2019-05-15T13:44:04-05:00 2018-06-30 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-07-01 390868982 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC ASPI 7154229292 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 SIDNEY C SCZYGELSKI CFO OF AI/SENIOR VP OF FINANCE 7154229292 2019-05-13 1 PAUL M TRACZEK CPA P01368830 7158323407 2019-05-13 137.26.200.211 2019-05-13 08:51:47 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 558C6F47C777A73CECB93EB9107DCB0C387663C8 2017 2019-02-21 02:37:17Z SIDNEY C SCZYGELSKI 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 147481682 0 X WWW.ASPIRUS.ORG X 1912 WI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 10 6 724 280 1091909 0 36837 47332 118864594 139141721 2488046 3216777 544209 307966 121933686 142713796 4195 500 0 0 48205191 56389469 0 0 0 58682872 66799271 106892258 123189240 15041428 19524556 169175282 197025509 61684920 70642377 107490362 126383132 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 93435964 500 137559798 ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. OWNS AND OPERATES THE FOLLOWING ENTITIES: (1) ASPIRUS RIVERVIEW HOSPITAL, ESTABLISHED IN 1912; (2) THE OUTPATIENT ASPIRUS RIVERVIEW THERAPIES; (3) ASPIRUS RIVERVIEW CLINICS - THIS SERVICE INCLUDES CLINICS IN WISCONSIN RAPIDS, NEKOOSA, AND THE ROME-LAKES AREA; (4) THE ASPIRUS UW CANCER CENTER. ASPIRUS RIVERVIEW CANCER CENTER OPENED IN 2003 IN COOPERATION WITH UW COMPREHENSIVE CANCER CENTER, MADISON; (5) ASPIRUS RIVERVIEW DENTAL CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THIS CLINIC IN 2009 TO SERVE RESIDENTS OF SOUTH WOOD COUNTY WHO ARE COVERED BY BADGER CARE/MEDICAID; (6) ASPIRUS RIVERVIEW WOUND AND HYPERBARIC CENTER. THE CENTER OPENED IN 2010 AND IS MANAGED BY HEALOGICS; (7) ASPIRUS HEART & VASCULAR CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THE CLINIC IN 2016, STAFFING IT WITH A FULL TIME CARDIOLOGIST AND NURSE PRACTITIONER; (8) ASPIRUS DOCTORS CLINIC WAS PURCHASED AS OF 1/1/17. (9) ASPIRUS RIVERVIEW BEHAVIORAL HEALTH CLINIC WAS ESTABLISHED IN 2018. IT PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AND IS STAFFED BY PSYCHIATRISTS, NURSE PRACTITIONERS AND LICENSED CLINICAL SOCIAL WORKERS.ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PROVIDES COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT, AND IT PROVIDES MEASURABLE IMPROVEMENT IN HEALTH ACCESS, HEALTH STATUS, AND THE USE OF HEALTH CARE RESOURCES. IN ADDITION, THE PROGRAMS AND SERVICES CONSIDERED COMMUNITY BENEFITS SHOULD MEET ONE OR MORE OF THE FOLLOWING CRITERIA: *SUPPORTS THE ORGANIZATION'S COMMUNITY-BASED MISSION *TARGETS THE PROBLEMS OF THE POOR OR MEDICALLY UNDERSERVED *IMPACTS THE HEALTH STATUS OF THE IDENTIFIED COMMUNITY *REDUCES COMMUNITY HEALTH COSTS *IS ACCESSIBLE TO THE ENTIRE TARGET COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY *STIMULATES EXTERNAL COMMUNITY PARTNERSHIPS *IMPROVES THE ACCESS TO NEEDED HEALTH CARE SERVICESFONEMED IS A FREE, CONFIDENTIAL TELEPHONE SERVICE THE COMMUNITY CAN CALL AFTER THE CLINICS ARE CLOSED TO GET ROUTINE HEALTH ADVICE OR GENERAL HEALTH INFORMATION FROM A REGISTERED NURSE. APPROXIMATELY 1,520 PERSONS BENEFITED FROM THIS PROGRAM.COALITION BUILDING: THE HEALTHY PEOPLE WOOD COUNTY OBESITY PREVENTION TEAM IS FOCUSING EFFORTS ON BUILDING ENVIRONMENTS AND POLICIES WHICH CAN SUPPORT HEALTHY BEHAVIOR CHANGE IN TERMS OF DIET AND EXERCISE. REPRESENTATIVES FROM ASPIRUS RIVERVIEW SERVE ON THE SAFE KIDS COALITION, WORKING TO PREVENT INJURY AND DEATH IN CHILDREN AGED 0-14. THE COMMUNITY RELATIONS ASSISTANT REPRESENTS ASPIRUS RIVERVIEW ON THE 3-0 DAY COMMITTEE (OUR BODIES, OUR RESPONSIBILITIES). THE COMMITTEE ORGANIZES A TEEN CONFERENCE ANNUALLY FOCUSING ON REDUCING AT-RISK BEHAVIOR IN JUNIOR AND SENIOR HIGH STUDENTS. APPROXIMATELY 355 PERSONS BENEFITED FROM THESE COALITIONS. ASPIRUS RIVERVIEW DENTAL CLINIC IN WISCONSIN RAPIDS IS OPEN