2019-05-15T13:38:21-05:00 2018-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2017-07-01 390806429 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN LANG 7156232331 112 EAST FIFTH AVENUE ANTIGO WI 54409 PAT TINCHER CFO 7156232331 2019-05-10 1 PAUL M TRACZEK CPA P01368830 7158323407 2019-05-10 137.26.200.211 2019-05-10 12:48:37 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E4255D669FE7A429B540D12C0E645A16D05D3497 2017 2019-02-21 02:37:17Z ASPIRUS LANGLADE HOSPITAL PAT TINCHER 112 EAST FIFTH AVENUE ANTIGO WI 54409 161760887 0 X WWW.ASPIRUS.ORG X 1933 WI THE COMMUNITY BENEFIT CONTRIBUTION OF ASPIRUS LANGLADE HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. 10 7 566 200 392217 -105671 40664 92928 103392353 106958885 2511524 5836351 93721 98909 106038262 112987073 123433 234339 0 0 42488975 44392575 0 0 0 47836627 50800879 90449035 95427793 15589227 17559280 180928333 195860107 33452291 32154428 147476042 163705679 AS A MINISTRY OF JESUS WE HEAL PEOPLE, PROMOTE HEALTH, AND STRENGTHEN COMMUNITIES. 0 0 65069402 234339 106991804 ACUTE GENERAL CARE HOSPITAL WITH BOTH INPATIENT AND OUTPATIENT RELATED SERVICES ALONG WITH A HOSPICE PROGRAM. INPATIENTS - 1,309 ADMISSIONS WITH 4,271 PATIENT DAYS AND 242 BIRTHS; OUTPATIENTS - 10,826 EMERGENCY VISITS, 13,004 URGENT CARE VISITS, 27,239 IMAGING PROCEDURES, 162,642 LAB TESTS, 39,583 THERAPY TREATMENTS, AND 8,828 SPECIALTY CLINIC VISITS; SURGICAL SERVICES - 2,404 TOTAL PATIENTS TREATED; HOSPICE - 4,020 PATIENT DAYS 65069402 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 120 0 1 566 1 1 1 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X PAT TINCHER 7156232331 112 EAST FIFTH AVENUE ANTIGO WI 54409 MIKE WINTER CHAIRMAN 1.00 X X 0 0 0 RICK NEVERS VICE CHAIRMAN/SVP REGIONAL 1.00 50.00 X X 0 422587 79085 KRISTINE FLOWERS MD BOARD MEMBER 1.00 1.00 X 0 0 0 SID SCZYGELSKI BOARD MEMBER/SVP OF FINANC 1.00 50.00 X 0 644952 106596 NOEL DEEP MD BOARD MEMBER 1.00 1.00 X 0 0 0 CHUCK HOLLAND BOARD MEMBER 1.00 X 0 0 0 MIKE OLSON DO BOARD MEMBER/PHYSICIAN RAD 40.00 X 545946 0 46056 CHARLIE ZANAYED BOARD MEMBER 0.00 X 0 0 0 ANN ROLLER BOARD MEMBER 0.00 X 0 0 0 JOHN REETZ BOARD MEMBER 0.00 X 0 0 0 MIKE TURNEY BOARD MEMBER (TERMED 9/16/17) 0.00 X 0 0 0 PAUL PAYANT BOARD MEMBER (TERMED 4/25/18) 0.00 X 0 0 0 RICHARD HIGLEY BOARD MEMBER (TERMED 9/30/17) 0.00 X 0 0 0 PATRICK TINCHER CFO ALH 40.00 X 284167 0 44747 ANDREW BARTH CEO ALH 40.00 1.00 X 148068 0 21222 MATT HEYWOOD CEO AI 1.00 50.00 X 0 1118732 163184 JANELLE MARKGRAF DIRECTOR HR & OFF CAMPUS S 40.00 X 219621 0 31310 SHERRY BUNTEN DIRECTOR OF PATIENT CARE S 40.00 X 241885 0 38387 JOHN HEISLER SVP & CHIEF HR OFFICER 1.00 50.00 X 0 369321 76970 DEAN DANNER SVP AMBULATORY SERVICES & PRESIDENT ACI 1.00 50.00 X 0 388969 44042 MICHAEL MCGRAIL MD SVP SYSTEM CMO 1.00 50.00 X 0 486338 77636 RUTH RISLEY-GRAY SVP NURSING, SYSTEM CNO 1.00 50.00 X 0 377496 77201 TODD RICHARDSON SVP & CIO 1.00 50.00 X 0 392900 87961 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXPERIENCE 1.00 40.00 X 0 274164 64677 RENEE SMITH EXECUTIVE DIRECTOR ANI 1.00 40.00 X 0 431396 46277 BESSANT PARKER ALH CMO 40.00 X 373986 0 28139 CARI LOGEMANN SVP & GENERAL COUNSEL 1.00 50.00 X 0 