2021-05-13T06:24:54-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 390782130 ASPIRUS EXTENDED SERVICES INC ASPI 7158472250 425 PINE RIDGE BLVD WAUSAU WI 54401 SIDNEY C SCZYGELSKI SENIOR VP OF FINANCE & CFO 7158472250 2021-05-03 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-05-03 2019 2022-09-23 18:48:47Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 5093901 0 X WWW.ASPIRUS.ORG X 1999 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 8 4 149 10 0 0 11137 4084 4917717 5066862 4424 2617 19740 20338 4953018 5093901 0 0 0 0 3677592 3797330 0 0 0 1749269 1897766 5426861 5695096 -473843 -601195 4551701 4699871 1365929 1716294 3185772 2983577 WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 3630928 5066862 ASPIRUS EXTENDED SERVICES, INC. (AES) OPERATES A 50-BED SKILLED NURSING FACILITY (PLEASANT VIEW), A SENIOR APARTMENT COMPLEX, A 16-UNIT CBRF (COMMUNITY BASED RESIDENTIAL CARE FACILITY), AND TWO ADULT FAMILY HOMES IN PHILLIPS, WISCONSIN. 3630928 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 24 0 149 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SIDNEY C SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 X CARI LOGEMANN SVP & GENERAL COUNSEL 2.00 50.00 X 0 527198 91251 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 2.00 50.00 X 0 527876 83274 RICK NEVERS SVP- REGIONAL OPERATIONS SIO 2.00 50.00 X 0 468168 87163 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXP. 2.00 50.00 X 0 449876 93739 JENNIFER REDMAN-SCHELL SVP & PRESIDENT- ASPIRUS CLINICS 2.00 50.00 X 0 450779 79716 JESSE TISCHER SVP & PRESIDENT- REGIONAL MARKETS 2.00 50.00 X 0 455557 71884 RENEE SMITH EXECUTIVE DIRECTOR ANI 2.00 50.00 X 0 457632 47266 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 2.00 50.00 X 0 458655 41443 RUTH RISLEY-GRAY SVP & SYSTEM CHIEF NURSING OFFICER 2.00 50.00 X 0 454475 44140 SCOTT REMMICH CHIEF COMPLIANCE OFFICER 2.00 50.00 X 0 252876 49923 LORI PECK VP- REVENUE CYCLE 2.00 50.00 X 0 261660 32868 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1351919 222225 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 742406 126380 PAUL DAVID INTERVIM SVP & GENERAL COUNSEL 1.00 50.00 X 0 0 0 DARRELL LENTZ VICE CHAIR (THRU JAN) 1.00 50.00 X X 0 543668 100169 TODD RICHARDSON SECRETARY/SVP & CIO AI 1.00 50.00 X X 0 443960 90922 JEANNINE NOSKO SECRETARY/VP-PATIENT CARE & CHIEF NURSING OFFIC 1.00 50.00 X X 0 297069 66372 LISA ROWE-PEPLINSKI TREASURER/VP-CORPORATE QLTY&PAT. SFTY 1.00 50.00 X X 0 277860 35486 CYNTHIA RIDER VP- POST ACUTE CARE 1.00 50.00 X X 0 255426 54719 MICHAEL RIGGLE DVM CHAIR (THRU SEPTEMBER) 1.00 0.00 X X 0 0 0 PAUL RYBAK CHAIR 1.00 0.00 X X 0 0 0 DALE HUSTEDT MEMBER/PRESIDENT- AMH 1.00 50.00 X 0 306806 38598 BRIAN BARATKA MEMBER 1.00 0.00 X 0 0 0 COURTNEY GRAFF MEMBER 1.00 0.00 X 0 0 0 0 8983866 1457538 0 0 1 0 STAFFENCY LLC 221 W COLLEGE AVENUE FLOOR 2 APPLETON WI 54911 STAFFING 169932 1 4084 4084 NET PATIENT REVENUE 623000 4961039 4961039 105823 105823 5066862 2617 2617 20338 0 20338 20338 20338 5093901 5066862 0 22955 2917026 2231870 685156 108635 84735 23900 563255 439339 123916 208414 162563 45851 2246 2246 1840 1840 264814 217932 46882 8090 8090 29504 12780 16724 175339 72132 103207 13399 8236 5163 5238 4921 317 23986 23986 537100 537100 300771 20824 279947 19670 19670 EQUIPMENT AND MAINTENAN 413269 375596 37673 WMAP ASSESSMENT 102000 102000 RECRUITMENT 500 500 5695096 3630928 2064168 0 941851 1288375 559612 624465 20942 22665 7552 48324 8751579 6046121 3004648 2705458 17096 10584 4551701 4699871 378431 584404 833094 765802 154404 366088 1365929 1716294 X 3185772 2983577 3185772 2983577 4551701 4699871 X -601195 399000 X 0 1 X 1 0 X 4055 13339 3246 11137 4084 35861 4617936 4992256 5006885 4917717 5066861 24601655 4621991 5005595 5010131 4928854 5070945 24637516 0 0 0 24637516 34990 22695 22458 24164 22955 127262 34990 22695 22458 24164 22955 127262 4656981 5028290 5032589 4953018 5093900 24764778 0.99490 0.99830 0.00510 0.00170 X 0 0 0 0 0 0 0 0 1 192 192 0 PART II-B, LINE 1: ASPIRUS EXTENDED SERVICES, INC. PAYS ANNUAL ASSOCIATION DUES TO LEADINGAGE WISCONSIN. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATION MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL INDUSTRY ENVIRONMENT. 