TO PATIENTS WHO HAVE MEDICAID OR BADGER CARE INSURANCE COVERAGE. THIS INSURANCE IS NOT TYPICALLY ACCEPTED BY INDEPENDENT DENTAL CLINICS. APPROXIMATELY 3,401 PERSONS BENEFITED FROM THIS PROGRAM IN 2018. THE LIFELINE PROGRAM IS A 24 HOUR A DAY PERSONAL RESPONSE SYSTEM. A LIFELINE UNIT IS INSTALLED IN THE "SUBSCRIBER'S" HOME AND OPERATES THROUGH THEIR PHONE LINE. HE/SHE WEARS A "PERSONAL HELP BUTTON", WHICH THEY USE TO ALERT LIFELINE SIMPLY BY PRESSING THE BUTTON. THERE IS ALSO AN AUTO ALERT PERSONAL HELP BUTTON, WHICH ALERTS LIFELINE AUTOMATICALLY IF THE SUBSCRIBER FALLS. A LIFELINE "MONITOR" ANSWERS THE CALL THROUGH THE LIFELINE UNIT AND THEY CALL THE SUBSCRIBER. AFTER THEY DETERMINE WHAT KIND OF HELP IS NEEDED, THEY CALL THE SUBSCRIBER'S "RESPONDERS", WHICH ARE FRIENDS, NEIGHBORS, OR RELATIVES THAT CAN CHECK ON THE SUBSCRIBER, OR IF THE SUBSCRIBER NEEDS MORE PROFESSIONAL HELP THE MONITOR WILL CALL FOR IT IMMEDIATELY. THE LIFELINE PROGRAM HELPS PEOPLE THAT WOULD OTHERWISE BE UNABLE TO REMAIN IN THEIR HOMES. IT PROVIDES THEM WITH FREEDOM AND SECURITY TO DO SO, WHILE ALSO PUTTING THEIR FAMILY AT EASE. OUR PROGRAM HELPS MANY PEOPLE IN WISCONSIN RAPIDS AND THE SURROUNDING AREA. THIS PAST YEAR APPROXIMATELY 209 PEOPLE BENEFITED FROM THE LIFELINE PROGRAM THAT ASPIRUS RIVERVIEW HOSPITAL OFFERS.VULNERABLE PEOPLE OF ALL AGES INCLUDING THE ELDERLY CAN REMAIN IN THEIR HOME AND BE SELF-SUFFICIENT BY RECEIVING A HOME DELIVERED MEAL THAT MEETS THEIR SPECIFIC NUTRITION REQUIREMENTS. HEALTH CONDITIONS OR PHYSICAL DISABILITIES RESTRICT THE ABILITY OF INDIVIDUALS TO REMAIN INDEPENDENT. THE HOME DELIVERED MEALS PROGRAM PROVIDES NUTRITION THAT IS MEDICALLY THERAPEUTIC TO ADDRESS THE SPECIAL NEEDS OF CLIENTS DIAGNOSED WITH DIABETES, CARDIAC AND PULMONARY ISSUES, RETINAL DISEASE, GLUTEN INTOLERANCE, WEIGHT LOSS DUE TO CANCER AND CHEWING AND SWALLOWING PROBLEMS. THE PROGRAM ALSO MEETS THE NEEDS OF CARETAKERS OF THE MENTALLY AND PHYSICALLY HANDICAPPED OR ALZHEIMER'S OR OTHER DEMENTIA DISORDERS BY PROVIDING MEALS TO ALLOW THEM TO CARE FOR THEIR LOVED ONES. NUTRITION EDUCATION IS ALSO OFFERED. COMMUNITY VOLUNTEERS DELIVER HOT LUNCHES MONDAY - FRIDAY AS WELL AS BROWN BAG MEALS FOR WEEKENDS. FOOD IS PREPARED WITH CONSIDERATION FOR EACH CLIENT'S PERSONAL PREFERENCES AS WELL AS DIETARY RESTRICTIONS. IN 2018, 16,877 MEALS WERE DELIVERED. IN AN EFFORT TO MEET THE COMMUNITY NEEDS OF STUDENTS IN THE WISCONSIN RAPIDS AREA, ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. OFFERS THE OPPORTUNITY FOR INTERESTED STUDENTS TO EXPERIENCE A GLIMPSE OF THE ROLE OF ITS PROFESSIONAL STAFF. THIS SERVICE IS MADE AVAILABLE TO STUDENTS WHO ARE INTERESTED IN LEARNING MORE ABOUT HEALTH CAREERS. IN 2018, ASPIRUS RIVERVIEW HAD 35 JOB SHADOW PARTICIPANTS.ASPIRUS RIVERVIEW OFFERS A FREE SEMINAR ENTITLED UNDERSTAND YOUR JOINT PAIN. THIS SEMINAR DISCUSSED WHAT YOU CAN DO ABOUT KNEE, HIP, AND OTHER JOINT PAIN. ATTENDANTS ALSO LEARNED ABOUT ARTHRITIS, THE CAUSES AND SYMPTOMS, AND TREATMENT OPTIONS INCLUDING MEDICATIONS, NUTRITION, EXERCISE, ALTERNATIVE TREATMENTS, AND NEW CONCEPTS IN JOINT REPLACEMENT. ASPIRUS RIVERVIEW OFFERS MONTHLY EVENTS TO ALL WOMEN IN THE SURROUNDING COMMUNITIES. THE EVENTS ARE FREE OF CHARGE AND EDUCATE WOMEN ON VARIOUS HEALTH TOPICS THAT COULD AFFECT THEM AND/OR MEMBERS OF THEIR FAMILIES. VARIOUS HEALTH TOPICES COVERED WERE CANCER, DIABETES, JOINT REPLACEMENT, AND IMMUNIZATIONS. IN 2018, NEARLY 1,517 INDIVIDUALS BENEFITED FROM THESE EVENTS.ASPIRUS RIVERVIEW COORDINATES AND FACILITATES SEVERAL SUPPORT GROUPS FOR INDIVIDUALS AND THEIR LOVED ONES WHO ARE DEALING WITH CHRONIC DISEASE, CANCER OR LOSS. THE SUPPORT GROUPS INCLUDE BOTH MEN'S AND WOMEN'S CANCER, DIABETES, CELIAC DISEASE, ARTHRITIS AND LOSS. IN ADDITION, LACTATION SPECIALISTS FROM THE ASPIRUS RIVERVIEW FAMILY BIRTHPLACE OFFER BREASTFEEDING SUPPORT TO NEW MOTHERS. APPROXIMATELY, 753 