421450 85137 DOUGLAS ARMATO MD PHYSICIAN RADIOLOGIST 40.00 X 464169 0 38594 KENNETH BOWMAN MD PHYSICIAN RADIOLOGIST 40.00 X 448610 0 35869 STACY KOLZ MANAGER PHARMACY 40.00 1.00 X 163760 0 26286 DIANE PETERSON MANAGER OF REHAB SERVICES 40.00 X 133785 0 27481 DEBORAH KITCH PHARMACIST 40.00 X 125334 0 28724 DAVID SCHNEIDER CEO ALH (TERMED 6/30/17) 40.00 1.00 X 427206 0 24321 3576537 5328305 1299902 26 1 1 0 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 ADMINISTRATIVE AND SUPPORT SERVICES 9700070 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 8183773 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 6353917 MIRON CONSTRUCTION 500 FIRST ST SUIT 4000 WAUSAU WI 54403 CONSTRUCTION 4017618 COMMUNITY LIVING SOLUTIONS 2801 E ENTERPRISE AVENUE 202 APPLETON WI 54913 CONSTRUCTION 2888421 51 53106 39822 92928 ACUTE HOSPITAL SERVICES-INPATIENT 621990 81893209 81893209 PHYSICIAN CLINICS 621110 14543128 14543128 OTHER OPERATING REVENUE 621990 8878483 8486266 392217 ASSISTED LIVING 623000 1080657 1080657 INDEPENDENT LIVING 623990 563408 563408 106958885 2138031 2138031 159097 60188 98909 98909 98909 52411946 48713626 3698320 3698320 3698320 112987073 106566668 392217 5935260 X 234339 234339 2343778 603558 1740220 32700118 28106886 4593232 1649998 1649998 5499634 3501695 1997939 2199047 2199047 93666 93666 20863 20863 65045 65045 24744985 11171222 13573763 181183 15729 165454 353189 177892 175297 2203103 52622 2150481 1370879 429927 940952 75286 44414 30872 147456 90538 56918 980986 980986 5387300 2646552 2740748 209109 89606 119503 SUPPLIES 13120689 12386755 733934 BAD DEBT EXPENSE 780159 780159 EQUIPMENT 472988 429553 43435 DUES AND SUBSCRIPTIONS 311087 173629 137458 282906 285281 -2375 95427793 65069402 30358391 0 44285456 17769971 5449560 20106230 13567894 14439325 1634676 1871583 1006222 1091219 100722798 44656285 56419977 56066513 52427889 78437446 4082080 3950129 2054579 2127691 180928333 195860107 7455971 6346072 24405000 23935000 1591320 1873356 33452291 32154428 X 146927792 163182823 548250 522856 147476042 163705679 180928333 195860107 X 17559280 -1584652 255009 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 5870 5870 0 PART II-B, LINE 1: ASPIRUS LANGLADE HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE WHA HAS NOTIFIED ASPIRUS LANGLADE HOSPITAL THAT APPROXIMATELY $2,810 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. ASPIRUS LANGLADE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, ASPIRUS LANGLADE HOSPITAL PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT APPROXIMATELY $3,060 OF THE FEES PAID BY ASPIRUS LANGLADE HOSPITAL IN FY2018 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 1365163 1365163 63098123 20014511 43083612 5363094 2236826 3126268 30837644 22404948 8432696 58774 58774 56066513 UNAMORTIZED BOND PREMIUM 718238 DEFERRED COMPENSATION 1385566 OTHER LONG-TERM LIABILITIES 32000 DEFERRED BOND ISSURANCE COSTS -262448 1873356 X 110682451 -1584651 -719971 -2304622 112987073 0 112987073 94707822 60188 60188 94647634 780159 780159 95427793 PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. THE ORGANIZATION IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). INCOME TAXES ON UBI ARE NOT SIGNIFICANT. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE ON FORM 990 60,188. BAD DEBT EXPENSE -780,159. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE ON FORM 990 60,188. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 780,159. 1 1 X 1 X 1 X 1 1 1 0 1 1 2414338 2414338 0.02550 12724103 9254753 3469350 0.03670 15138441 9254753 5883688 0.06220 1556787 1096319 460468 0.00490 197077 197077 0.00210 1252971 985912 267059 0.00280 14363 14363 0.00020 3021198 2082231 938967 0.01000 18159639 11336984 6822655 0.07220 459345 369477 89868 0.00090 459345 369477 89868 0.00090 1 351072 22933596 22212805 720791 X 1 0 1 1 ASPIRUS LANGLADE HOSPITAL 112 E 5TH AVENUE ANTIGO WI 54409 1055 X X X ASPIRUS LANGLADE HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X WWW.ASPIRUS.ORG/ COMMUNITY-RESOURCES X X 1 15 1 WWW.ASPIRUS.ORG/ COMMUNITY-RESOURCES 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X ASPIRUS.ORG/FINANCIALAID X ASPIRUS.ORG/FINANCIALAID X ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 5: THE LANGLADE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS A COLLABORATIVE EFFORT LED BY ASPIRUS LANGLADE HOSPITAL AND INVOLVING COMMUNITY PARTNERS INCLUDING HEALTH ORGANIZATIONS, SOCIAL SERVICE AGENCIES, SCHOOLS AND OTHER EDUCATIONAL ORGANIZATIONS, LAW ENFORCEMENT AS WELL AS COUNTY AND LOCAL GOVERNMENT, AND OTHER LOCAL PARTNERS. A NUMBER OF LISTENING SESSIONS WERE HELD THROUGHOUT THE SERVICE AREA AND ALL MEMBERS OF THE COMMUNITY WERE WELCOME AT THESE LISTENING SESSIONS. ADDITIONALLY, SURVEYS WITH RETURN POSTAGE WERE MAILED TO RESIDENTS OF THE SERVICE AREA AND RESIDENTS WERE ALSO INVITED TO TAKE AN ONLINE SURVEY TO SHARE THEIR INPUT. ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 6B: UNIFIED SCHOOL DISTRICT OF ANTIGOUNIVERSITY OF WISCONSIN- LANGLADE COUNTY EXTENSIONLANGLADE COUNTY HEALTH DEPARTMENTLANGLADE COUNTY SOCIAL SERVICESANTIGO POLICE DEPARTMENT, WHITE LAKE COUNTY CLERK OFFICE, ACTION ALLIANCE OF LANGLADE COUNTY, ANTIGO HEAD START, LANGLADE COUNTY SHERRIFF'S DEPARTMENT ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 7D: A COPY OF THE CHNA AND IMPLEMENTATION STRATEGY IS ATTACHED TO THE FORM 990. ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 11: AS A RESULT OF THE JUNE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, THE LANGLADE HEALTH COALITION, A LOCAL COMMUNITY TEAM OF GOVERNMENT, SOCIAL SERVICE AND HEALTH CARE ORGANIZATIONS, WAS ESTABLISHED. THE HOSPITAL WILL CONTINUE TO BE A LARGE PLAYER AND SUPPORTER WITHIN THE COMMUNITY COALITION IN COLLABORATION WITH MANY COMMUNITY PARTNERS TO WORK ON IDENTIFIED HEALTH PRIORITIES IDENTIFIED BY 2015 CHNA. RESEARCH AND FINDINGS OF THE 2015 CHNA INDICATE THE FOLLOWING HEALTH ISSUES WERE IDENTIFIED AS TOP PRIORITIES FOR THE JUNE 2016-2019 ASSESSMENT:1. WELLNESS & PREVENTION AND NUTRITIONAL & PHYSICAL ACTIVITY 2. SUBSTANCE ABUSE3. AFFORDABILITY OF HEALTHCARE AND PRESCRIPTION MEDICATION COSTS(MENTAL HEALTH/ BEHAVIORAL HEALTH ISSUES WERE IDENTIFIED AS AN INHERENT FACTOR IN EACH OF THE ABOVE THREE HEALTH PRIORITIES AND ARE INCORPORATED WITHIN EACH PRIORITY.)THE HOSPITAL WILL CONTINUE TO SUPPORT AND EXECUTE THE FOLLOWING INITIATIVES; MENTAL HEALTH AWARENESS AND COMMUNITY EDUCATION, THE 