326736 326736 5913378 4668349 1245029 243221 210383 32838 2268244 1167389 1100855 2705458 DUE TO AFFILIATES 166283 LONG TERM INSURANCE LIABILITY 30514 MEDICARE ACCELERATED PAYMENTS 169291 366088 X 1 1 0 1 0 0 0 0 0 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 381456 0 102648 0 43094 0 16832 0 74419 0 618449 0 41199 MICHAEL MCGRAIL SVP & SYSTEM CHIEF MEDICAL OFFICER 0 406549 0 109773 0 11554 0 14438 0 68836 0 611150 0 0 RICK NEVERS SVP- REGIONAL OPERATIONS SIO 0 339937 0 83542 0 44689 0 19582 0 67581 0 555331 0 38399 ERIC ANDERSON SVP- SERVICE LINE & PATIENT EXP. 0 360168 0 88372 0 1336 0 16832 0 76907 0 543615 0 0 JENNIFER REDMAN-SCHELL SVP & PRESIDENT- ASPIRUS CLINICS 0 384617 0 62473 0 3689 0 8400 0 71316 0 530495 0 0 JESSE TISCHER SVP & PRESIDENT- REGIONAL MARKETS 0 374250 0 80770 0 537 0 1971 0 69913 0 527441 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 359068 0 65045 0 33519 0 16832 0 30434 0 504898 0 32734 JOHN HEISLER SVP & CHIEF HUMAN RESOURCES OFFICER 0 317113 0 85743 0 55799 0 16832 0 24611 0 500098 0 41623 RUTH RISLEY-GRAY SVP & SYSTEM CHIEF NURSING OFFICER 0 291384 0 78869 0 84222 0 19582 0 24558 0 498615 0 76355 SCOTT REMMICH CHIEF COMPLIANCE OFFICER 0 214132 0 36753 0 1991 0 6555 0 43368 0 302799 0 0 LORI PECK VP- REVENUE CYCLE 0 219881 0 40703 0 1076 0 12349 0 20519 0 294528 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 920866 0 410719 0 20334 0 16832 0 205393 0 1574144 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 536087 0 132967 0 73352 0 19582 0 106798 0 868786 0 60259 DARRELL LENTZ VICE CHAIR (THRU JAN) 0 385979 0 110481 0 47208 0 16232 0 83937 0 643837 0 45555 TODD RICHARDSON SECRETARY/SVP & CIO AI 0 313273 0 88199 0 42488 0 16832 0 74090 0 534882 0 39566 JEANNINE NOSKO SECRETARY/VP-PATIENT CARE & CHIEF NU 0 231583 0 43850 0 21636 0 13561 0 52811 0 363441 0 20780 LISA ROWE-PEPLINSKI TREASURER/VP-CORPORATE QLTY&PAT. SFT 0 218238 0 40547 0 19075 0 13788 0 21698 0 313346 0 17651 CYNTHIA RIDER VP- POST ACUTE CARE 0 226076 0 26717 0 2633 0 7734 0 46985 0 310145 0 0 DALE HUSTEDT MEMBER/PRESIDENT- AMH 0 227490 0 63699 0 15617 0 8400 0 30198 0 345404 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: J. REDMAN-SCHELL - $3,300 PART I, LINE 1B ASPIRUS EXTENDED SERVICES, INC. FOLLOWS THE COMPENSATION REVIEW PROCEDURES AND POLICIES OF ASPIRUS, INC. PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS EXTENDED SERVICES, INC. RELIED UPON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: D. LENTZ $45,555 J. NOSKO $20,780 L. ROWE-PEPLINSKI $17,651 T. RICHARDSON $39,566 S. SCZYGELSKI $60,259 J. HEISLER $41,623 C. LOGEMANN $41,199 R. NEVERS $38,399 R. RISLEY-GRAY $76,355 R. SMITH $32,734 457(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 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. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS: THE PARENT ORGANIZATION, ASPIRUS, INC. (72.68%), AND MEMORIAL MEMBER ASSOCIATION, INC. (27.23%). FORM 990, PART VI, SECTION A, LINE 7A SEE COMMENTS FOR FORM 990, PART VI, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE MEMBERS 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 ACCUMULATES ALL 990 INFORMATION. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND ARE MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH DIRECTOR'S DESK OR OTHER MEANS OF ELECTRONIC RETRIEVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL MANAGERS ARE REQUIRED TO SIGN BIANNUAL CONFLICT OF INTEREST STATEMENTS. THE ORGANIZATION'S CEO AND BOARD CHAIR REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTION WHERE A CONFLICT HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS EXTENDED SERVICES, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, NOR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, LINE 1A, EXPLANATION FOR HOURS WORKED: SOME OFFICERS AND DIRECTORS ALSO PROVIDED SERVICE TO OTHER RELATED ORGANIZATIONS OTHER THAN ASPIRUS EXTENDED SERVICES, INC. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. FORM 990, PART XI, LINE 9: EQUITY TRANSFER AI 363,400. EQUITY TRANSFER MMA 136,600. SYSTEM MEMBERSHIP FEE -101,000. ASPIRUS INC 333 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 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 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 HEALTHCARE 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 CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501(C)(3) LINE 10 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 IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501(C)(3) LINE 3 ASPIRUS INC 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501(C)(3) LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTAGE 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 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 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 3000 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 0 0 1 0 0 1 0 0 0 0 ASPIRUS WAUSAU HOSPITAL INC O 416479 COST ASPIRUS INC C 101000 COST ASPIRUS INC L 537100 COST SCHEDULE R, PART V, LINE 1D: ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.