INDIVIDUALS BENEFITED FROM THESE PROGRAMS.ASPIRUS RIVERVIEW OFFERS PRECEPTORSHIP OPPORTUNITIES TO STUDENTS ENROLLED IN AREA NURSING PROGRAMS. THIS STRUCTURED PROGRAM PROVIDES INSTRUCTION, DIRECTION AND GUIDANCE TO STUDENTS WHO ARE NOT EMPLOYEES OF ASPIRUS RIVERVIEW. THE PROGRAM MEETS THE REQUIREMENTS FOR COURSE CREDIT IN A HEALTHCARE SETTING. IN 2018, 55 STUDENTS BENEFITED FROM PRECEPTORSHIP OPPORTUNITIES.ASPIRUS RIVERVIEW HELD MONTHLY WORKSHOPS ON HOW TO COMPLETE AN ADVANCED DIRECTIVE AND APPOINT A HEALTHCARE POWER OF ATTORNEY. ADDITIONAL PRESENTATIONS WERE GIVEN TO THE WISCONSIN RAPIDS ROTARY CLUB IN AN EVENING SEMINAR. IN 2018, 326 PEOPLE RECEIVED THIS EDUCATION.ASPIRUS RIVERVIEW IS A BUSINESS SITE FOR PROJECT SEARCH - AN INTERNATIONAL PROGRAM THAT PROVIDES YOUNG ADULTS WITH COGNITIVE AND PHYSICAL DISABILITIES WITH ON-SITE INTERNSHIPS. ASPIRUS RIVERVIEW PROVIDES CLASSROOM SPACE AND 10-WEEK INTERNSHIPS IN VARIOUS DEPARTMENTS. AT THE END OF THE YEAR, STUDENTS HAVE GAINED VALUABLE SOCIAL AND EMPLOYMENT SKILLS THAT WILL HELP THEM FIND GAINFUL EMPLOYMENT IN THE COMMUNITY. IN 2018, 10 STUDENTS BENEFITED FROM THIS PROGRAM.ASPIRUS RIVERVIEW BELIEVES THAT BREAST FEEDING IS IMPORTANT AND OFFERS FREE BREAST FEEDING SUPPORT TO NEW MOTHERS. THIS SUPPORT IS AVAILABLE SEVEN DAYS A WEEKS AND NEW MOTHERS ARE ALSO INVITED TO RECEIVE ONE-ON-ONE COUNSELING FROM CERTIFIED LACTATION SPECIALISTS. 93435964 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 60 0 1 724 1 1 1 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X SIDNEY SCZYGELSKI 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 FORREST DEAN DANNER JR BOARD CHAIR / PRESIDENT ACI 1.00 40.00 X X 0 388969 44042 DAVID STARK BOARD VICE CHAIR 1.00 X X 0 0 0 SIDNEY C SCZYGELSKI BOARD TREASURER 1.00 50.00 X X 0 644952 106596 MARY JO CARSON BOARD SECRETARY 1.00 X X 0 0 0 MICHAEL BOVEE DIRECTOR 1.00 X 0 0 0 STEVEN BERLYN DIRECTOR 1.00 X 0 0 0 BONITA KOLRUD DIRECTOR 1.00 40.00 X 0 434904 43112 MARY IRONSIDE DIRECTOR 1.00 X 0 0 0 CRAIG R FLINDERS DO DIRECTOR 1.00 40.00 X 0 315244 38922 MARTIN J LOY DIRECTOR 1.00 X 0 0 0 MATT HEYWOOD CEO OF ASPIRUS INC. 1.00 50.00 X 0 1118732 163184 NANCY ROTH-MALLEK VP OF FINANCE 40.00 X 191168 0 43047 TODD BURCH PRESIDENT OF ASPIRUS RIVERVIEW 1.00 40.00 X 0 320086 76164 ERIC ANDERSON SVP OF SERVICE LINE & PT EXP 1.00 40.00 X 0 274164 64677 KIMBERLY JOHNSON V.P. - PATIENT SERVICES 40.00 X 184082 0 25057 THOMAS VOELKER PRESIDENT OF MEDICAL AFFAIRS 20.00 20.00 X 180032 180030 74514 RUTH RISLEY-GRAY SVP NURSING, CNO 1.00 50.00 X 0 377496 77201 JOHN HEISLER SVP & CHIEF HR OFFICER 1.00 50.00 X 0 369321 76970 MICHAEL MCGRAIL MD SVP SYSTEM CMO 1.00 50.00 X 0 486338 77636 CARI LOGEMANN SVP & GENERAL COUNSEL 1.00 50.00 X 0 421450 85137 RENEE SMITH ANI EXECUTIVE DIRECTOR 1.00 50.00 X 0 431396 46277 TODD RICHARDSON SVP & CIO 1.00 50.00 X 0 392900 87961 RICK NEVERS SVP REG OPS SYSTEM INT OFF 1.00 50.00 X 0 422587 79085 REBECCA PHILLIP DIRECTOR OF PHARMACY 40.00 X 198643 0 21789 MATTHEW MALOOLY PHARMACIST 40.00 X 167092 0 17665 MARJORIE TELL V.P. - ANCILLARY SERVICES-TERMED 40.00 X 140232 0 28198 STACI SOVA NURSE PRACTITIONER 40.00 X 135322 0 33576 1196571 6578569 1310810 26 0 1 0 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 18218311 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 ADMINISTRATIVE & SUPPORT SERVICES 17561186 ASPIRUS WAUSAU HOSPITAL 333 PINE RIDGE BLVD WAUSAU WI 54401 ADMINISTRATIVE & SUPPORT SERVICES 8385275 MIDWEST GROUP MEA EMERGENCY MGMT PO BOX 634850 CINCINNATI OH 452634850 ER SERVICE 4171343 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 PATHOLOGY FEE 729980 18 34495 12837 47332 PATIENT SERVICES 900099 137367846 137367846 LAB SERVICE FOR NON PATIENTS 621500 797720 797720 OTHER 900099 490343 294189 196154 FOOD 900099 293860 293860 HEALTH INCENTIVE PROGRAMS 900099 80984 80984 110968 110968 139141721 141048 141048 618814 