2017-02-10T13:34:14-06:00 2016-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2015-07-01 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 2017-01-19 1 Kathleen J LaBrake CPA P00164006 7158453111 2017-01-19 2015 2021-01-29 14:40:06Z Sidney C Sczygelski 410 Dewey Street Wisconsin Rapids WI 54494 173144939 0 X www.aspirus.org X 1912 WI Aspirus Riverview Hospital & Clinics, Inc. is an integrated, community-governed healthcare system which leads by advancing initiatives dedicated to improving the health of all we serve. We work collaboratively with others who share our passion for excellence and compassion for people. 10 5 723 385 989031 -90365 143991 77542 75676763 98022071 18021588 9939129 547440 898900 94389782 108937642 31332362 0 0 0 39410615 43359965 0 0 0 32859532 41403102 103602509 84763067 -9212727 24174575 146374906 151551408 61650328 58563198 84724578 92988210 X Aspirus Riverview Hospital & Clinics, Inc. is an integrated, community-governed healthcare system which leads by advancing initiatives dedicated to improving the health of all we serve. We work collaboratively with others who share our passion for excellence and compassion for people. 0 0 64231699 96581732 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; and (5) Aspirus Riverview Dental Clinic. Aspirus Riverview established this clinic in 2009 to serve residents of South Wood County.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 servicesAsk a Nurse 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 1,400 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 form 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 350 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 3700 persons benefited from this program in 2016. 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's. 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 by 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 270 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 2016, 15,875 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 2016, Aspirus Riverview had 35 job shadow participants.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, diebetes, joint replacement, and immunizations. In 2016, nearly 1,950 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, celliac disease, arthritis and loss. In addition, lactation specialists from the Riverview Family Birthplace offer breastfeeding support to new mothers. Approximately, 480 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 2016, 56 students benefited from preceptorship opportunities.Aspirus Riverview held workshops on how to complete an advanced directive and appoint a healthcare power of attorney. In 2016, 80 people received this education. 64231699 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 78 0 1 723 1 1 1 0 0 0 0 0 0 0 0 0 X 10 5 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 333 PINE RIDGE BLVD WAUSAU WI 54401 X FORREST DEAN DANNER JR BOARD CHAIR / PRESIDENT ACI & SVP AMBULATORY SERVI 1.00 48.00 X X 0 333863 69073 CRAIG R FLINDERS DO BOARD VICE CHAIR 40.00 X X 297913 0 54132 SIDNEY C SCZYGELSKI SECRETARY 1.00 50.00 X X 0 580594 89460 CHESTON E PRICE MD DIRECTOR 1.00 40.00 X 0 214934 29944 MICHAEL BOVEE DIRECTOR / FORMER CFO OF ARH 1.00 X 113678 0 13605 MARY JO CARSON DIRECTOR 1.00 X 0 0 0 NELSON DAHL DIRECTOR 1.00 X 0 0 0 JASON DEITZ DIRECTOR 1.00 X 0 0 0 DAVID STARK DIRECTOR 1.00 X 0 0 0 MARTIN J LOY DIRECTOR 1.00 X 0 0 0 THOMAS A VOELKER MD DIRECTOR - TERMED 1/2016 / PRESIDENT OF MEDICAL AF 40.00 41.00 X 0 346678 41097 MATT HEYWOOD CEO OF ASPIRUS INC. 1.00 50.00 X 0 884848 132937 NANCY ROTH-MALLEK VP OF FINANCE 40.00 X 137583 0 31952 TODD BURCH PRESIDENT OF ASPIRUS RIVERVIEW / CEO 40.00 X 0 0 0 RICHARD BAILEY MD FACP PRESIDENT OF MEDICAL AFFAIRS ENDING 12/2015 40.00 X 357708 0 54046 PEGGY OSE V.P. - PATIENT SERVICES 40.00 X 225790 0 38207 RUTH RISLEY-GREY SVP NURSING, CNO 1.00 49.00 X 0 307360 65088 JOHN HEILSER SVP & CHIEF HR OFFICER 1.00 49.00 X 0 336213 63612 MCHAEAL MCGRAIL SVP SYSTEM CMO 1.00 50.00 X 0 439142 69729 CARI LOGEMANN SVP & GENERAL COUNSEL 1.00 50.00 X 0 324135 70669 KATHRYNE MCGOWAN ANI EXECUTIVE DIRECTOR, SVP POPULATION HEALTH 1.00 50.00 X 0 288000 61581 TODD RICHARDSON SVP & CIO 1.00 50.00 X 0 334322 77297 RICK NEVERS SVP REG OPS SYSTEM INT OFFICER 1.00 50.00 X 0 391429 71338 RONNIE KIRSCHLING MD PHYSICIAN 40.00 X 1219137 0 51571 JAMES TORHORST DPM PHYSICIAN 40.00 X 860661 0 54494 KEVIN FERREIRA MD PHYSICIAN 40.00 X 496736 0 53778 THEODORE REAHM DO PHYSICIAN 40.00 X 427382 0 53268 RIDHWI MUKERJI MD PHYSICIAN 40.00 X 369631 0 51216 CELSE BERARD FORMER PRESIDENT / CEO 40.00 X 430473 0 39990 4936692 4781518 1338084 41 1 1 0 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 INTERCOMPANY TRANSACTIONS 2202217 COAST TO COAST HEALTHCARE SERVICES 5195 HAMPSTED VILLAGE CENTER SUITE NEW ALBANY OH 43054 ER SERVICES 806350 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 PATHOLOGY FEE 592164 HEALOGICS WOUND CARE & HYPERBARIC SERVIC 3087 MOMENTUM PLACE CHICAGO IL 606895330 WOUND CARE 465275 QUARLES & BRADY LLP 411 EAST WISCONSIN AVENUE MILWUAKEE WI 53202 LEGAL 465056 21 37153 40389 77542 PATIENT SERVICES 900099 96055262 96055262 LAB SERVICE FOR NON PATIENTS 621500 738717 738717 HEALTH INCENTIVE PROGRAMS 900099 509203 509203 OTHER 900099 425518 250314 175204 FOOD 900099 276104 276104 17267 17267 98022071 12243 12243 1437920 539020 898900 898900 898900 73591285 63664399 9926886 9926886 9926886 3878 37153 3878 0 108937642 96581732 989031 11289337 1051868 872511 179357 32802457 29064637 3737820 1287281 1141896 145385 6000527 5321628 678899 2217832 1839663 378169 46519 2431 44088 98530 28167 70363 13522 3778 9744 3006365 193761 2812604 259701 53 259648 209903 169650 40253 1460249 1460249 186873 130083 56790 1379732 1379732 4845654 4845654 219347 37678 181669 PURCHASED SERVICES 9163928 7027058 2136870 SUPPLIES 8841213 8762172 79041 DRUGS 6833599 6806195 27404 HOSPITAL ASSESSMENT 1939400 1939400 2898567 2830338 68229 84763067 64231699 20531368 0 55854 19037 14299443 38498689 13474643 13966673 1915501 1912971 1364714 495132 149177289 83478833 58956428 65698456 55659269 30488897 649054 471553 146374906 151551408 14631627 12269144 2061551 2069129 44953150 44224925 4000 0 61650328 58563198 X 84091455 92469662 633123 518548 84724578 92988210 146374906 151551408 X 24174575 -9918516 -5992427 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 13522 13522 0 Part II-B, Line 1: Percentage of AHA dues used for lobbying in fiscal year 2016 - 22.12% Percentage of WHA dues used for lobbying in fiscal year 2016 - 15.5% 3684940 3684940 79479279 31279696 48199583 2841887 1680680 1161207 62193113 50070383 12122730 978070 448074 529996 65698456 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, 2016 AND 2015. Love Lights 27526 27451 75 75 Christmas at the Ridges 13505 9702 3803 3803 41031 37153 3878 3878 3878 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 1163823 183735 980088 0.01160 13467338 8145273 5322065 0.06320 14631161 8329008 6302153 0.07480 288485 131123 157362 0.00190 500870 500870 0.00590 3288177 2822492 465685 0.00550 42621 42621 0.00050 129930 85443 44487 0.00050 4250083 3039058 1211025 0.01430 18881244 11368066 7513178 0.08910 12 10852 10852 0.00010 12 10852 10852 0.00010 1 206495 16992094 20118104 -3126010 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 See Part V, Section C, for line 5d X 1 15 1 http://aspirus.org/Main/Community-Resources.aspx?srcaud=Main 1 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X 1 X http://aspirus.org/Main/Pay-My-Bill.aspx?srcaud=Main#tab2 X http://aspirus.org/Main/Pay-My-Bill.aspx?srcaud=Main#tab2 X http://aspirus.org/Main/Pay-My-Bill.aspx?srcaud=Main#tab2 X X X X X 1 X 0 X X X X 1 X 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. Aspirus Riverview Hospital & Clinics, Inc. Part V, Section B, Line 22d: THE LOOK BACK METHOD USING TRADITIONAL MEDICARE RATES UNDER REG. 501(R) IS UTILIZED TO CALCULATE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. 5 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 Nekossa WI 54457 Clinic 4 - Aspirus Riverview Family Clinic - Lakes 1160 Rome Center Drive Town of Rome Nekossa WI 54457 Clinic 5 - Aspirus Riverview Community Dental 820 Two Mile Avenue Wisconsin Rapids WI 54494 Dental 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, exclude 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 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, Lakes Family Clinic, and Nekoosa 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 & Respite Care reported costs of $51,620. The Palliative Care reported costs of $312,052 with offsetting revenue of $147,668. The Lakes Family Clinic reported costs of $1,147,443 with offsetting revenue of $961,294. The Nekoosa Family Clinic reported costs of $1,777,062 with offsetting revenue of $1,713,530. 