2021-02-09T07:27:12-06:00 2020-03-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156352111 1280 CHANDLER DRIVE SPOONER WI 54801 MICHAEL D SCHAFER CHIEF EXECUTIVE OFFICER 7156352111 2021-02-05 1 RYAN STRUSZ P01604381 6123764500 2021-02-05 2019 2022-09-23 18:48:47Z MICHAEL D SCHAFER 1280 CHANDLER DRIVE SPOONER WI 54801 32120762 0 X WWW.SPOONERHEALTH.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 6 6 171 55 0 0 684401 1144364 26320451 25327558 439857 580389 138211 123187 27582920 27175498 6000 7000 0 0 10990795 10936739 0 0 0 14482106 14181384 25478901 25125123 2104019 2050375 54037734 55814008 22226433 22430466 31811301 33383542 X TO PROVIDE HIGH QUALITY HEALTHCARE. 0 0 20543008 7000 24915769 SPOONER HEALTH SYSTEM 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, AND HOSPICE CARE. FOR THE FISCAL YEAR ENDING 3/31/2020, THERE WERE 1,924 INPATIENT DAYS, 372 INPATIENT DISCHARGES, 21,208 OUTPATIENT VISITS, 7,154 EMERGENCY ROOM VISITS, AND 338 SURGERIES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS ATSUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THIS PROGRAM INCLUDES FEE DISCOUNTS, AS WELL AS 100% FREE CARE. SPOONER HEALTH SYSTEM ALSO PROVIDES NUMEROUS HEALTHCARE AND WELLNESS CLASSES. IN ADDITION, SPOONER PROVIDES SUPPORT GROUPS AND OTHER VARIOUS EDUCATIONAL/HEALTH SCREENING OPPORTUNITIES AS A COMMUNITY BENEFIT. THESE PROGRAMS ARE OFFERED TO ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS AND THE GENERAL PUBLIC. SPOONER HEALTH SYSTEM ALSO RECEIVES DONATED SERVICES FROM COMMMUNITY VOLUNTEERS. 720122 0 411789 THE HOME HEALTH AGENCY PROVIDES NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/2020, THERE WERE 2,278 HOME HEALTH VISITS, 95 ADMITTED CASES, AND 98 DISCHARGED CASES. 21263130 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 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 18 0 171 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X REBECCA BUSCH CFO 7159391732 1280 CHANDLER DRIVE SPOONER WI 54801 PATRICK MCCANN MD ER MEDICAL DIRECTOR 40.00 X 251545 0 42748 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 40.00 X 215318 0 39846 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 40.00 X 168445 0 39643 TIMOTHY BASSETT PHARMACY DIRECTOR 40.00 X 161567 0 13271 THERESA HUTZLER APNP HOSPITALIST 40.00 X 148931 0 32274 REBECCA BUSCH CHIEF FINANCIAL OFFICER 40.00 X 126101 0 22631 MICHAEL SCHAFER CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 JAMIE MORALES BOARD PRESIDENT 1.00 X X 0 0 0 LESLIE ARF BOARD VP THROUGH DEC 2019 1.00 X X 0 0 0 MICHAEL KNOEPKE BOARD VP THROUGH JUL 2019 1.00 X X 0 0 0 ADAM LIEGL BOARD TREASURER 1.00 X X 0 0 0 MARK VAN ETTEN MD BOARD SECRETARY/MEDICAL DI 5.00 X X 0 0 0 BRIAN GASKILL MD BOARD MEMBER 1.00 X 0 0 0 TIM REEDY BOARD MEMBER 1.00 X 0 0 0 MAUREEN REVAK BOARD MEMBER 1.00 X 0 0 0 1071907 0 190413 12 0 1 0 WAPITI MEDICAL GROUP-WOOD RIVER LLC 107 FLYNN DR STE 600 MILBANK SD 57252 ER PHYSICIAN COVERAGE 1437590 ARAMARK 27310 NETWORK PLACE CHICAGO IL 60673 CULINARY/LAUNDRY 1220669 ESSENTIA HEALTH 1180 CHANDLER DRIVE SPOONER WI 54801 CONTRACTED LABOR 770565 HEALTHTECH MANAGEMENT SERVICES 5110 MARYLAND WAY STE 200 BRENTWOOD TN 37027 MANAGEMENT FEES 657028 SHARED MEDICAL TECHNOLOGY INC 2020 W NEWTON ST RICE LAKE WI 54868 DIAGNOSTIC RADIOLOGY 504056 8 6833 11335 1126196 1144364 PATIENT SERVICE REVENUE 621400 24897417 24897417 OTHER PATIENT REVENUE