DO SO, WHILE ALSO PUTTING THEIR FAMILY AT EASE. OUR PROGRAM HELPS MANY PEOPLE IN WISCONSIN RAPIDS AND THE SURROUNDING AREA. IN 2021, ASPIRUS RIVERVIEW PARTNERED WITH PHILIPS LIFELINE. APPROXIMATELY 160 PEOPLE BENEFITED FROM THE LIFELINE PROGRAM.VULNERABLE PEOPLE OF ALL AGES INCLUDING THE ELDERLY CAN REMAIN IN THEIR HOME AND BE SELF-SUFFICIENT BY RECEIVING A HOME DELIVERED MEAL THAT MEETS THEIR SPECIFIC NUTRITION REQUIREMENTS. HEALTH CONDITIONS OR PHYSICAL DISABILITIES RESTRICT THE ABILITY OF INDIVIDUALS TO REMAIN INDEPENDENT. THE HOME DELIVERED MEALS PROGRAM PROVIDES NUTRITION THAT IS MEDICALLY THERAPEUTIC TO ADDRESS THE SPECIAL NEEDS OF CLIENTS DIAGNOSED WITH DIABETES, CARDIAC AND PULMONARY ISSUES, RETINAL DISEASE, GLUTEN INTOLERANCE, WEIGHT LOSS DUE TO CANCER AND CHEWING AND SWALLOWING PROBLEMS. THE PROGRAM ALSO MEETS THE NEEDS OF CARETAKERS OF THE MENTALLY AND PHYSICALLY HANDICAPPED OR ALZHEIMER'S OR OTHER DEMENTIA DISORDERS BY PROVIDING MEALS TO ALLOW THEM TO CARE FOR THEIR LOVED ONES. NUTRITION EDUCATION IS ALSO OFFERED. COMMUNITY VOLUNTEERS DELIVER HOT LUNCHES MONDAY - FRIDAY AS WELL AS BROWN BAG MEALS FOR WEEKENDS. FOOD IS PREPARED WITH CONSIDERATION FOR EACH CLIENT'S PERSONAL PREFERENCES AS WELL AS DIETARY RESTRICTIONS. IN 2021, 22,260 MEALS WERE DELIVERED. IN AN EFFORT TO MEET THE COMMUNITY NEEDS OF STUDENTS IN THE WISCONSIN RAPIDS AREA, ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. OFFERS THE OPPORTUNITY FOR INTERESTED STUDENTS TO EXPERIENCE A GLIMPSE OF THE ROLE OF ITS PROFESSIONAL STAFF. THIS SERVICE IS MADE AVAILABLE TO STUDENTS WHO ARE INTERESTED IN LEARNING MORE ABOUT HEALTH CAREERS. IN 2020, ASPIRUS RIVERVIEW HAD 25 JOB SHADOW PARTICIPANTS. THIS WAS NOT OFFERED IN FY21 DUE TO COVID.ASPIRUS RIVERVIEW OFFERS A FREE SEMINAR ENTITLED UNDERSTAND YOUR JOINT PAIN. THIS SEMINAR DISCUSSED WHAT YOU CAN DO ABOUT KNEE, HIP, AND OTHER JOINT PAIN. ATTENDANTS ALSO LEARNED ABOUT ARTHRITIS, THE CAUSES AND SYMPTOMS, AND TREATMENT OPTIONS INCLUDING MEDICATIONS, NUTRITION, EXERCISE, ALTERNATIVE TREATMENTS, AND NEW CONCEPTS IN JOINT REPLACEMENT. ASPIRUS RIVERVIEW COORDINATES AND FACILITATES SEVERAL SUPPORT GROUPS FOR INDIVIDUALS AND THEIR LOVED ONES WHO ARE DEALING WITH CHRONIC DISEASE, CANCER, OR LOSS. THE SUPPORT GROUPS INCLUDE BOTH MEN'S AND WOMEN'S CANCER, DIABETES, CELIAC DISEASE, ARTHRITIS, AND LOSS. IN ADDITION, LACTATION SPECIALISTS FROM THE ASPIRUS RIVERVIEW FAMILY BIRTHPLACE OFFER BREASTFEEDING SUPPORT TO NEW MOTHERS. APPROXIMATELY, 420 INDIVIDUALS BENEFITED FROM THESE PROGRAMS.ASPIRUS RIVERVIEW OFFERS PRECEPTORSHIP OPPORTUNITIES TO STUDENTS ENROLLED IN AREA NURSING PROGRAMS. THIS STRUCTURED PROGRAM PROVIDES INSTRUCTION, DIRECTION AND GUIDANCE TO STUDENTS WHO ARE NOT EMPLOYEES OF ASPIRUS RIVERVIEW. THE PROGRAM MEETS THE REQUIREMENTS FOR COURSE CREDIT IN A HEALTHCARE SETTING. IN 2021, 262 STUDENTS BENEFITED FROM PRECEPTORSHIP OPPORTUNITIES.ASPIRUS RIVERVIEW HELD MONTHLY WORKSHOPS ON HOW TO COMPLETE AN ADVANCED DIRECTIVE AND APPOINT A HEALTHCARE POWER OF ATTORNEY. ADDITIONAL PRESENTATIONS WERE GIVEN TO THE WISCONSIN RAPIDS ROTARY CLUB IN AN EVENING SEMINAR. IN 2021, 28 