2020-02-14T15:05:24-06:00 2019-03-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156352111 1280 CHANDLER DRIVE SPOONER WI 54801 MICHAEL D SCHAFER CHIEF EXECUTIVE OFFICER 7156352111 2020-02-10 1 KOREY BOELTER P00775161 6123764500 67.137.57.251 2020-02-10 09:00:59 CS P 39F506601BE52B1AEC27478C749FC3D7BEC65D0C 9C1DED54EE6A56468881F41BE7A7DD662CF8FCB7 2018 2020-11-06 18:47:13Z MICHAEL D SCHAFER 1280 CHANDLER DRIVE SPOONER WI 54801 38007333 0 X WWW.SPOONERHEALTH.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 7 7 177 55 0 0 291121 684401 24297638 26320451 320495 439857 143894 138211 25053148 27582920 5500 6000 0 0 9585706 10990795 0 0 0 14447595 14482106 24038801 25478901 1014347 2104019 52490281 54037734 23193540 22226433 29296741 31811301 X TO PROVIDE HIGH QUALITY HEALTHCARE. 0 0 20781393 6000 25953035 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 3/31/19, THERE WERE 2,090 INPATIENT DAYS, 401 INPATIENT DISCHARGES, 21,675 OUTPATIENT VISITS, 7,004 EMERGENCY ROOM VISITS, AND 291 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, SUPPORT GROUPS, AND 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. 747713 0 367416 THE HOME HEALTH AGENCY PROVIDES NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/19, THERE WERE 2,451 HOME HEALTH VISITS, 119 ADMITTED CASES, AND 110 DISCHARGED CASES. 21529106 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 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 1 0 0 0 0 0 0 0 0 1 22 0 177 1 0 0 0 0 0 1 1 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 0 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 MICHAEL KNOEPKE BOARD VICE PRESIDENT 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 DIRECTOR 5.00 X X 0 0 0 LESLIE ARF BOARD MEMBER 1.00 X 0 0 0 BRIAN GASKILL MD BOARD MEMBER 1.00 X 0 0 0 MAUREEN REVAK 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 118260 0 19588 PATRICK MCCANN MD ER MEDICAL DIRECTOR 40.00 X 252265 0 36817 THERESA HUTZLER APNP HOSPITALIST 40.00 X 190163 0 32736 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 40.00 X 179757 0 34809 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 40.00 X 170472 0 32781 TIMOTHY BASSETT PHARMACY DIRECTOR 40.00 X 156132 0 9332 1067049 0 166063 9 0 1 0 WAPITI MEDICAL GROUP-WOOD RIVER LLC 107 FLYNN DR STE 600 MILBANK SD 57252 ER PHYSICIAN COVERAGE 1350985 ARAMARK 27310 NETWORK PLACE CHICAGO IL 60673 CULINARY/LAUNDRY 1120374 HEALTHTECH MANAGEMENT SERVICES 5110 MARYLAND WAY STE 200 BRENTWOOD TN 37027 MANAGEMENT FEES 616530 SHARED MEDICAL TECHNOLOGY INC 2020 W NEWTON ST RICE LAKE WI 54868 DIAGNOSTIC RADIOLOGY 508277 ESSENTIA HEALTH 1180 CHANDLER DRIVE SPOONER WI 54801 CONTRACTED LABOR 365483 11 6641 9660 668100 167860 684401 PATIENT SERVICE REVENUE 621400 25843495 25843495 JOINT VENTURE REVENUE 621400 476956 476956 26320451 403454 403454 40935 0 40935 40935 40935 10450178 10411632 2143 38546 -2143 36403 36403 7646 6641 10364 -2718 -2718 970 274 696 696 MEAL INCOME 900099 81965 81965 MISCELLANEOUS 900099 17333 17333 99298 27582920 26320451 0 578068 6000 6000 140189 140189 8630391 7543212 1087179 243532 209452 34080 1357393 1167437 189956 619290 532626 86664 697997 697997 105281 105281 61417 61417 2859 2859 1739680 1591156 148524 238589 238589 213212 136352 76860 804452 174134 630318 1112634 1078917 33717 77525 65343 12182 38010 35325 2685 751187 751187 2552564 2552564 96311 96311 DRUGS 3348946 3348946 MEDICAL SUPPLIES 1228351 1178241 50110 BAD DEBT EXPENSE 1064447 1064447 MISCELLANEOUS 192157 549 191608 156487 93218 63269 25478901 21529106 3949795 0 2384050 3751090 3951638 1576600 3948462 3687641 463505 430811 262506 232474 35676683 8844495 29088864 26832188 11550882 16420914 840374 1019016 0 87000 52490281 54037734 3342063 3200094 19593477 19026339 258000 0 23193540 22226433 X 29296741 31811301 29296741 31811301 52490281 54037734 2104019 410541 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 2859 2859 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 20263309 3165844 17097465 802629 203128 599501 13332029 5475523 7856506 63045 63045 26832188 X 26923573 410541 410541 26513032 1069888 1069888 27582920 24409013 0 24409013 1069888 1069888 25478901 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: MISCELLANEOUS INCOME 5,441. PROVISION FOR BAD DEBTS 1,064,447. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,064,447. MISCELLANEOUS INCOME 5,441. 