310848 307966 307966 307966 7528325 4452596 3075729 3075729 3075729 4442 34495 4442 0 142713796 137559798 1091909 4014757 X 500 500 695000 695000 43957203 37417986 6539217 2197661 2175050 22611 6709102 4454784 2254318 2830503 2812895 17608 315776 315776 238522 238522 32195 32195 18150 18150 12818059 11426092 1391967 278901 16415 262486 861523 596650 264873 435666 168461 267205 5020072 2689106 2330966 221564 114174 107390 9699 9699 1289245 1289245 5586529 3537211 2049318 240349 122512 117837 MEDICAL SUPPLIES 19720170 18639290 1080880 CORPORATE ALLOCATION 14306856 5142116 9164740 BAD DEBT 3351172 3351172 HOSPITAL TAX 1823558 1823558 231265 455774 -224509 123189240 93435964 29753276 0 28026 22775 47978849 72177641 18941200 20091712 2269646 2396275 527409 539593 165412967 96602673 63629521 68810294 34889147 32194251 911484 792968 169175282 197025509 16757931 12624846 2215989 2129462 42664684 55833004 46316 55065 61684920 70642377 X 106868344 125524497 622018 858635 107490362 126383132 169175282 197025509 X 19524556 1374772 -2006559 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 9700 9700 0 PART II-B, LINE 1: THE PERCENTAGES THAT ARE SPECIFIC FOR LOBBYING PURPOSES ARE AS FOLLOWS: 22.98% OF THE AMERICAN HOSPITAL ASSOCIATION TOTALING $3,993.23, 14.3% OF THE WISCONSIN HOSPITAL ASSOCIATION TOTALING $3,813.81, AND OTHER MINOR ACTIVITY OF $1,892.61 MAKING THE GRAND TOTAL OF DUES DIRECTED TOWARDS LOBBYING $9,699.65. 3764622 3764622 80982636 37045054 43937582 3006780 1923337 1083443 70258925 57055064 13203861 7400004 579218 6820786 68810294 RETIREE HEALTHCARE BENEFITS 19865 LONG TERM INSURANCE 35200 55065 X PART X, LINE 2: ALL SUBISIDIARIES, EXCEPT FOR ANI, ARE TAX-EXEMPT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(2) OF THE CODE. THEY ARE ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. ASPIRUS IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME(UBI). INCOME TAXES FOR ANI, A NOT-FOR-PROFIT TAXABLE CORPORATION, WERE IMMATERIAL FOR THE YEAR ENDED JUNE 30, 2018 AND 2017. LOVE LIGHTS 24839 24720 119 119 CHRISTMAS AT THE RIDGES 14098 9775 4323 4323 38937 34495 4442 4442 4442 0 WI 1 0 1 0 1.00000 ELAINE SEMROW 5774 SCHUDY ROAD WISCONSIN RAPIDS WI 54495 0 ELAINE SEMROW TREASURER OF AUXILIARY FUNDRAISING EVENTS X 0 1 1 X 1 X 1 X 1 1 1 0 1 1 1335044 111570 1223474 0.01020 18617348 12769605 5847743 0.04880 19952392 12881175 7071217 0.05900 205751 116939 88812 0.00070 386683 386683 0.00310 1611271 1004137 607134 0.00490 6455 6328 127 0.00000 2210160 1127404 1082756 0.00870 22162552 14008579 8153973 0.06770 10 8825 8825 0.00010 10 8825 8825 0.00010 1 1277245 17992004 21221692 -3229688 X 1 0 1 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54495 HTTP://WWW.ASPIRUS.ORG/MAIN/HOME.ASPX WI #11 X X X ASPIRUS RIVERVIEW HOSPITAL & CLINICS IN 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES 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 WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X WWW.ASPIRUS.ORG/FINANCIALAID X X X X X X 1 X 0 X X X 1 X 0 0 ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 5: INPUT WAS GATHERED FROM PERSONS WHO REPRESENT THE COMMUNITY IN THE FOLLOWING WAYS: 1) A COMMUNITY-WIDE SURVEY 2) FOCUS GROUPS WITH DISENFRANCHISED POPULATIONS 3) A FORUM WITH COMMUNITY STAKEHOLDERS. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6A: MINISTRY SAINT JOSEPH'S HOSPITAL AND MARSHFIELD CLINIC ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 6B: WOOD COUNTY HEALTH DEPARTMENT AND THE LEGACY FOUNDATION ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PART V, SECTION B, LINE 11: ASPIRUS RIVERVIEW HOSPITAL IS WORKING WITH THE WOOD COUNTY HEALTH DEPARTMENT, AS WELL AS OTHER COMMUNITY STAKEHOLDERS ON A COLLABORATIVE IMPROVEMENT PLAN. SEVERAL TASK FORCES HAVE BEEN PUT IN PLACE AND ARE MOVING FORWARD ON IMPROVEMENT STRATEGIES THAT HAVE MEASURABLE OUTCOMES. IN ADDITION, ASPIRUS