FROM JV 621400 430141 430141 25327558 507348 507348 36884 0 36884 36884 36884 5006220 4871481 61698 134739 -61698 73041 73041 9122 6833 11752 -2630 -2630 990 333 657 657 MEAL INCOME 900099 78811 78811 MISCELLANEOUS 900099 9465 9465 88276 27175498 25327558 0 703576 7000 7000 151916 151916 8357168 7349263 1007905 340357 293965 46392 1486700 1284057 202643 600598 518734 81864 743360 743360 106833 106833 61146 61146 3342 3342 1615818 1492132 123686 224719 224719 243649 156982 86667 693519 163866 529653 1161931 1131173 30758 79809 60011 19798 39328 29180 10148 734878 734878 2595341 2595341 99375 99375 DRUGS 3104989 3104989 MEDICAL SUPPLIES 1189786 1140180 49606 BAD DEBT EXPENSE 1092839 1092839 MISCELLANEOUS 225164 395 224769 165558 108145 57413 25125123 21263130 3861993 0 3751090 4233932 1576600 1432607 3687641 3776359 430811 503129 232474 246179 35081448 10068820 26832188 25012628 16420914 19636973 1019016 972201 87000 0 54037734 55814008 3200094 3079265 19026339 18434201 0 917000 22226433 22430466 X 31811301 33383542 31811301 33383542 54037734 55814008 2050375 -478134 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 3342 3342 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND WISCONSIN HOSPITAL ASSOCIATION WERE USED BY THOSE ASSOCIATIONS TO LOBBY ON BEHALF OF SPOONER HEALTH SYSTEM AND OTHER MEMBERS. 1215671 1215671 20273644 4386574 15887070 810951 286519 524432 12562773 5395727 7167046 218409 218409 25012628 THIRD PARTY PAYOR PAYABLE 917000 917000 X 25604525 -478134 -478134 26082659 1092839 1092839 27175498 24032284 0 24032284 1092839 1092839 25125123 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 1,092,839. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,092,839. GOLF OUTING 15955 6833 9122 5866 3617 1797 473 15955 6833 9122 5866 3617 1797 473 11753 -2631 1 1 1 X 1 X 1 1 1 0 1 1 280 218478 218478 0.00910 3964534 2002163 1962371 0.08170 280 4183012 2002163 2180849 0.09080 22 16279 81535 11273 70262 0.00290 21 81 35949 35949 0.00150 2 264 746993 411773 335220 0.01390 26 120 45628 45628 0.00190 71 16744 910105 423046 487059 0.02020 71 17024 5093117 2425209 2667908 0.11100 682 682 0.00000 3 78 963 963 0.00000 2 84 1629 1629 0.00010 5 162 3274 3274 0.00010 1 1092839 12646925 12828249 -181324 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 18 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 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. SH HOSTS THE ALCOHOLICS ANONYMOUS MEETING AT OUR FACILITY ON A WEEKLY BASIS. THE SH PAIN MANAGEMENT CLINIC OPENED IN 2018 AND TREATED ALMOST 75 PATIENTS IN FISCAL YEAR 2020. 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 MEETS MONTHLY AND 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 CONTINUES TO TREAT AROUND 60 PATIENTS A YEAR. SH HAS COORDINATED TWO GRIEF TALKS IN THE LAST FISCAL YEAR ON GRIEVING THE LOSS OF ABILITY AND THE SHOCK OF CAREGIVER GRIEF AFTER DEATH, AS WELL AS PROVIDING REGULAR MEETING SPACE AT OUR FACILITY FOR A LOCAL GRIEF SUPPORT GROUP. 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. SH HOLDS FREE HAND SCREENING EVENTS IN THE REHABILITATION DEPARTMENT AS WELL AS HOLDING NUMEROUS FLU SHOT CLINICS AT VARIOUS LOCATIONS IN THE COMMUNITY. SH ORGANIZES AN ANNUAL HEALTH FAIR WHERE FREE LAB CHOLESTEROL SCREENINGS ARE PROVIDED ONSITE AND ALSO VOUCHERS ARE ISSUED THAT CAN BE USED FOR THE FREE SCREENING WITHIN A CERTAIN TIME FRAME AFTER THE FAIR. IN FISCAL YEAR 2020, 109 PERSONS TOOK ADVANTAGE OF THE FREE LAB SCREENINGS. 