100 MILE CLUB DESIGNED TO ENCOURAGE KIDS TO WALK OR RUN DURING THE SCHOOL YEAR, THE WEEKEND BACKPACK PROGRAM FOR CHILDREN AND FAMILY LIVING IN POVERTY, AND THE ASPIRUS LANGLADE HOSPITAL PREVENTION FUND TO SUPPORT LOCAL COMMUNITY HEALTH NEEDS AND EMERGENCIES, ARE JUST TO NAME A FEW. FOR A FULL DESCRIPTION OF THE 2015 CHNA ACTION PLANS AND IMPLEMENTATION STRATEGIES, PLEASE REFERENCE THE FULL REPORT OR THE CHNA 2015 EXECUTIVE SUMMARY FOR A SUMMARIZED VERSION. AS FOR THOSE INITIATIVES NOT YET ADDRESSED, COMMUNITY PROJECTS ARE CHOSEN BY FACILITATED LOGIC MODELS TO DETERMINE PRIORITY AND GAUGE INTEREST OF COMMUNITY COALITION WORK GROUPS ALONG WITH ATTAINABLE TIMELINES. ASPIRUS LANGLADE HOSPITAL STILL PLANS TO WORK ON INITIATIVES IDENTIFIED IN THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT WITH SUFFICIENT DATA STILL INDICATING A NEED IN THE 2015 DATA COLLECTION PROCESS. 5 1 - ASPIRUS ANTIGO CLINIC 110 E 5TH AVE ANTIGO WI 54409 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES 2 - ASPIRUS BIRNAMWOOD CLINIC 400 RAILROAD BIRNAMWOOD WI 54414 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES 3 - ASPIRUS ELCHO CLINIC W10618 CLINIC ST ELCHO WI 54428 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES 4 - PINE MEADOWS 525 FLIGHT RD ANTIGO WI 54409 SENIOR HOUSING 5 - ROSALIA GARDENDS 525 FLIGHT RD ANTIGO WI 54409 ASSISTED LIVING PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990, SCHEDULE H IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. 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 FORM 990. PART I, LINE 7G: THE COST OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE HOSPICE AND DIALYSIS PROGRAMS OF ASPIRUS LANGLADE HOSPITAL. ASPIRUS LANGLADE USED A COST TO CHARGE RATIO TO ESTIMATE THE COST OF EACH DEPARTMENET AND USED INTERNAL DEPARTMENT REPORTS TO DETERMINE THE DIRECT REVENUE OFFSET. THE DIALYSIS PROGRAM HAD AN ESTIMATED COST OF $1,316,231 WITH DIRECT REVENUE OFFSET OF $985,912. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 780,159. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS A GROWING ARGUMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. ASPIRUS LANGLADE HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. ASPIRUS LANGLADE HOSPITAL, 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 HOSPITAL PROVIDES LOCAL ACCESS TO MANY OTHER HEALTH SERVICES. THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES FOCUS ON EFFORTS TO ENRICH THE LIVES OF COMMUNITY MEMBERS WHO ARE STRUGGLING WITH ISSUES THAT MAY HAVE A NEGATIVE IMPACT ON THEIR HEALTH. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY:IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, ASPIRUS LANGLADE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, ASPIRUS LANGLADE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), ASPIRUS LANGLADE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. ANY SHORTFALL IS TREATED AS A COMMUNITY BENEFIT SINCE THE HOSPITAL IS PROVIDING SERVICES AT A LOSS WHICH ARE ESSENTIAL TO THE COMMUNITY. THE AMOUNTS OF MEDICARE ALLOWANCE COSTS ARE DETERMINED USING THE PRINCIPLES OF MEDICARE REIMBURSEMENT. PART III, LINE 9B: UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENTS ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORKQUEUE 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: MANAGEMENT REVIEWS HEALTH AND SOCIAL DATA AND TRENDS TO DETERMINE WHETHER THERE IS AN UNMET NEED WITHIN THE COMMUNITY. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINACIAL 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 AT 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 LANGLADE HOSPITAL SERVES THE POPULATION OF LANGLADE COUNTY AND SURROUNDING COUNTIES. LANGLADE COUNTY IS A RURAL COUNTY WITH NO TOWNS OF ANY SIGNIFICANT SIZE. THE POPULATION IS AGING AND PROJECTIONS INDICATE 50% OF THE POPULATION WILL BE OVER 64 YEARS OF AGE BY 2018. VERY LITTLE GROWTH IS PROJECTED FOR THE SERVICE AREA IN THE COMING YEARS. LANGLADE COUNTY HAS TRADITIONALLY SEEN HIGH RATES OF UNEMPLOYMENT. THERE ARE NO OTHER HOSPITALS IN THE IMMEDIATE AREA THAT SERVE LANGLADE COUNTY. THERE ARE HOSPITALS IN RHINELANDER AND IN WAUSAU; HOWEVER, DEPENDING UPON LOCATION IN LANGLADE COUNTY, THESE FACILITIES WOULD BE FAIRLY FAR AWAY. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPRISED OF 10 VOTING MEMBERS FROM THE SURROUNDING AREA. OF THESE 10 VOTING BOARD MEMBERS, 7 ARE INDEPENDENT. THE HOSPITAL DOES EXTEND PRIVILEGES TO ALL QUALIFIED LOCAL PHYSICIANS. THE HOSPITAL PARTICIPATES IN LOCAL HEALTH FAIRS AND PROVIDES FREE SCREENINGS THROUGH THESE HEALTH FAIRS. PART VI, LINE 6: ASPIRUS LANGLADE HOSPITAL IS A PARTNER WITH ASPIRUS, INC. (ASPIRUS) A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. ASPIRUS LANGLADE HOSPITAL WORKS WITH ASPIRUS TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES THEY SERVE. A NUMBER OF REPRESENTATIVES FROM ASPIRUS HAVE ROLES ON THE BOARD OF DIRECTORS OF ASPIRUS LANGLADE HOSPITAL AND TOGETHER PROMOTE THE MISSION OF ASPIRUS. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTH CARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES TO IMPROVING THE HEALTH OF ALL IT SERVES. ASPIRUS WORKS COLLABORATIVELY WITH OTHERS WHO SHARE ITS PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. ASPIRUS AND ASPIRUS LANGLADE HOSPITAL WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE TO PROVIDE HIGH QUALITY CARE TO MEMBERS OF COMMUNITIES WHICH OTHERWISE WITHOUT THE EFFORTS OF A COMBINED PARTNERSHIP MAY NOT HAVE ACCESS TO THIS CARE LOCALLY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 MENOMINEE INDIAN TRIBE OF WISCONSIN PO BOX 910 KESHENA WI 54409 391205576 82327 PROVIDE MORE ACCESS TO BUSING SERVICES FOR COMMUNITY MEMBERS MEMORIAL HOSPITAL AND COMMUNITY HEALTH FOUNDATION INC 112 E 5TH AVE ANTIGO WI 54409 391304761 501(C)(3) 28015 OTHER WAGES AND BENEFITS INKIND FOR ACCOUNTING AND MANAGEMENT SERVICES BOYS AND GIRLS CLUB OF LANGLADE COUNTY 411 SUPERIOR ST ANTIGO WI 54499 391980025 501(C)(3) 14000 PROVIDE HEALTHY MEALS TO MEMBERS AND EDUCATE FAMILIES ON PROPER NUTRITION AND EXERCISE ANTIGO AREA FOOD PANTRY 2120 PROGRESS BLVD ANTIGO WI 54135 454834406 501(C)(3) 22900 FUNDING FOR A WEEKEND MEAL PROGRAM FOR SCHOOL-AGE CHILDREN LANGLADE COUNTY SHERIFF DEPT 3800 CLERMONT STREET ANTIGO WI 54409 396005713 501(C)(3) 30000 MENTAL HEALTH SERVICES EXPANSION 4 1 PART I, LINE 2: THE ORGANIZATION PROVIDES BOARD APPROVED CAPTIAL DISTRIBUTIONS, WAGES AND