PEOPLE RECEIVED THIS EDUCATION.ASPIRUS RIVERVIEW IS A BUSINESS SITE FOR PROJECT SEARCH - AN INTERNATIONAL PROGRAM THAT PROVIDES YOUNG ADULTS WITH COGNITIVE AND PHYSICAL DISABILITIES WITH ON-SITE INTERNSHIPS. ASPIRUS RIVERVIEW PROVIDES CLASSROOM SPACE AND 10-WEEK INTERNSHIPS IN VARIOUS DEPARTMENTS. AT THE END OF THE YEAR, STUDENTS HAVE GAINED VALUABLE SOCIAL AND EMPLOYMENT SKILLS THAT WILL HELP THEM FIND GAINFUL EMPLOYMENT IN THE COMMUNITY. IN 2021, 7 STUDENTS BENEFITED FROM THIS PROGRAM. 109760578 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 72 0 753 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 SIDNEY C SCZYGELSKI SBP & CHIEF FINANCIAL OFFICER 1.00 50.00 X X 0 861658 64993 JESSE TISCHER TREAS. & SVP & PRES.-REGIONAL MKTS 1.00 50.00 X 0 551417 54420 BONITA KOLRUD MD DIRECTOR/PHYSICIAN 1.00 40.00 X 0 424196 49221 JON HARDESTY VP-CORPORATE HUMAN RESOURCES 1.00 40.00 X X 0 298294 42249 CHRISTOPHER STINES PRESIDENT-ASPIRUS RIVERVIEW 40.00 X X 0 296659 22851 MARY IRONSIDE BOARD VICE-CHAIR 1.00 X X 0 0 0 MARTIN J LOY BOARD SECRETARY 1.00 X X 0 0 0 DAVID STARK BOARD CHAIR 1.00 X X 0 0 0 STEVEN BERLYN DIRECTOR 1.00 X 0 0 0 MICHAEL BOVEE DIRECTOR 1.00 X 0 0 0 MARY MERDAN DIRECTOR/NURSE PRACTITIONER 1.00 40.00 X 0 102452 32134 SHELLY MONDEIK DIRECTOR 1.00 X 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 1.00 50.00 X 0 1316596 71205 JOHN HEISLER SVP&CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 571823 43247 RENEE SMITH EXECUTIVE DIRECTOR-ANI 2.00 50.00 X 0 506661 49619 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 475604 56304 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-ASPIRUS CLINICS 2.00 50.00 X 0 481240 39357 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 2.00 50.00 X 0 455671 52263 ANDREW BARTH PRESIDENT-ASPIRUS LANGLADE HOSPITAL 2.00 40.00 X 0 422187 49666 RUTH RISLEY-GRAY SVP & SYSTEM CNO 2.00 50.00 X 0 419745 45966 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 2.00 50.00 X 0 426022 0 RICK NEVERS SVP-REG. OPS. SYSTEM INT. OFFICER 2.00 50.00 X 0 371883 30050 BRETT DAVIS PRESIDENT-ASPIRUS HEALTH PLAN 2.00 40.00 X 0 303898 26541 NANCY ROTH-MALLEK VP-FINANCE 40.00 X 221008 0 45855 KIMBERLY JOHNSON VP-PATIENT CARE & CNO 40.00 X 212245 0 44477 REBECCA PHILLIP DIRECTOR-PHARMACY 40.00 X 203029 0 24353 LISA SKIBBA VP-ANCILLARY SERVICES 40.00 X 172698 0 43986 LORI SLATTERY MANAGER-CLINIC 40.00 X 160867 0 29659 JESSICA FOX VP-HUMAN RESOURCES ARH 40.00 X 162293 0 23056 STACI SOVA NURSE PRACTITIONER 40.00 X 176215 0 40858 JACOB MALOOLY PHYSICIAN ASSISTANT 40.00 X 153755 0 42616 DENISE KNIPRATH NURSE PRACTITIONER 40.00 X 160809 0 31406 ROCHELLE ANDERSON-TESCH REGISTERED NURSE-TEAM LEAD 40.00 X 133321 0 37907 MATTHEW MALOOLY PHARMACIST 40.00 X 151653 0 12406 CARI LOGEMANN SVP & GEN. COUNSEL (THRU 06/20) 2.00 50.00 X 0 437354 22668 1907893 8723360 1129333 33 1 1 0 MEA EMERGENCY MANAGEMENT PO BOX 634850 CINCINNATI OH 452634850 ER SERVICE 5527216 ELLIS STONE CONSTRUCTION CO PO BOX 366 STEVENS POINT WI 54481 CONSTRUCTION SERVICE 1442557 MIRON CONSTRUCTION 1471 MCMAHON DRIVE NEENAH WI 54957 CONSTRUCTION SERVICE 903993 ANESTHESIA ASSOCIATES OF WISCONSIN RAPID 225 S EXECUTIVE DRIVE BROOKFIELD WI 53005 ANESTHESIA SERVICE 518686 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 PATHOLOGY FEE 454700 19 4724470 434582 5159052 PATIENT SERVICES 621500 153682120 153682120 LAB SERVICE FOR NON PATIENTS 621500 68650 68650 386325 341954 44371 154137095 26931 26931 583135 280832 302303 302303 302303 31584125 8000 25613316 250142 5970809 -242142 5728667 5728667 CAFETERIA 722514 238754 146948 91806 EHR INCENTIVE PAYMENTS 624200 19289 19289 258043 165612091 154043363 259969 6149707 X 425 425 1329783 1329783 45815053 40861706 4953347 2120812 1839915 280897 6746522 5775896 970626 3066261 2581415 484846 69793 69793 17500 17500 13867143 12439162 1427981 42117 2731 39386 201375 109448 91927 298351 111491 186860 2189465 719928 1469537 109174 79123 30051 550 550 1720945 3355 1717590 8182996 7816324 366672 278025 146370 131655 MEDICAL SUPPLIES 23744555 23594195 150360 CORPORATE ALLOCATIONS 18135775 8485795 9649980 REPAIRS & MAINTENANCE 2667459 2173500 493959 BAD DEBT EXPENSE 2269792 2256279 13513 3206837 763520 2443317 136080708 109760578 26320130 0 87122 68880 17160459 641155 19392055 19932802 2885869 2793453 507199 226264 187228612 106976063 79630245 80252549 70146619 78866082 20242736 20119516 210052304 202900701 15415124 10521022 52287175 50431758 9711567 1976201 77413866 62928981 X 130770486 138644358 1867952 1327362 132638438 139971720 210052304 202900701 X 29531383 11657570 -33855671 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8057 8057 0 PART II-B, LINE 1: THE PERCENTAGES THAT ARE SPECIFIC FOR LOBBYING PURPOSES ARE AS FOLLOWS: 25.6% OF THE AMERICAN HOSPITAL ASSOCIATION TOTALING $4,534, 11.3% OF THE WISCONSIN HOSPITAL ASSOCIATION TOTALING $1,583 AND OTHER MINOR ACTIVITY OF $1,940 MAKING THE GRAND TOTAL OF DUES DIRECTED TOWARDS LOBBYING $8,057. 3765872 3765872 103428722 49464321 53964401 76470674 56492935 19977739 3563344 1018807 2544537 80252549 CASH VALUE OF LIFE INSURANCE 984012 DUE FROM ASPIRUS INC 19135504 20119516 RETIREE HEALTHCARE BENEFITS 8721 DEFERRED COMPENSATION 2047269 LONG TERM INSURANCE 704554 FINANCE LEASE LIABILITY 428656 LONG TERM FICA 614591 MEDICARE REFUNDABLES ADVANCES -1827590 1976201 X PART X, LINE 2: ASPIRUS HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND CONCLUDED THAT NO MATERIAL LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS AT JUNE 30, 2021. ASPIRUS' FEDERAL INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED JUNE 30, 2017, AND PRIOR YEARS. ASPIRUS' WISCONSIN AND MICHIGAN STATE INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR THE YEAR ENDED JUNE 30, 2016, AND PRIOR YEARS. 1 1 X 1 X 1 X 1 1 1 0 1 1 1260606 59888 1200718 0.00880 21090620 14508931 6581689 0.04840 22351226 14568819 7782407 0.05720 208693 59811 148882 0.00110 175416 175416 0.00130 4099799 1651445 2448354 0.01800 23862 23862 0.00020 136332 89725 46607 0.00030 4644102 1800981 2843121 0.02090 26995328 16369800 10625528 0.07810 3046 3046 0.00000 8863 8863 0.00010 11909 11909 0.00010 1 779814 15380685 18511769 -3131084 X 1 1 1 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54495 HTTP://WWW.ASPIRUS.ORG/MAIN/HOME.ASPX WI #11 X X X ASPIRUS RIVERVIEW HOSPITAL & CLINICS IN 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES X 1 18 0 1 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: INPUT WAS GATHERED FROM PERSONS WHO REPRESENT THE COMMUNITY IN THE FOLLOWING WAYS: 1) A COMMUNITY-WIDE SURVEY 2) FOCUS GROUPS WITH DISENFRANCHISED POPULATIONS 3) A FORUM WITH COMMUNITY STAKEHOLDERS. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: MARSHFIELD CLINIC HEALTH SYSTEMS - MARSHFIELD, WI ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6B: WOOD COUNTY HEALTH DEPARTMENT ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: ADDRESSING THE NEEDS:1. BEHAVIORAL HEALTH: IN RESPONSE TO THE NEED FOR ADDITIONAL BEHAVIORAL HEALTH SERVICES, ASPIRUS RIVERVIEW HOSPITAL ESTABLISHED AN OUTPATIENT BEHAVIORAL HEALTH SERVICE. IN FY 2021, 4,387 PEOPLE RECEIVED SERVICES. 2. SUBSTANCE USE: ASPIRUS RIVERVIEW HOSPITAL INTRODUCED A PEER COUNSELING PROGRAM TO HELP THOSE WANTING HELP WITH SUBSTANCE ADDITION. THE PEER COUNSELORS ARE AVAILABLE 24 HOURS A DAY/SEVEN DAYS A WEEK AND WILL COME TO THE EMERGENCY ROOM TO MEET WITH PATIENTS WHO ARE THERE DUE TO AN OVERDOSE. PEER COUNSELORS HAVE ALSO BEEN PROVIDED SPACE WITHIN THE CLINIC. IN ADDITION, ASPIRUS RIVERVIEW STARTED A MEDICATION-ASSISTED TREATMENT PROGRAM TO SUSTAIN THE RECOVERY OF PATIENTS STRUGGLING TO OVERCOME ADDICTION. 3. ACTIVE COMMUNITIES AND COMMUNITY FOOD SYSTEMS: IN COLLABORATION WITH THE WOOD COUNTY HEALTH DEPARTMENT, ASPIRUS RIVERVIEW HOSPITAL FUNDED A FRUIT/VEGETABLE PRESCRIPTION PROGRAM AT THE LOCAL FARMER'S MARKET. PROVIDERS CAN PROVIDE LOW-INCOME PATIENTS AND THEIR FAMILIES WITH A PRESCRIPTION AND VOUCHER TO PURCHASE FRESH PRODUCE FROM THE MARKET. THE PROGRAM ENSURES THAT LOCALLY SOURCED, FRESH PRODUCE IS AVAILABLE FOR PATIENTS AND FAMILIES WHO OTHERWISE WOULD NOT BE ABLE TO AFFORD IT. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 8 1 - ASPIRUS DOCTORS CLINIC 2031 PEACH STREET WISCONSIN RAPIDS WI 54494 CLINIC 2 - ASPIRUS CANCER CARE WISCONSIN RAPIDS 410 DEWEY STREET WISCONSIN RAPIDS WI 54495 CANCER CENTER 3 - ASPIRUS RIVERVIEW CLINIC WI RAPIDS 420 DEWEY STREET PO BOX 8080 WISCONSIN RAPIDS WI 54495 CLINIC 4 - APIRUS RIVERVIEW CLINIC NEKOOSA 1015 ANGELUS DRIVE NEKOOSA WI 54457 CLINIC 5 - ASPIRUS RIVERVIEW CLINIC ADAMS 419 N OAK STREET ADAMS WI 53910 CLINIC 6 - ASPIRUS RIVERVIEW CLINIC MARSHFIELD 146 N CENTRAL AVENUE MARSHFIELD WI 54449 CLINIC 7 - ASPIRUS RIVERVIEW DENTAL 820 TWO MILE AVENUE WISCONSIN RAPIDS WI 54494 DENTAL CLINIC 8 - ASPIRUS RIVERVIEW CLINIC ROME 1160 ROME CENTER DRIVE TOWN OF ROME NEKOOSA WI 54457 CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF: 1) PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200% EQUITY ALLOWANCE IS $75,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G., DAIRY FARM) IS EVALUATED INDIVIDUALLY ON A CASE-BY-CASE BASIS. 2) CASH ASSETS IN EXCESS OF $4,000 AT THE TIME OF APPLICATION. SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS AND IRREVOCABLE BURIAL TRUST FUNDS. 3) TOTAL NET ASSETS CANNOT EXCEED 800% OF FEDERAL POVERTY GUIDELINES. THIS INCLUDES ALL ASSETS INCLUDING CASH ASSETS ABOVE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSE, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION. PART I, LINE 7G: THE ABOVE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE ASPIRUS RIVERVIEW CLINIC ADAMS, ASPIRUS RIVERVIEW CLINIC NEKOOSA AND BEHAVIORAL HEALTH CLINIC. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. THE ASPIRUS RIVERVIEW CLINIC ADAMS REPORTED COSTS OF $1,055,267 WITH OFFSETTING REVENUE OF $317,117. THE ASPIRUS RIVERVIEW CLINIC NEKOOSA REPORTED COSTS OF $1,551,324 WITH OFFSETTING REVENUE OF $899,343. THE BEHAVIORAL HEALTH CLINIC REPORTED COSTS OF $1,493,208 WITH OFFSETTING REVENUE OF $434,985. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24B, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $2,269,792 PART II, COMMUNITY BUILDING ACTIVITIES: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. 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. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC., 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 ORGANIZATION PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: CARDIOLOGY, CANCER CENTER, CLINIC SERVICES, DENTAL SERVICES, DIAGNOSTIC IMAGING, BIRTHING CENTER, LABORATORY SERVICES, RESPIRATORY CARE, SLEEP LAB, WOMEN'S SERVICES, SURGICAL SERVICES, AND REHABILITATION SERVICES. 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 ORGANIZATIONS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. 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 III, LINE 4: 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 A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. SOMETIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED FINANCIAL ASSISTANCE APPLICATION AND ARE SCREENED THROUGH THE PRESUMPTIVE ELIGIBILITY PROCESS BUT MAY BE TRANSFERRED TO THE COLLECTION AGENCY REGARDLESS OF ALL THESE EFFORTS. PART III, LINE 8: THE AMOUNT OF MEDICARE ALLOWABLE COSTS WAS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY 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 HAVE THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNT LISTED FOR MEDICARE REVENUE DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT ASPIRUS RIVERVIEW HOSPITAL, PHYSICIAN SERVICES PROVIDED AT THE OUTLYING CLINIC LOCATIONS, AND A SIGNIFICANT PORTION OF LAB SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE AND OUTPATIENT LAB SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY PHYSICIAN 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 ASPIRUS RIVERVIEW HOSPITAL PROVIDES TO THE COMMUNITY AND THE SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY THE HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED BASED ON MEDICARE REGULATIONS. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR. 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: REPRESENTATIVES FROM ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. ACTIVELY PARTICIPATE IN HEALTHY PEOPLE WOOD COUNTY (HPWC). THE PURPOSE OF HPWC IS TO ESTABLISH PRIORITIES AND RECOMMEND STRATEGIES TO ENHANCE THE QUALITY OF LIFE, HEALTH STATUS, AND THE ENVIRONMENT IN WOOD COUNTY. IN ORDER TO ACCOMPLISH THIS, MULTIPLE PARTNERS WORK TOGETHER TO ANALYZE HEALTH DATA, QUALITY OF LIFE INDICATORS AND THE COMMUNITY'S PERCEPTION OF HEALTH. IN MARCH 2015, ASPIRUS RIVERVIEW BEGAN COLLABORATING WITH THE WOOD COUNTY PUBLIC HEALTH DEPARTMENT, MINISTRY SAINT JOSEPH'S HOSPITAL AND MARSHFIELD CLINIC ON A COMPREHENSIVE HEALTH NEEDS ASSESSMENT. HEALTH NEEDS ARE BEING DETERMINED AND PRIORITIZED THROUGH COMMUNITY SURVEYS, STAKEHOLDER FOCUS GROUPS AND RECENT HEALTH DATA. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATION AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AS WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: ASPIRUS RIVERVIEW HOSPITAL AND CLINICS OWNS AND OPERATES THE FOLLOWING ENTITIES: (1) ASPIRUS RIVERVIEW HOSPITAL; (2) THE OUTPATIENT ASPIRUS RIVERVIEW THERAPIES; (3) ASPIRUS RIVERVIEW CLINIC, THIS SERVICE INCLUDES CLINICS IN WISCONSIN RAPIDS, NEKOOSA, THE ROME-LAKES AREA, ADAMS CLINIC AND MARSHFIELD CLINIC ESTABLISHED IN 2021. (4) THE ASPIRUS CANCER CARE - WISCONSIN RAPIDS; AND (5) ASPIRUS RIVERVIEW DENTAL CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THIS CLINIC IN 2009 TO SERVE RESIDENTS OF SOUTH WOOD COUNTY. RIVERVIEW DENTAL CLINIC IN WISCONSIN RAPIDS IS OPEN TO PATIENTS WHO HAVE MEDICAID OR BADGER CARE INSURANCE COVERAGE. THIS INSURANCE IS NOT TYPICALLY ACCEPTED BY INDEPENDENT DENTAL CLINICS. APPROXIMATELY 1,521 PERSONS BENEFITED FROM THIS PROGRAM IN FISCAL YEAR 2021. WHILE MANY RIVERVIEW PATIENTS COME FROM WOOD COUNTY, AN INCREASING NUMBER ARE COMING TO US FROM SURROUNDING COUNTIES - SPECIFICALLY THOSE ALONG THE INTERSTATE 39 CORRIDOR: MARATHON, PORTAGE, WAUPACA, ADAMS, JUNEAU, WAUSHARA, MARQUETTE, COLUMBIA, AND DANE. FOR THE UW CANCER CENTER-RIVERVIEW IN 2021, OVER 20% OF ALL PATIENTS CAME FROM THESE SAME COUNTIES-NOT INCLUDING OUR "HOME" COUNTY OF WOOD. IN THE RIVERVIEW "SERVICE AREA" THERE ARE SEVERAL FEDERALLY DESIGNATED "MEDICALLY UNDERSERVED AREAS." THEY ARE WOOD COUNTY (THE CENTRAL PART BETWEEN MARSHFIELD AND WISC. RAPIDS), PORTAGE COUNTY (PART), ADAMS COUNTY (ALL), WAUSHARA COUNTY (ALL), MARQUETTE COUNTY (ALL), JUNEAU COUNTY (THE NORTHERN HALF), MARATHON COUNTY (PART), AND CLARK COUNTY (ALL). THERE ARE SCATTERED INDIAN TRIBAL LANDS IN WOOD COUNTY, JUNEAU COUNTY, AND ADAMS COUNTY (ALL HO CHUNK), THESE WOULD BE CONSIDERED "MEDICALLY UNDERSERVED POPULATIONS" PER FEDERAL DESIGNATION. OTHER HOSPITALS IN OUR SERVICE AREA INCLUDE MARSHFIELD MEDICAL CENTER IN MARSHFIELD, MINISTRY - ST. MICHAEL'S HOSPITAL IN STEVENS POINT, MOUNDVIEW MEMORIAL HOSPITAL IN FRIENDSHIP, AND HESS MEMORIAL HOSPITAL IN MAUSTON. PART VI, LINE 5: AS A COMMUNITY-BASED ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS 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 LOCAL ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS. PART VI, LINE 6: AS A COMMUNITY-BASED ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS 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 LOCAL ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 992466 0 321290 0 2840 0 17196 0 54009 0 1387801 0 0 SIDNEY C SCZYGELSKI SBP & CHIEF FINANCIAL OFFICER 0 571336 0 102719 0 187603 0 20046 0 44947 0 926651 0 174000 JOHN HEISLER SVP&CHIEF HUMAN RESOURCES OFFICER 0 339009 0 66240 0 166574 0 17196 0 26051 0 615070 0 152214 JESSE TISCHER TREAS. & SVP & PRES.