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 $ 523,797. Part II, Community Building Activities: While there is a growing argument in the United States about what constitutes a non-profit hospitals "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: 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 Organization's 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 patient 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: 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, 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 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 patients 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: 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 Joseph's 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 (FAP). 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 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 Clinics 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 3,781 persons benefited from this program in 2016. 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 2016, over 20% 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 X 1 1 X X X X 1 1 0 0 0 0 0 0 0 FORREST DEAN DANNER JR BOARD CHAIR / PRESIDENT ACI & SVP AM 0 232445 0 63986 0 37432 0 17028 0 52045 0 402936 0 0 CRAIG R FLINDERS DO BOARD VICE CHAIR 218818 0 78659 0 436 0 33786 0 20346 0 352045 0 0 0 SIDNEY C SCZYGELSKI SECRETARY 0 376534 0 157197 0 46863 0 18661 0 70799 0 670054 0 0 CHESTON E PRICE MD DIRECTOR 0 204140 0 4574 0 6220 0 8431 0 21513 0 244878 0 0 THOMAS A VOELKER MD DIRECTOR - TERMED 1/2016 / PRESIDENT 0 336104 0 0 0 10574 0 18660 0 22437 0 387775 0 0 MATT HEYWOOD CEO OF ASPIRUS INC. 0 649912 0 232922 0 2014 0 13360 0 119577 0 1017785 0 0 NANCY ROTH-MALLEK VP OF FINANCE 132398 0 5038 0 147 0 11606 0 20346 0 169535 0 0 0 RICHARD BAILEY MD FACP PRESIDENT OF MEDICAL AFFAIRS ENDING 319358 0 37744 0 606 0 34450 0 19596 0 411754 0 0 0 PEGGY OSE V.P. - PATIENT SERVICES 207038 0 15873 0 2879 0 18611 0 19596 0 263997 0 0 0 RUTH RISLEY-GREY SVP NURSING, CNO 0 237122 0 67504 0 2734 0 14872 0 50216 0 372448 0 0 JOHN HEILSER SVP & CHIEF HR OFFICER 0 256725 0 70436 0 9052 0 12179 0 51433 0 399825 0 0 MCHAEAL MCGRAIL SVP SYSTEM CMO 0 370677 0 58414 0 10051 0 3750 0 65979 0 508871 0 0 CARI LOGEMANN SVP & GENERAL COUNSEL 0 253718 0 69397 0 1020 0 15593 0 55076 0 394804 0 0 KATHRYNE MCGOWAN ANI EXECUTIVE DIRECTOR, SVP POPULATI 0 245256 0 41541 0 1203 0 4662 0 56919 0 349581 0 0 TODD RICHARDSON SVP & CIO 0 261084 0 71992 0 1246 0 18113 0 59184 0 411619 0 0 RICK NEVERS SVP REG OPS SYSTEM INT OFFICER 0 291780 0 68268 0 31381 0 18145 0 53193 0 462767 0 0 RONNIE KIRSCHLING MD PHYSICIAN 1209108 0 7150 0 2879 0 31734 0 19837 0 1270708 0 0 0 JAMES TORHORST DPM PHYSICIAN 299484 0 560741 0 436 0 34148 0 20346 0 915155 0 0 0 KEVIN FERREIRA MD PHYSICIAN 490300 0 6000 0 436 0 34450 0 19328 0 550514 0 0 0 THEODORE REAHM DO PHYSICIAN 421007 0 4500 0 1875 0 34450 0 18818 0 480650 0 0 0 RIDHWI MUKERJI MD PHYSICIAN 363295 0 6000 0 336 0 31686 0 19530 0 420847 0 0 0 CELSE BERARD FORMER PRESIDENT / CEO 167356 0 0 0 263117 0 20268 0 19722 0 470463 0 0 0 Part I, Line 1a TRAVEL FOR COMPANIONS: M. HEYWOOD $174; J. HEISLER $184; R. RISLEY-GREY $175; S. SCZYGELSKI $166; R. NEVERS $202; T. RICHARDSON $105; D. DANNER $105; K. MCGOWAN $120; T. VOELKER $184 - INCLUDED IN INCOME. TAX GROSS-UP PAYMENTS: C. PRICE $438; T. VOELKER $640 - INCLUDED IN INCOME. HOUSING ALLOWANCE: M. MCGRAIL $1,200 - 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 OFFICES, 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, Lines 4a-b SCHEDULE J, PART I, LINE 4A - SEVERANCE PAYMENT C. BERARD - $262,770 SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI - $40,323 R. NEVERS - $29,240 D. DANNER - $31,730 457(F) RETIREMENT PLAN PROFILE: KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31ST. EMPLOYER CONTRIBUTIONS: THE CONTRIBUTION MADE BY THE EMPLOYER IS A THREE-TIERED STRUCTURE DEPENDING UPON THE EXECUTIVE'S POSITION, WHICH ARE AS FOLLOWS: 9% FOR VICE PRESIDENT, 13% FOR SENIOR LEADERSHIP COUNCIL, AND 15% FOR THE CEO. IF A PARTICIPANT TERMINATES DURING THE YEAR, THE PARTICIPANT'S EXECUTIVE ALLOWANCE IS PRORATED BASED ON THE NUMBER OF FULL CALENDAR MONTHS FROM THE BEGINNING OF THE PLAN YEAR TO THE BEGINNING OF THE CALENDAR YEAR MONTH CLOSEST TO THE CHANGE OR TERMINATION OF EMPLOYMENT. DISTRIBUTIONS: CONTINUATION OF EMPLOYMENT THROUGH THE DEFERRED VESTING DATE; THE DATE ON WHICH THE PARTICIPANT'S EMPLOYMENT IS TERMINATED AS A RESULT OF DEATH OR DISABILITY; THE DATE ON WHICH THE PARTICIPANT INCURS AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE; OR THE DATE THAT IS 24 MONTHS FOLLOWING THE PARTICIPANT'S SEPARATION FROM SERVICE, BUT ONLY IF THE PARTICIPANT'S INTEREST HAS NOT BEEN FORFEITED FOR COMPETITION DURING SUCH 24 MONTH PERIOD AND THE PARTICIPANT HAS NOT ENGAGED IN COMPETITION AFTER HIS OR HER SEPARATION FROM SERVICE AND PRIOR TO HIS OR HER DEATH, THE PARTICIPANT SHALL BE VESTED AT HIS OR HER DATE OF DEATH. 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 A 120000 26748065 0 1 1 1 B 18738269 0 1 1 1 A 0 0 1 0 0 0 0 0 B 0 1 1 0 0 0.01430 0.01430 0 0 0 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 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 an contract by contract basis, Aspirus, Inc. will seek help from Bond Counsel as management deems necessary. WOOD TRUST BANK JASON DIETZ IS A BOARD MEMBER AND SENIOR VICE PRESIDENT AT WOOD TRUST BANK 72807 ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. PAID INVESTMENT MANAGEMENT FEES TO WOOD TRUST BANK. 0 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 11 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 ae 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 be determined to exist. All conflicts are 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 VII Micheal Bovee was compensated by Aspirus Riverview Hospital & Clinics, Inc. during calendar year 2015 while he served as the Chief Financial Officer. Michael is not compensated for his role as a board member of Aspirus Riverview Hospital & Clinics, Inc. Form 990, Part XI, line 9: Intercompany Net Asset Transfers -5,941,585. Temp net asset contributions and other changes -50,842. 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 RIVERVIEW FOUNDATION INC PO BOX 8080 WISCONSIN RAPIDS WI 544958080 391509239 THE FOUNDATION IS OPERATED PRIMARILY FOR THE BENEFIT OF ASPIRUS RIVERVIEW WI 501 (C) 3 Line 11c, III-FI N/A 0 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE WI 501 (C) 3 Line 11b, 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 9 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 425 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 Line 9 ASPIRUS INC 1 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 Line 9 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 9 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 Line 9 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 GRAND VIEW 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 9 ASPIRUS GRAND VIEW 1 ASPIRUS GRAND VIEW SERVICE CORPORATION N 10561 GRAND VIEW LANE IRONWOOD MI 49938 383005582 PHYSICIAN SERVICES MI 501 (C) 3 Line 3 ASPIRUS GRAND VIEW 1 Greater Iron County EMS Inc 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383491283 Emergency medical care and transportation MI 501 (C) 3 Line 11a, I Aspirus Iron RIver 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 GRAND VIEW CARING CAREGIVERS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382902754 PERSONAL NEEDS SERVICES MI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 0 1 0 0 0 0 1 1 0 1 0 0 1 0 1 1 1 0 1 ASPIRUS WAUSAU HOSPITAL INC O 2244684 COST ASPIRUS WAUSAU HOSPITAL INC P 150060 COST ASPIRUS INC B 2000000 COST ASPIRUS INC G 67670 COST ASPIRUS INC H 119695 COST ASPIRUS CLINICS INC J 550040 COST ASPIRUS INC M 3383235 COST ASPIRUS INC Q 71485 COST ASPIRUS INC O 826891 COST ASPIRUS INC P 967106 COST ASPIRUS CLINICS INC O 3792946 COST ASPIRUS WAUSAU HOSPITAL INC S 3941585 COST