RIVERVIEW ESTABLISHED AN OUTPATIENT BEHAVIORAL HEALTH CLINIC IN AUGUST 2018, STAFFED WITH PSYCHIATRISTS, PSYCHIATRIC NURSE PRACTITIONERS AND LICENSED COUNSELORS. THE BEHAVIORAL HEALTH CLINIC WILL HELP ADDRESS THE FIRST TWO PRIORITIES, MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES, IDENTIFIED IN THE CHNA. 6 1 - ASPIRUS UW CANCER CENTER 410 DEWEY STREET WISCONSIN RAPIDS WI 54495 CANCER CENTER 2 - ASPIRUS RIVERVIEW FAMILY CLINIC - WR 420 DEWEY STREET PO BOX 8080 WISCONSIN RAPIDS WI 54495 CLINIC 3 - ASPIRUS RIVERVIEW FAMILY CLINIC NEKOOSA 1015 ANGELUS DRIVE NEKOOSA WI 54457 CLINIC 4 - ASPIRUS RIVERVIEW FAMILY CLINIC - LAKES 1160 ROME CENTER DRIVE TOWN OF ROME NEKOOSA WI 54457 CLINIC 5 - ASPIRUS RIVERVIEW COMMUNITY DENTAL CLINI 820 TWO MILE AVENUE WISCONSIN RAPIDS WI 54494 DENTAL CLINIC 6 - ASPIRUS DOCTORS CLINIC 2031 PEACH STREET WISCONSIN RAPIDS WI 54494 CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF: 1) PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200% EQUITY ALLOWANCE IS $75,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G., DAIRY FARM) IS EVALUATED INDIVIDUALLY ON A CASE-BY-CASE BASIS. 2) CASH ASSETS IN EXCESS OF $4,000 AT THE TIME OF APPLICATION. SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS AND IRREVOCABLE BURIAL TRUST FUNDS. 3) TOTAL NET ASSETS CANNOT EXCEED 800% OF FEDERAL POVERTY GUIDELINES. THIS INCLUDES ALL ASSETS INCLUDING CASH ASSETS ABOVE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSE, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION. PART I, LINE 7G: THE ABOVE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE BREASTFEEDING SUPPORT, PALLIATIVE CARE, AND LAKES FAMILY CLINIC. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. THE BREASTFEEDING SUPPORT REPORTED COSTS OF $100,100. THE PALLIATIVE CARE REPORTED COSTS OF $170,602 WITH OFFSETTING REVENUE OF $13,946. THE LAKES FAMILY CLINIC REPORTED COSTS OF $1,340,569 WITH OFFSETTING REVENUE OF $990,191. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24C, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $3,351,172. 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 RIVERVIEW HOSPITAL & CLINICS, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: CARDIOLOGY, CANCER CENTER, CLINIC SERVICES, DENTAL SERVICES, DIAGNOSTIC IMAGING, BIRTHING CENTER, LABORATORY SERVICES, RESPIRATORY CARE, SLEEP LAB, WOMENS SERVICES, SURGICAL SERVICES, AND REHABILITATION SERVICES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATIONS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. SOMETIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED FINANCIAL ASSISTANCE APPLICATION AND ARE SCREENED THROUGH THE PRESUMPTIVE ELIGIBILITY PROCESS BUT MAY BE TRANSFERRED TO THE COLLECTION AGENCY REGARDLESS OF ALL THESE EFFORTS. PART III, LINE 8: THE AMOUNT OF MEDICARE ALLOWABLE COSTS WAS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD HAVE THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNT LISTED FOR MEDICARE REVENUE DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT ASPIRUS RIVERVIEW HOSPITAL, PHYSICIAN SERVICES PROVIDED AT THE OUTLYING CLINIC LOCATIONS, AND A SIGNIFICANT PORTION OF LAB SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE AND OUTPATIENT LAB SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ASPIRUS RIVERVIEW HOSPITAL PROVIDES TO THE COMMUNITY AND THE SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY THE HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED BASED ON MEDICARE REGULATIONS. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR. PART III, LINE 9B: UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENT'S ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A 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: REPRESENTATIVES FROM ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. ACTIVELY PARTICIPATE IN HEALTHY PEOPLE WOOD COUNTY (HPWC). THE PURPOSE OF HPWC IS TO ESTABLISH PRIORITIES AND RECOMMEND STRATEGIES TO ENHANCE THE QUALITY OF LIFE, HEALTH STATUS, AND THE ENVIRONMENT IN WOOD COUNTY. IN ORDER TO ACCOMPLISH THIS, MULTIPLE PARTNERS WORK TOGETHER TO ANALYZE HEALTH DATA, QUALITY OF LIFE INDICATORS AND THE COMMUNITY'S PERCEPTION OF HEALTH. IN MARCH 2015, ASPIRUS RIVERVIEW BEGAN COLLABORATING WITH THE WOOD COUNTY PUBLIC HEALTH DEPARTMENT, MINISTRY SAINT JOSEPHS HOSPITAL AND MARSHFIELD CLINIC ON A COMPREHENSIVE HEALTH NEEDS ASSESSMENT. HEALTH NEEDS ARE BEING DETERMINED AND PRIORITIZED THROUGH COMMUNITY SURVEYS, STAKEHOLDER FOCUS GROUPS AND RECENT HEALTH DATA. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATON AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AS WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: ASPIRUS RIVERVIEW HOSPITAL AND CLINCS OWNS AND OPERATES THE FOLLOWING ENTITIES: (1) ASPIRUS RIVERVIEW HOSPITAL; (2) THE OUTPATIENT ASPIRUS RIVERVIEW THERAPIES; (3) ASPIRUS RIVERVIEW CLINIC, THIS SERVICE INCLUDES CLINICS IN WISCONSIN RAPIDS, NEKOOSA, AND THE ROME-LAKES AREA (4) THE ASPIRUS UW CANCER CENTER; AND (5) ASPIRUS RIVERVIEW DENTAL CLINIC. ASPIRUS RIVERVIEW ESTABLISHED THIS CLINIC IN 2009 TO SERVE RESIDENTS OF SOUTH WOOD COUNTY. RIVERVIEW DENTAL CLINIC IN WISCONSIN RAPIDS IS OPEN TO PATIENTS WHO HAVE MEDICAID OR BADGER CARE INSURANCE COVERAGE. THIS INSURANCE IS NOT TYPICALLY ACCEPTED BY INDEPENDENT DENTAL CLINICS. APPROXIMATELY 3,401 PERSONS BENEFITED FROM THIS PROGRAM IN FISCAL YEAR 2018. WHILE MANY RIVERVIEW PATIENTS COME FROM WOOD COUNTY, AN INCREASING NUMBER ARE COMING TO US FROM SURROUNDING COUNTIES - SPECIFICALLY THOSE ALONG THE INTERSTATE 39 CORRIDOR: MARATHON, PORTAGE, WAUPACA, ADAMS, JUNEAU, WAUSHARA, MARQUETTE, COLUMBIA, AND DANE. FOR THE UW CANCER CENTER-RIVERVIEW IN 2018, OVER 18% OF ALL PATIENTS CAME FROM THESE SAME COUNTIES-NOT INCLUDING OUR "HOME"COUNTY OF WOOD. IN THE RIVERVIEW "SERVICE AREA" THERE ARE SEVERAL FEDERALLY DESIGNATED "MEDICALLY UNDERSERVED AREAS." THEY ARE WOOD COUNTY (THE CENTRAL PART BETWEEN MARSHFIELD AND WISC. RAPIDS), PORTAGE COUNTY (PART), ADAMS COUNTY (ALL), WAUSHARA COUNTY (ALL), MARQUETTE COUNTY (ALL), JUNEAU COUNTY (THE NORTHERN HALF), MARATHON COUNTY (PART), AND CLARK COUNTY (ALL). THERE ARE SCATTERED INDIAN TRIBAL LANDS IN WOOD COUNTY, JUNEAU COUNTY, AND ADAMS COUNTY (ALL HO CHUNK). THESE WOULD BE CONSIDERED "MEDICALLY UNDERSERVED POPULATIONS" PER FEDERAL DESIGNATION. OTHER HOSPITALS IN OUR SERVICE AREA INCLUDE: MINISTRY - ST. JOSEPH'S HOSPITAL IN MARSHFIELD, MINISTRY - ST. MICHAEL'S HOSPITAL IN STEVENS POINT, MOUNDVIEW MEMORIAL HOSPITAL IN FRIENDSHIP, AND HESS MEMORIAL HOSPITAL IN MAUSTON. PART VI, LINE 5: AS A COMMUNITY-BASED ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS PROVIDES SERVICES AND EDUCATIONAL OPPORTUNITIES EITHER FREE OF CHARGE OR AT A NOMINAL FEE IN AN ATTEMPT TO PROVIDE THESE OPPORTUNITIES TO THOSE MEMBERS OF THE COMMUNITIES WHO OTHERWISE MAY NOT BE ABLE TO AFFORD OR HAVE LOCAL ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 FORREST DEAN DANNER JR BOARD CHAIR / PRESIDENT ACI 0 291709 0 50695 0 46565 0 19030 0 25012 0 433011 0 0 SIDNEY C SCZYGELSKI BOARD TREASURER 0 500272 0 97238 0 47442 0 19030 0 87566 0 751548 0 0 BONITA KOLRUD DIRECTOR 0 389978 0 0 0 44926 0 12722 0 30390 0 478016 0 0 CRAIG R FLINDERS DO DIRECTOR 0 306172 0 1012 0 8060 0 8725 0 30197 0 354166 0 0 MATT HEYWOOD CEO OF ASPIRUS INC. 0 822805 0 293232 0 2695 0 19030 0 144154 0 1281916 0 0 NANCY ROTH-MALLEK VP OF FINANCE 161215 0 29301 0 652 0 14665 0 28382 0 234215 0 0 0 TODD BURCH PRESIDENT OF ASPIRUS RIVERVIEW 0 250681 0 65613 0 3792 0 12617 0 63547 0 396250 0 0 ERIC ANDERSON SVP OF SERVICE LINE & PT EXP 0 233292 0 40147 0 725 0 4819 0 59858 0 338841 0 0 KIMBERLY JOHNSON V.P. - PATIENT SERVICES 167468 0 16146 0 468 0 100 0 24957 0 209139 0 0 0 THOMAS VOELKER PRESIDENT OF MEDICAL AFFAIRS 151917 151917 25647 25646 2468 2467 9515 9515 27742 27742 217289 217287 0 0 RUTH RISLEY-GRAY SVP NURSING, CNO 0 275808 0 58636 0 43052 0 19030 0 58171 0 454697 0 0 JOHN HEISLER SVP & CHIEF HR OFFICER 0 292124 0 63187 0 14010 0 18924 0 58046 0 446291 0 0 MICHAEL MCGRAIL MD SVP SYSTEM CMO 0 391427 0 82975 0 11936 0 12004 0 65632 0 563974 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 319704 0 64915 0 36831 0 19030 0 66107 0 506587 0 0 RENEE SMITH ANI EXECUTIVE DIRECTOR 0 344370 0 42139 0 44887 0 19030 0 27247 0 477673 0 0 TODD RICHARDSON SVP & CIO 0 292477 0 62933 0 37490 0 19030 0 68931 0 480861 0 0 RICK NEVERS SVP REG OPS SYSTEM INT OFF 0 322120 0 61986 0 38481 0 19030 0 60055 0 501672 0 0 REBECCA PHILLIP DIRECTOR OF PHARMACY 171479 0 17112 0 10052 0 10672 0 11117 0 220432 0 0 0 MATTHEW MALOOLY PHARMACIST 167005 0 0 0 87 0 7078 0 10587 0 184757 0 0 0 MARJORIE TELL V.P. - ANCILLARY SERVICES-TERMED 112233 0 27024 0 975 0 12020 0 16178 0 168430 0 0 0 STACI SOVA NURSE PRACTITIONER 114300 0 600 0 20422 0 4778 0 28798 0 168898 0 0 0 PART I, LINE 1A TAX GROSS-UP PAYMENTS: S.SOVA $20,325 - INCLUDED IN INCOME. PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI - $38,440 R. NEVERS - $32,268 D. DANNER - $35,422 R. RISLEY-GRAY - $38,590 T. RICHARDSON- $35,685 R. SMITH - $10,121 C. LOGEMANN - $34,955 457(F) RETIREMENT PLAN PROFILE: KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31. EMPLOYER CONTRIBUTIONS: THE CONTRIBUTION MADE BY THE EMPLOYER IS A THREE-TIERED STRUCTURE DEPENDING UPON THE EXECUTIVE'S POSITION, WHICH ARE AS FOLLOWS: 9% FOR VICE PRESIDENT, 13% FOR SENIOR LEADERSHIP COUNCIL, AND 15% FOR THE CEO. IF A PARTICIPANT TERMINATES DURING THE YEAR, THE PARTICIPANT'S EXECUTIVE ALLOWANCE IS PRORATED BASED ON THE NUMBER OF FULL CALENDAR MONTHS FROM THE BEGINNING OF THE PLAN YEAR TO THE BEGINNING OF THE CALENDAR YEAR MONTH CLOSEST TO THE CHANGE OR TERMINATION OF EMPLOYMENT. DISTRIBUTIONS: CONTINUATION OF EMPLOYMENT THROUGH THE DEFERRED VESTING DATE; THE DATE ON WHICH THE PARTICIPANT'S EMPLOYMENT IS TERMINATED AS A RESULT OF DEATH OR DISABILITY; THE DATE ON WHICH THE PARTICIPANT INCURS AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; OR THE DATE THAT IS 24 MONTHS FOLLOWING THE PARTICIPANT'S SEPARATION FROM SERVICE, BUT ONLY IF THE PARTICIPANT'S INTEREST HAS NOT BEEN FORFEITED FOR COMPETITION DURING SUCH 24 MONTH PERIOD AND THE PARTICIPANT HAS NOT ENGAGED IN COMPETITION AFTER HIS OR HER SEPARATION FROM SERVICE AND PRIOR TO HIS OR HER DEATH, THE PARTICIPANT SHALL BE VESTED AT HIS OR HER DATE OF DEATH. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG8 2015-05-07 26748065 REFINANCE 2008 BOND 1 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DMG9 2015-05-07 18738269 REFINANCE 2010 BOND 1 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DC53 2017-11-02 15000000 NEW CONSTRUCRTION 0 0 0 A 970000 26748065 26748065 0 1 1 1 B 1830000 18738269 18738269 0 1 1 1 C 15000000 15000000 0 0 0 1 A 0 0 1 0 0 0 0 0 B 0 1 1 0 0 0.00310 0.00310 0 0 0 C 0 0 1 0 0 0 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 1 A 1 B 1 C 1 PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2015 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982), ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC. (EIN 38-3236977), AND ASPIRUS KEWEENAW HOSPITAL (EIN 38-1443361). INFORMATION REGARDING THE SERIES 2015 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION, RESPECTIVELY. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2015 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2015 BONDS.] PART III - LINE 3A AND 3B ASPIRUS, INC. THE PARENT ORGANIZATION OF ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. HAS POLICY AND PROCEDURES IN PLACE TO REVIEW MANAGEMENT AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. PART VI THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2017 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. (EIN 38-2908586); AND ASPIRUS ONTONAGON HOSPITAL, INC. (EIN 26-0806477). INFORMATION REGARDING THE SERIES 2017 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 2017 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2017 BONDS.] FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE SOLE MEMBER OF THE ORGANIZATION, ASPIRUS INC.: 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 OFFICERS; 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 AND 990-T INFORMATION, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 AND THE 990-T ARE REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND ARE MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH DIRECTOR'S DESK OR OTHER MEANS OF ELECTRONIC RETRIEVAL. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS AND ALL MANAGERS ARE REQUIRED TO SIGN BIANNUAL CONFLICT OF INTEREST STATEMENTS. THE ORGANIZATION'S CEO AND BOARD CHAIR REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTION WHERE A CONFLICT HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR PURPOSES OF DETERMINING COMPENSATION, ASPIRUS RIVERVIEW HOSPITAL & CLINIC, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 7,279,263. MANAGEMENT AND GENERAL EXPENSES 911,885. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,191,148. CONTRACT/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,240,790. MANAGEMENT AND GENERAL EXPENSES 379,515. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,620,305. CONSULTING: PROGRAM SERVICE EXPENSES 5,750. MANAGEMENT AND GENERAL EXPENSES 72,026. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 77,776. CREDENTIALING: PROGRAM SERVICE EXPENSES 800. MANAGEMENT AND GENERAL EXPENSES 28,541. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,341. LAB PURCHASED SERVICE: PROGRAM SERVICE EXPENSES 2,879,744. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,879,744. LINEN CONTRACT: PROGRAM SERVICE EXPENSES 16,625. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,625. PATIENT TRANSPORTATION: PROGRAM SERVICE EXPENSES 3,120. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,120. FORM 990, PART XI, LINE 9: INTERCOMPANY NET ASSET TRANSFERS -2,729,000. RETIREE MEDICAL BENEFITS -16,117. TEMP NET ASSET CONTRIBUTIONS AND OTHER CHANGES 738,558. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF ASPIRUS, INC., THE PARENT ORGANIZATION, OF ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC., ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE IN THIS PROCESS IN THE PAST YEAR. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE WI 501 (C) 3 LINE 12B, II N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS ONTONAGON HOSPITAL INC 601 SEVENTH STREET ONTONAGON MI 49953 260806477 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTH CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS VNA HOME HEALTH INC 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 GRAND VIEW HOSPITAL AUXILIARY N 10561 GRAND VIEW LANE IRONWOOD MI 49938 237178363 LIFELINE EMERGENCY SYSTEM MI 501 (C) 3 LINE 10 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 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 DR 11202 WAUSAU WI 54401 391931679 HEALTH CARE NETWORK WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 0 0 1 1 0 0 0 0 0 1 1 0 1 0 1 1 1 0 0 ASPIRUS WAUSAU HOSPITAL INC J 77453 COST ASPIRUS WAUSAU HOSPITAL INC K 67712 COST ASPIRUS WAUSAU HOSPITAL INC O 7183553 COST ASPIRUS WAUSAU HOSPITAL INC P 417990 COST ASPIRUS INC C 2729000 COST ASPIRUS INC M 14292662 COST ASPIRUS INC O 1940714 COST ASPIRUS INC P 3263530 COST ASPIRUS INC Q 241201 COST ASPIRUS CLINICS INC J 168804 COST ASPIRUS CLINICS INC M 350375 COST ASPIRUS CLINICS INC O 16014468 COST ASPIRUS CLINICS INC P 396766 COST ASPIRUS KEWEENAW HOSPTIAL INC O 152166 COST SCHEDULE R, PART V, LINE 1D ALL OUTSTANDING OBLIGATED GROUP DEBT IS GUARANTEED BY ALL MEMBERS OF THE OBLIGATED GROUP.