-REGIONAL MKTS 0 458373 0 92613 0 431 0 11473 0 42947 0 605837 0 0 RENEE SMITH EXECUTIVE DIRECTOR-ANI 0 381673 0 68268 0 56720 0 17196 0 32423 0 556280 0 55911 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP. 0 399509 0 67809 0 8286 0 17196 0 39108 0 531908 0 0 JENNIFER REDMAN-SCHELL SVP & PRESIDENT-ASPIRUS CLINICS 0 411201 0 69616 0 423 0 17196 0 22161 0 520597 0 0 TODD RICHARDSON SVP & CHIEF INFORMATION OFFICER 0 341475 0 67414 0 46782 0 17196 0 35067 0 507934 0 43823 BONITA KOLRUD MD DIRECTOR/PHYSICIAN 0 418642 0 5554 0 0 0 16793 0 32428 0 473417 0 0 ANDREW BARTH PRESIDENT-ASPIRUS LANGLADE HOSPITAL 0 353720 0 68003 0 464 0 17196 0 32470 0 471853 0 0 RUTH RISLEY-GRAY SVP & SYSTEM CNO 0 309508 0 60518 0 49719 0 20046 0 25920 0 465711 0 41695 CARI LOGEMANN SVP & GEN. COUNSEL (THRU 06/20) 0 228246 0 78456 0 130652 0 15527 0 7141 0 460022 0 129488 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 0 0 0 0 0 426022 0 0 0 0 0 426022 0 425671 RICK NEVERS SVP-REG. OPS. SYSTEM INT. OFFICER 0 263896 0 64103 0 43884 0 17172 0 12878 0 401933 0 39905 JON HARDESTY VP-CORPORATE HUMAN RESOURCES 0 240017 0 31703 0 26574 0 9980 0 32269 0 340543 0 21227 BRETT DAVIS PRESIDENT-ASPIRUS HEALTH PLAN 0 244032 0 59522 0 344 0 13276 0 13265 0 330439 0 0 CHRISTOPHER STINES PRESIDENT-ASPIRUS RIVERVIEW 0 262856 0 31250 0 2553 0 13376 0 9475 0 319510 0 0 NANCY ROTH-MALLEK VP-FINANCE 190697 0 29403 0 908 0 12895 0 32960 0 266863 0 0 0 KIMBERLY JOHNSON VP-PATIENT CARE & CNO 183328 0 28211 0 706 0 12479 0 31998 0 256722 0 0 0 REBECCA PHILLIP DIRECTOR-PHARMACY 184636 0 14691 0 3702 0 11293 0 13060 0 227382 0 0 0 STACI SOVA NURSE PRACTITIONER 171740 0 125 0 4350 0 6612 0 34246 0 217073 0 0 0 LISA SKIBBA VP-ANCILLARY SERVICES 148094 0 23275 0 1329 0 9813 0 34173 0 216684 0 0 0 JACOB MALOOLY PHYSICIAN ASSISTANT 150683 0 3072 0 0 0 8365 0 34251 0 196371 0 0 0 DENISE KNIPRATH NURSE PRACTITIONER 156327 0 375 0 4107 0 8155 0 23251 0 192215 0 0 0 LORI SLATTERY MANAGER-CLINIC 154912 0 5514 0 441 0 8802 0 20857 0 190526 0 0 0 JESSICA FOX VP-HUMAN RESOURCES ARH 138440 0 21099 0 2754 0 8810 0 14246 0 185349 0 0 0 ROCHELLE ANDERSON-TESCH REGISTERED NURSE-TEAM LEAD 130821 0 2500 0 0 0 6573 0 31334 0 171228 0 0 0 MATTHEW MALOOLY PHARMACIST 151580 0 73 0 0 0 8034 0 4372 0 164059 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE, WHEN APPLICABLE, WAS ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE - INCLUDED IN INCOME: C. STINES - $1,937 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4A - SEVERANCE PAY MICHAEL MCGRAIL RECEIVED SEVERANCE PAY TOTALING $426,022 FOR CALENDAR YEAR 2020. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: J. HARDESTY $21,227 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 $55,911 457(F) RETIREMENT PLAN PROFILE: KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31. 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. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG8 2015-05-07 26748065 REFINANCE 2008 BOND 1 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG9 2015-05-07 18738269 REFINANCE 2010 BOND 1 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DC53 2017-11-02 15000000 NEW CONSTRUCRTION 0 0 0 A 2360000 26748065 26748065 0 1 1 1 B 4490000 18738269 18738269 0 1 1 1 C 15000000 14157758 1097390 0 0 0 1 A 0 0 1 0 0 0 0 0 B 0 1 1 0 0 0.00200 0.00200 0 0 0 C 0 0 1 0 0 0 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 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 THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE DIRECTORS OF THE ORGANIZATION: 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 ACCUMULATED ALL 990 AND 990-T 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, ASPIRUS RIVERVIEW HOSPITAL & CLINIC, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 373,951. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 373,951. LAB FEES: PROGRAM SERVICE EXPENSES 2,691,863. MANAGEMENT AND GENERAL EXPENSES 83. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,691,946. FOOD SERVICE: PROGRAM SERVICE EXPENSES 71,704. MANAGEMENT AND GENERAL EXPENSES 63,585. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 135,289. HOUSEKEEPING FEES: PROGRAM SERVICE EXPENSES 169,310. MANAGEMENT AND GENERAL EXPENSES 56,939. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,249. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,219,078. MANAGEMENT AND GENERAL EXPENSES 215,157. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,434,235. CONTRACTED NURSING AND OTHER LABOR: PROGRAM SERVICE EXPENSES 6,913,256. MANAGEMENT AND GENERAL EXPENSES 1,092,217. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,005,473. FORM 990, PART XI, LINE 9: NET TRANSFER TO ASPIRUS INC. -33,850,538. RETIREE MEDICAL BENEFITS -5,133. 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. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE WI 501 (C) 3 LINE 12B, II N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS MEDICAL GROUP INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS ONTONAGON HOSPITAL INC 601 SEVENTH STREET ONTONAGON MI 49953 260806477 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTH CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS VNA HOME HEALTH INC 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTGAGE WI 53901 390806250 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI N/A 0 0 THE WESTWOOD CONFERENCE CENTER LLC 333 PINE RIDGE BLVD WAUSAU WI 54401 571184256 CONFERENCE CENTER WI N/A 0 0 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 ASPIRUS HEALTH VENTURES 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 1 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 ASPIRUS WAUSAU HOSPITAL INC K 68460 COST ASPIRUS WAUSAU HOSPITAL INC M 773116 COST ASPIRUS WAUSAU HOSPITAL INC O 456728 COST ASPIRUS WAUSAU HOSPITAL INC P 1896052 COST ASPIRUS WAUSAU HOSPITAL INC Q 51184 COST ASPIRUS INC C 630000 COST ASPIRUS INC M 18568619 COST ASPIRUS INC O 57433123 COST ASPIRUS INC P 621735 COST ASPIRUS INC Q 68498 COST ASPIRUS MEDICAL GROUP INC J 218753 COST ASPIRUS MEDICAL GROUP INC O 1156761 COST ASPIRUS MEDICAL GROUP INC P 440876 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.