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, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE ALL AVAILABLE ON THE WEBSITE AT HTTPS://WWW.SPOONERHEALTH.COM/PATIENTS-VISITORS/PATIENT-VISITOR-INFO/ FINANCIAL-SERVICES/. THE INFORMATION ON THE WEBSITE 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: WWW.SPOONERHEALTH.COM/ABOUT-US/COMM-HEALTH-ASSESSMENT/ PART V, LINE 10A, IMPLEMENTATION STRATEGY WEBSITE: WWW.SPOONERHEALTH.COM/ABOUT-US/COMM-HEALTH-ASSESSMENT/ 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 $717,448 WITH DIRECT OFFSETTING REVENUE OF $391,731 RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $325,717. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $29,545 WITH DIRECT OFFSETTING REVENUE OF $20,042, RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $9,503. 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) IS PARTNERED WITH WASHBURN COUNTY AND THE STATE OF WISCONSIN IN THEIR EMERGENCY PREPAREDNESS EFFORTS THROUGH INVOLVEMENT WITH THE NORTHWEST WISCONSIN HEALTH CARE COALITION AND REGIONAL TRAUMA ADVISORY COUNCIL. WORKFORCE DEVELOPMENT EXPERIENCES ARE PROVIDED THROUGH JOB SHADOWING IN SEVERAL DEPARTMENTS OF THE HOSPITAL SUCH AS NURSING, PHARMACY, LABORATORY, IMAGING, SPEECH AND OCCUPATIONAL THERAPY AS WELL AS SUPPORTING SCHOOL-BASED PROGRAMS ON LEADERSHIP AND HEALTH RELATED CAREERS. SH PROVIDES FREE MEETING ROOM SPACE TO NON-PROFIT COMMUNITY GROUPS SUCH AS AA, AGING & DISABLITY RESOURCE CENTER OF WASHBURN COUNTY, HOSPICE GRIEF SUPPORT GROUP, STRONG BODIES EXERCISE CLASS AND MANY OTHERS. SH IS ALSO A COMMUNITY DROP OFF LOCATION FOR INFECTIOUS WASTE, WHICH IS ROUTINELY COLLECTED AND PROPERLY DISPOSED OF FOR ENVIRONMENTAL SAFETY IN THE REGION. 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 2020 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $181,324 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 15,720 (PER JULY 2019 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $48,422 WITH 12.5% OF PERSONS BELOW POVERTY LEVEL (PER 2014-2018 DATA). WASHBURN COUNTY HAD A 4.5% UNEMPLOYMENT RATE IN SEPTEMBER 2020 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 5 5000 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 251545 0 0 0 0 0 13027 0 29721 0 294293 0 0 0 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 215318 0 0 0 0 0 10483 0 29363 0 255164 0 0 0 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 168445 0 0 0 0 0 8922 0 30721 0 208088 0 0 0 TIMOTHY BASSETT PHARMACY DIRECTOR 161567 0 0 0 0 0 8280 0 4991 0 174838 0 0 0 THERESA HUTZLER APNP HOSPITALIST 148931 0 0 0 0 0 0 0 32274 0 181205 0 0 0 A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-10-23 21200000 CONSTRUCTING REPLACEMENT HOSPITAL 0 0 0 A 2320000 21240408 21240408 2016 0 0 1 1 A 0 0 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 SCHEDULE K, PART II, LINE 3 TOTAL PROCEEDS OF THE ISSUE REPORTED ON LINE 3 INCLUDE INVESTMENT INCOME OF $40,408 EARNED FROM THE DATE OF ISSUE THROUGH THE DATE OF SUBSTANTIAL COMPLETION OF THE CAPITAL PROJECT. 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 2019, THE CEO RECEIVED $253,544 OF TAXABLE PAY, $10,258 OF NONTAXABLE DEFERRED COMPENSATION, AND $21,948 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 15 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.