1 1 X 1 X 1 X 1 1 0 1 1 205743 205743 0.00840 4156030 1723443 2432587 0.09960 4361773 1723443 2638330 0.10800 26 17463 67175 10369 56806 0.00230 23 36 36658 36658 0.00150 2 287 794563 361816 432747 0.01770 33 50516 50516 0.00210 84 17786 948912 372185 576727 0.02360 84 17786 5310685 2095628 3215057 0.13160 1 625 625 0.00000 10 48 3615 3615 0.00010 1 948 948 0.00000 2 16 1449 1449 0.00010 4 1107 1107 0.00000 12 124 3246 3246 0.00010 30 188 10990 10990 0.00030 1 1064447 0 12940802 13127797 -186995 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 WHEN COMPLETING 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 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 AND ALSO COORDINATED AN INFORMATIONAL SESSION FOR THE COMMUNITY ENTITLED OPIOIDS: LET'S TALK ABOUT PAIN MEDS. THE SH PAIN MANAGEMENT CLINIC OPENED IN 2018 AND TREATED ALMOST 100 PATIENTS IN FISCAL YEAR 2019. 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 ONCE A MONTH AND CONTINUES TO TREAT AROUND 65 PATIENTS A YEAR. SH HAS COORDINATED TWO GRIEF TALKS IN THE LAST FISCAL YEAR ON GRIEVING THE LOSS OF A CHILD AND THE REALITY OF CAREGIVING 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 AND SURGERY DEPARTMENT. SEVERAL DAYS A WEEK THERE ARE SPECIALTY PHYSICIANS PROVIDING SERVICES THAT INCLUDE ORTHOPEDICS, 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 2019, 88 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 $762,215 WITH DIRECT OFFSETTING REVENUE OF $340,643 RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $421,572. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $32,348 WITH DIRECT OFFSETTING REVENUE OF $21,173, RESULTING IN A NET COMMUNITY BENEFIT EXPENSE OF $11,175. PART I, LN 7 COL(F): THE HOSPITAL IS REPORTING $1,064,447 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24B. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $24,414,454. 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. SH IS ALSO PARTNERED WITH THE FOLLOWING ORGANIZATIONS THAT DIRECTLY PROMOTE HEALTH OF PERSONS LIVING IN WASHBURN AND BURNETT COUNTIES: DRUG ENDANGERED CHILDREN M TEAM, SAFETY COALITION, WASHBURN COUNTY AND POLK-BURNETT COUNTY TRANSITIONS OF CARE COALITIONS, COORDINATED COMMUNITY RESPONSE TEAM, COMMUNITY ALLIANCE FOR PREVENTION, MENTAL HEALTH TASK FORCE, DOMESTIC/SEXUAL ABUSE RESPONSE TEAM, CHILD DEATH REVIEW TEAM, FAITH IN ACTION WASHBURN COUNTY, AND BURNETT COUNTY CRISIS OVERSIGHT COMMITTEE. SH PLANNED AND HOSTED AN AGING & HEALTH DAY FOR THE LEADERSHIP WASHBURN COUNTY GROUP AS WELL AS HOSTED AN EMS LISTENING SESSION FOR 24 PERSONS INTERESTED IN PROVIDING MORE COORDINATED CARE TO THE REGION. JOB SHADOWING EXPERIENCES WERE PROVIDED IN SEVERAL DEPARTMENTS OF THE HOSPITAL SUCH AS NURSING, SOCIAL SERVICES, LABORATORY, IMAGING AND OCCUPATIONAL THERAPY. SH PROVIDES FREE MEETING ROOM SPACE TO NON-HEALTH RELATED GROUPS, SPONSORS SCHOOL-BASED PROGRAMS ON HEALTH CAREERS AND ROUTINELY COLLECTS AND DISPOSES OF INFECTIOUS WASTE FROM THE PUBLIC. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT 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 2019 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $186,995 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.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 15,878 (PER JULY 2018 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 3.7% UNEMPLOYMENT RATE IN AUGUST 2019 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 4 4000 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 252265 0 0 0 0 0 7816 0 29001 0 289082 0 0 0 THERESA HUTZLER APNP HOSPITALIST 190163 0 0 0 0 0 0 0 32736 0 222899 0 0 0 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 179757 0 0 0 0 0 5589 0 29220 0 214566 0 0 0 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 170472 0 0 0 0 0 5316 0 27465 0 203253 0 0 0 TIMOTHY BASSETT PHARMACY DIRECTOR 156132 0 0 0 0 0 4791 0 4541 0 165464 0 0 0 A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-10-23 21200000 CONSTRUCTING REPLACEMENT HOSPITAL 0 0 0 A 1705000 21200000 619 518316 20681065 2016 0 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 X 1 167860 DAILY TRADING PRICE 0 0 0 0 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 2018, THE CEO RECEIVED $241,956 OF TAXABLE PAY, $10,202 OF NONTAXABLE DEFERRED COMPENSATION, AND $15,814 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.