BENEFITS TO RELATED ENTITIES AND NON-RELATED ENTITIES; NO FORMAL MONITORING IS REQUIRED. X X X X X 0 1 0 0 0 0 0 0 0 RICK NEVERS VICE CHAIRMAN/SVP REGIONAL 0 322120 0 61986 0 38481 0 19030 0 60055 0 501672 0 0 SID SCZYGELSKI BOARD MEMBER/SVP OF FINANC 0 500272 0 97238 0 47442 0 19030 0 87566 0 751548 0 0 MIKE OLSON DO BOARD MEMBER/PHYSICIAN RAD 545459 0 0 0 487 0 13250 0 32806 0 592002 0 0 0 PATRICK TINCHER CFO ALH 224138 0 35580 0 24449 0 14802 0 29945 0 328914 0 0 0 ANDREW BARTH CEO ALH 147696 0 0 0 372 0 7510 0 13712 0 169290 0 0 0 MATT HEYWOOD CEO AI 0 822805 0 293232 0 2695 0 19030 0 144154 0 1281916 0 0 JANELLE MARKGRAF DIRECTOR HR & OFF CAMPUS S 171510 0 27444 0 20667 0 8971 0 22339 0 250931 0 0 0 SHERRY BUNTEN DIRECTOR OF PATIENT CARE S 193653 0 30460 0 17772 0 9727 0 28660 0 280272 0 0 0 JOHN HEISLER SVP & CHIEF HR OFFICER 0 292124 0 63187 0 14010 0 18924 0 58046 0 446291 0 0 DEAN DANNER SVP AMBULATORY SERVICES & PRESIDENT 0 291709 0 50695 0 46565 0 19030 0 25012 0 433011 0 0 MICHAEL MCGRAIL MD SVP SYSTEM CMO 0 391427 0 82975 0 11936 0 12004 0 65632 0 563974 0 0 RUTH RISLEY-GRAY SVP NURSING, SYSTEM CNO 0 275808 0 58636 0 43052 0 19030 0 58171 0 454697 0 0 TODD RICHARDSON SVP & CIO 0 292477 0 62933 0 37490 0 19030 0 68931 0 480861 0 0 ERIC ANDERSON SVP SERVICE LINE & PATIENT EXPERIENC 0 233292 0 40147 0 725 0 4819 0 59858 0 338841 0 0 RENEE SMITH EXECUTIVE DIRECTOR ANI 0 344370 0 42139 0 44887 0 19030 0 27247 0 477673 0 0 BESSANT PARKER ALH CMO 325406 0 48113 0 467 0 12455 0 15684 0 402125 0 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 319704 0 64915 0 36831 0 19030 0 66107 0 506587 0 0 DOUGLAS ARMATO MD PHYSICIAN RADIOLOGIST 461842 0 0 0 2327 0 13265 0 25329 0 502763 0 0 0 KENNETH BOWMAN MD PHYSICIAN RADIOLOGIST 445038 0 0 0 3572 0 13250 0 22619 0 484479 0 0 0 STACY KOLZ MANAGER PHARMACY 163440 0 0 0 320 0 8333 0 17953 0 190046 0 0 0 DIANE PETERSON MANAGER OF REHAB SERVICES 132472 0 0 0 1313 0 6880 0 20601 0 161266 0 0 0 DEBORAH KITCH PHARMACIST 125233 0 0 0 101 0 6683 0 22041 0 154058 0 0 0 DAVID SCHNEIDER CEO ALH (TERMED 6/30/17) 320323 0 103284 0 3599 0 12174 0 12147 0 451527 0 0 0 PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: R. NEVERS $32,268 S. SCZYGELSKI $38,440 R. RISLEY-GRAY $38,590 T. RICHARDSON $35,685 A. TINCHER $ 23,403 B. BUNTEN $17,236 J. MARKGRAF $16,391 D. DANNER $35,422 C. LOGEMANN $34,955 R. SMITH $10,121 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. A WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 2013-04-12 27000592 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 A 2195000 27000592 2013 0 0 1 1 A 0 0 1 0 0 0.00200 0.00200 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2013 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (EIN 39-0964813); ASPIRUS GRAND VIEW (EIN 38-2908586); AND LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN (EIN 39-0806429). INFORMATION REGARDING THE SERIES 2013 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2013 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2013 BONDS.] PART III - LINE 3 AND 3B ASPIURS, INC., A MEMBER OF ASPIRUS LANGLADE HOSPITAL, HAS A POLICY AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCE PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. PART III - LINE 9 SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES THAT WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. MAUREEN WINTER FAMILY MEMBER OF MIKE WINTER, BOARD MEMBER 47287 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL HAS TWO MEMBERS, THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH HEALTH CORPORATION (55%) AND ASPIRUS, INC. (45%). FORM 990, PART VI, SECTION A, LINE 7A SEE EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7B. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL OPERATES UNDER THE CONTROL AND DIRECTION OF THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH HEALTH CORPORATION (RHSJ), A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH AND ASPIRUS, INC. EACH OF WHICH APPOINT 3 BOARD MEMBERS AND JOINTLY APPROVE THE REMAINING MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES 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 HOSPITAL'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 DTERMINED 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 LANGLADE HOSPITAL RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABISHING 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 HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, NOR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G LAB PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 746,497. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 746,497. PROVIDER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 5,122,730. MANAGEMENT AND GENERAL EXPENSES 14,544. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,137,274. LAUNDRY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 37,584. MANAGEMENT AND GENERAL EXPENSES 356,198. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 393,782. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,216,037. MANAGEMENT AND GENERAL EXPENSES 72,273. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,288,310. CORPORATE ALLOCATION: PROGRAM SERVICE EXPENSES 59,441. MANAGEMENT AND GENERAL EXPENSES 12,822,717. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,882,158. PHARMACY DISPENSING FEES: PROGRAM SERVICE EXPENSES 1,849,534. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,849,534. RECRUITMENT: PROGRAM SERVICE EXPENSES 47,022. MANAGEMENT AND GENERAL EXPENSES 19,769. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,791. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,092,377. MANAGEMENT AND GENERAL EXPENSES 288,262. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,380,639. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 30. CONTRIBUTIONS FOR PROPERTY AND EQUIPMENT 254,978. ROUNDING 1. FORM 990, PART XII, LINE 2C, AUDIT PROCESS: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. RELIGIOUS HOSPITALLERS OF ST JOSEPH HEALTH CORP 411 E WIS AVE STE 700 MILWAUKEE WI 53202 271341591 HEALTH CARE WI 501(C)(3) LINE 1 N/A 0 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTH CARE WI 501(C)(3) LINE 12B, II N/A 0 0 0 1 1 1 0 0 0 1 0 0 0 1 1 1 1 1 0 0 ASPIRUS INC B 2140000 ASPIRUS INC M 12870249 ASPIRUS INC O 195942 ASPIRUS INC Q 135799 ASPIRUS INC P 93815 SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP