2016-02-08T13:35:39-06:00 2015-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2014-07-01 390806429 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN LANG 7156232331 112 EAST FIFTH AVENUE ANTIGO WI 54409 PAT TINCHER CFO 7156232331 2016-01-23 1 KATHLEEN J LABRAKE CPA P00164006 7158323407 2016-01-23 2014 2016-04-25 22:37:26Z ASPIRUS LANGLADE HOSPITAL PAT TINCHER 112 EAST FIFTH AVENUE ANTIGO WI 54409 130786467 0 X WWW.LANGLADEHOSPITAL.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. 15 12 669 194 327618 -24501 119806 920428 85957576 95347537 1426324 2686481 22456 9686 87526162 98964132 0 0 0 0 41896110 44914333 0 0 0 36007638 32901663 77903748 77815996 9622414 21148136 137550554 155882060 37398232 36049470 100152322 119832590 X AS A MINISTRY OF JESUS, WE HEAL, PROMOTE HEALTH, AND ENRICH LIVES. 0 0 41754267 73953730 ACUTE GENERAL CARE HOSPITAL WITH BOTH INPATIENT AND OUTPATIENT RELATED SERVICES AND SUPPORTIVE HOMECARE SERVICES FOR ELDERLY CLIENTS.- INPATIENTS - 1,224 ADMISSIONS WITH 3,917 PATIENT DAYS AND 240 BIRTHS.- OUTPATIENTS - 55,912 OUTPATIENT VISITS, INCLUDING 11,624 EMERGENCY VISITS, 28,675 IMAGING PROCEDURES.- SURGICAL SERVICES - 1,412 TOTAL PATIENTS TREATED. 16942876 18693251 PHYSICIAN CLINIC SERVICES - URGENT CARE, PRIMARY CARE, AND VARIOUS SPECIALTIES.- CLINIC VISITS - 82,653 1277115 1152704 ELDERLY HOUSING AND SUPPORT SERVICES- INDEPENDENT LIVING - 13,505 RESIDENT DAYS- ASSISTED LIVING - 5,501 RESIDENT DAYS- ADULT DAY CARE - 987 TREATMENT DAYS- HOSPICE - 3,148 PATIENT DAYS 833053 320510 PROVIDING DAYCARE, PATHOLOGY SERVICES, AND MEALS. 833053 320510 60807311 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 115 0 1 669 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 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 VICE CHAIRMAN 1.00 X X 0 0 0 LYNNE HENRICKS BOARD MEMBER 1.00 X 0 0 0 JOE SVEDA BOARD MEMBER 1.00 X 0 0 0 KEITH WAGNER BOARD MEMBER 1.00 X 0 0 0 RICHARD HIGLEY BOARD MEMBER 1.00 X 0 0 0 SID SCZYGELSKI BOARD MEMBER 1.00 X 0 445401 99296 F DEAN DANNER JR BOARD MEMBER 1.00 X 0 0 0 SISTER ROSE-MARIE DUFAULT BOARD MEMBER 1.00 X 0 0 0 MIKE OLSON BOARD MEMBER/PHYSICIAN 40.00 X 479701 0 48445 NOEL DEEP MD BOARD MEMBER 1.00 X 0 0 0 KRISTINE FLOWERS MD BOARD MEMBER 1.00 X 0 0 0 MIKE TURNEY CHAIRMAN 1.00 X X 0 0 0 TOM BRADLEY BOARD MEMBER 1.00 X 0 0 0 PAUL PAYANT SECRETARY/TREASURER 1.00 X X 0 0 0 RICK NEVERS BOARD MEMBER 1.00 X 0 331104 71838 DAVID SCHNEIDER CEO 40.00 X 367256 0 42866 PATRICK TINCHER CFO 40.00 X 229997 0 46115 JANELLE MARKGRAF DIRECTOR OF HUMAN RESOURCES AND OFF CAMPUS SERVICE 40.00 X 159654 0 34405 MARK SZMANDA DO PHYSICIAN 40.00 X 266742 0 48687 DOUGLAS ARMATO MD PHYSICIAN 40.00 X 431416 0 41536 KENNETH BOWMAN MD PHYSICIAN 40.00 X 417289 0 47711 MICHAEL OLSON MD PHYSICIAN 40.00 X 479701 0 48445 STACY BROWNELL PHARMACY MANAGER 40.00 X 162825 0 29720 2994581 776505 559064 14 0 1 0 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 9963092 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 ADMINISTRATIVE AND SUPPORT SERVICES 4477903 ASPIRUS WAUSAU HOSPITAL 333 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 4304323 MIDWEST EMERGENCY PHYSICIANS PO BOX 674579 DETROIT MI 482674579 EMERGENCY ROOM PHYSICIANS 1728167 PROGRESSIVE ANESTHESIA PO BOX 290 ANTIGO WI 54409 CRNAS 930515 21 44141 570480 305807 920428 ACUTE HOSPITAL SERVICES-INPATIENT 621990 73665563 73665563 PHYSICIAN CLINICS 621110 18693251 18693251 MISCELLANEOUS 621990 899724 899724 ROSALIA GARDENS 623990 632156 632156 CONGREGATE HOUSING 623990 520548 520548 936295 608677 327618 95347537 928946 928946 101396 91710 9686 9686 9686 33488160 31730625 1757535 1757535 1757535 98964132 94120195 327618 3595891 X 1286789 480828 805961 32350183 28233182 4117001 1462289 1277197 185092 7754397 6729648 1024749 2060675 1793707 266968 43166 43166 67987 67987 23875 23697 178 15827820 10465738 5362082 65728 1262 64466 1049 1049 422622 57033 365589 944385 701744 242641 326215 176583 149632 6463802 2860047 3603755 365027 172163 192864 MEDICAL/PROFESSIONAL 10183154 10170271 12883 MAINTENANCE AND REPAIR 1395116 1321287 73829 MINOR EQUIPMENT 530276 435741 94535 MISCELLANEOUS 455402 120095 335307 -4213961 -4213961 77815996 60807311 17008685 0 9441260 31002514 10857063 4416697 14287116 15236273 1579513 1362099 893897 592448 87997456 33970643 57497119 54026813 40376564 48139079 355520 334740 2262502 771397 137550554 155882060 9878010 8929298 25720000 25295000 1800222 1825172 37398232 36049470 X 99755835 119355399 396487 477191 100152322 119832590 137550554 155882060 X 21148136 -1574443 106575 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5468 5468 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 $2,571 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, 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 $2,897 OF THE FEES PAID BY ASPIRUS LANGLADE HOSPITAL IN FY2014 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 903460 903460 52091066 13234773 38856293 4541479 1555864 2985615 30334737 19180006 11154731 126714 126714 54026813 UNAMORTIZED BOND PREMIUM 805297 DEFERRED COMPENSATION 987823 OTHER LONG-TERM LIABILITIES 32052 1825172 X 97481399 -1574443 91710 -1482733 98964132 0 98964132 77907706 91710 91710 77815996 0 77815996 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 91,710. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE ON FORM 990 91,710. 1 1 1 X 1 X 1 1 1 0 1 1 3485067 3485067 0.04250 13405956 8766597 4639359 0.05660 16891023 8766597 8124426 0.09910 1424710 1180080 244630 0.00300 21005 21005 0.00030 1546722 1206364 340358 0.00410 13926 13926 0.00020 3006363 2386444 619919 0.00760 19897386 11153041 8744345 0.10670 439657 313131 126526 0.00150 439657 313131 126526 0.00150 1 1896282 23248962 23947583 -698621 X 1 1 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 12 1 0 1 1 X HTTP://ASPIRUS.ORG/MAIN/COMMUNITY-RESOURCES.ASPX?SRCAUD=MAIN X X 1 12 1 HTTP://ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/COMM-BENEFIT-REPORT-LH.PDF 1 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.ASPIRUS.ORG/MAIN/PAY-MY-BILL.ASPX#TAB2 X HTTP://WWW.ASPIRUS.ORG/MAIN/PAY-MY-BILL.ASPX#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 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 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, MANY COMMUNITY PROGRAMS HAVE EMERGED ADDRESSING THE FOLLOWING IDENTIFIED HEALTH PRIORITIES: AFFORDABILITY OF HEALTHCARE AND PRESCRIPTION MEDICATION COSTS, OBESITY, SUBSTANCE ABUSE AND WELLNESS AND PREVENTION. THE LANGLADE HEALTH COALITION, A LOCAL COMMUNITY TEAM OF GOVERNMENT, SOCIAL SERVICE AND HEALTH CARE ORGANIZATIONS, WAS ESTABLISHED AS A RESULT OF THE FIRST CHNA AND WILL CONTINUE TO WORK ON THE IDENTIFIED HEALTH INITIATIVES. SOME OF THE PROGRAMS RE-VITALIZED AND/OR STARTED WITHIN THE COMMUNITY DUE TO THE CHNA PROCESS AND RESEARCH INCLUDE THE VACATION BIBLE SCHOOL NUTRITION AND HYGIENE EDUCATION PROGRAM, AN AFTER SCHOOL PROGRAM FOR KIDS DESIGNED TO TEACH BASICS ON NUTRITION AND HEALTHY ACTIVE LIFESTYLE HABITS, A YEARLONG COMMUNITY HEART HEALTH CAMPAIGN, 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. ASPIRUS LANGLADE HOSPITAL WILL BE PUBLISHING A FULL COMMUNITY REPORT ON THESE AND THE MANY PROGRAMS THAT HAVE BEEN ESTABLISHED OVER THE LAST THREE YEARS FROM THE CHNA EFFORTS. AS FOR THOSE INITIATIVES NOT YET ADDRESSED, COMMUNITY PROJECTS WERE 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 2013 COMMUNITY HEALTH NEEDS ASSESSMENT WITH SUFFICIENT DATA STILL INDICATING A NEED IN THE 2015 DATA COLLECTION PROCESS. ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 22D: ASPIRUS LANGLADE HOSPITAL USES THE LOOK-BACK METHOD FOR DETERMINING AMOUNT GENERALLY BILLED (AGB) PERCENTAGES. THE AGB PERCENTAGES ARE DETERMINED USING ALLOWED TRADITIONAL MEDICARE CLAIMS FOR SERVICE DATES JULY 1, 2014 TO JUNE 30, 2015. PATIENTS APPROVED FOR ASPIRUS LANGLADE HOSPITAL FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE THAN THIS PERCENTAGE OF GROSS CHARGES FOR EMERGENT AND MEDICALLY NECESSARY CARE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.ASPIRUS.ORG/MAIN/PAY-MY-BILL.ASPX#TAB2 ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.ASPIRUS.ORG/MAIN/PAY-MY-BILL.ASPX#TAB2 ASPIRUS LANGLADE HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://ASPIRUS.ORG/MAIN/PAY-MY-BILL.ASPX?SRCAUD=MAIN#TAB2 5 ASPIRUS GENERAL CLINIC 110 E 5TH AVE ANTIGO WI 54409 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES ASPIRUS GENERAL CLINIC 400 RAILROAD BIRNAMWOOD WI 54414 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES ASPIRUS GENERAL CLINIC W10618 CLINIC ST ELCHO WI 54428 CLINIC PROVIDING A WIDE RANGE OF OUTPATIENT SERVICES PINE MEADOWS RETIREMENT COMMUNITY 525 FLIGHT RD ANTIGO WI 54409 SENIOR HOUSING ROSALIA GARDENS ASSISTED LIVING 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 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 $ -4,213,961. 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 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. 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 HOSPITAL. THE HOSPITAL 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 HOSPITAL. 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: UNDER THE HOSPITAL'S CREDIT AND COLLECTION POLICY, ASPIRUS LANGLADE HOSPITAL MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION.DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE FINANCIAL ASSISTANCE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES. 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: THE HOSPITAL UTILIZES PATIENT FINANCIAL SERVICES COUNSELORS WHO WORK WITH PATIENTS ON A ONE-ON-ONE BASIS TO EDUCATE THE PATIENT/MAKE THEM AWARE OF THE AVAILABLE OPTIONS. THE HOSPITAL ALSO PARTNERS WITH A LOCAL CREDIT UNION TO PROVIDE INFORMATION REGARDING RESOURCES AVAILABLE TO THE RESIDENTS OF THE MARKETS SERVED. 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 15 INDIVIDUALS FROM THE SURROUNDING AREA. OF THESE 15 BOARD MEMBERS, 12 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 X 1 0 X X X X X 0 1 0 0 0 0 0 0 0 SID SCZYGELSKI BOARD MEMBER 0 335544 0 103558 0 6299 0 15500 0 83796 0 544697 0 0 MIKE OLSON BOARD MEMBER/PHYSICIAN 452787 0 26147 0 767 0 14769 0 33676 0 528146 0 0 0 RICK NEVERS BOARD MEMBER 0 236472 0 74420 0 20212 0 14127 0 57711 0 402942 0 0 DAVID SCHNEIDER CEO 331492 0 30547 0 5217 0 13381 0 29485 0 410122 0 0 0 PATRICK TINCHER CFO 218861 0 10112 0 1024 0 11422 0 34693 0 276112 0 0 0 JANELLE MARKGRAF DIRECTOR OF HUMAN RESOURCES AND OFF 143840 0 14586 0 1228 0 7646 0 26759 0 194059 0 0 0 MARK SZMANDA DO PHYSICIAN 264260 0 31 0 2451 0 13255 0 35432 0 315429 0 0 0 DOUGLAS ARMATO MD PHYSICIAN 385934 0 43522 0 1960 0 14212 0 27324 0 472952 0 0 0 KENNETH BOWMAN MD PHYSICIAN 385389 0 26277 0 5623 0 18065 0 29646 0 465000 0 0 0 MICHAEL OLSON MD PHYSICIAN 452787 0 26147 0 767 0 14769 0 33676 0 528146 0 0 0 STACY BROWNELL PHARMACY MANAGER 162498 0 34 0 293 0 8309 0 21411 0 192545 0 0 0 PART I, LINE 1A TRAVEL FOR COMPANIONS, WHEN APPLICABLE, WERE ADDED TO THE INDIVIDUAL'S COMPENSATION AT FAIR MARKET VALUE. TRAVEL FOR COMPANIONS - S. SCZYGELSKI $435; R. NEVERS $510; D. SCHNEIDER $410 PART I, LINE 4B R. NEVERS $17,763 KEY EMPLOYEES OF THE ORGANIZATION OR A PARTICIPATING AFFILIATE ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. THE PLAN YEAR IS JANUARY 1 TO DECEMBER 31ST. EMPLOYER CONTRIBUTIONS: THE CONTRIBUTION MADE BY THE EMPLOYER IS A THREE-TIERED STRUCTURE DEPENDING UPON THE EXECUTIVE'S POSITION, WHICH ARE AS FOLLOWS: 9% FOR VICE PRESIDENT, 13% FOR SENIOR LEADERSHIP COUNCIL, AND 15$ FOR 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 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, THE PARTICIPANT SHALL BE VESTED AT HIS OR HER DATE OF DEATH. A WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 2013-04-12 26130000 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 A 835000 27000592 317586 27000592 2012 0 0 1 1 A 0 0 0 0 0.00200 0.00200 0 0 0 A 0 1 0 0 0 0 0 0 0 A 1 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 11 THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 AND 990-T INFORMATION, INCLUDING THE UBIT 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 316,884. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 316,884. PROVIDER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 5,691,760. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,691,760. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 141,362. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 141,362. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,457,094. MANAGEMENT AND GENERAL EXPENSES 1,822,038. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,279,132. CORPORATE ALLOCATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,876,436. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,876,436. FINANCIAL CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 198,862. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 198,862. HOSPITAL TAX: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 188,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 188,384. MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 135,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 135,000. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 106,575. FORM 990, PART XII, LINE 2C, AUDIT PROCESS: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. RELIGIOUS HOSPITALLERS OF ST JOSEPH HEALTH CORP C/O VAN BRIESEN ROPER 411 E WIS AVE 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 11B, II N/A 0 ASPIRUS GENERAL CLINIC 112 EAST FIFTH AVENUE ANTIGO WI 54409 383741338 HEALTH CARE WI 501(C)(3) LINE 7 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN 1 0 1 1 1 0 0 0 1 0 1 0 1 1 1 1 1 1 1 1 ASPIRUS INC M 3084513 COST ASPIRUS INC P 655903 COST