2016-01-11T09:56:19-06:00 2015-03-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156351225 819 ASH STREET SPOONER WI 54801 MICHAEL D SCHAFER CHIEF EXECUTIVE OFFICER 7156351225 2016-01-11 1 KOREY BOELTER P00775161 6123764500 2014 2016-04-25 22:37:26Z MICHAEL D SCHAFER 819 ASH STREET SPOONER WI 54801 25362397 0 X WWW.SPOONERHEALTHSYSTEM.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 7 7 163 54 0 0 42303 30221 19125601 19576856 452054 1610862 222400 66030 19842358 21283969 101026 5796 0 0 8661749 9099524 0 0 0 9057604 9068489 17820379 18173809 2021979 3110160 25843763 47691063 3548741 23913106 22295022 23777957 X TO PROVIDE HIGH QUALITY HEALTHCARE. 0 0 12401626 5796 19251954 SPOONER HEALTH SYSTEM PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, OBSTETRICS, REHABILITATION, DIAGNOSTIC, AND HOSPICE CARE. FOR THE FISCAL YEAR ENDING 3/31/15, THERE WERE 1,965 INPATIENT DAYS, 438 INPATIENT DISCHARGES, 76 NEWBORN DAYS, 14,708 OUTPATIENT VISITS, 6,542 EMERGENCY ROOM VISITS, AND 408 SURGERIES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THIS PROGRAM INCLUDES FEE DISCOUNTS, AS WELL AS 100% FREE CARE. SPOONER HEALTH SYSTEM ALSO PROVIDES NUMEROUS HEALTHCARE AND WELLNESS CLASSES, SUPPORT GROUPS, AND VARIOUS EDUCATIONAL/HEALTH SCREENING OPPORTUNITIES AS A COMMUNITY BENEFIT. THESE PROGRAMS ARE OFFERED TO ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS AND THE GENERAL PUBLIC. SPOONER HEALTH SYSTEM ALSO RECEIVES DONATED SERVICES FROM COMMUNITY VOLUNTEERS. 865604 0 324902 THE HOME HEALTH AGENCY PROVIDES NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/15, THERE WERE 2,411 HOME HEALTH VISITS, 113 ADMITTED CASES, AND 127 DISCHARGED CASES. 13267230 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 26 0 163 1 0 0 0 0 0 1 1 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X REBECCA BUSCH CFO 7156351225 819 ASH STREET SPOONER WI 54801 JAMIE MORALES BOARD PRESIDENT 1.00 X X 0 0 0 MICHAEL KNOEPKE BOARD VICE PRESIDENT 1.00 X X 0 0 0 ADAM LIEGL BOARD TREASURER 1.00 X X 0 0 0 DON HAACK FORMER BOARD TREASURER 1.00 X X 0 0 0 MARK VAN ETTEN MD BOARD SECRETARY/MEDICAL DIRECTOR 5.00 X X 0 0 0 SHELDON JOHNSON BOARD MEMBER/FORMER PRESIDENT 1.00 X X 0 0 0 NANCY MARKGREN BOARD MEMBER 1.00 X 0 0 0 MAUREEN REVAK BOARD MEMBER 1.00 X 0 0 0 MICHAEL SCHAFER CHIEF EXECUTIVE OFFICER 40.00 X 0 0 0 REBECCA BUSCH CHIEF FINANCIAL OFFICER 40.00 X 116651 0 16765 TIMOTHY BASSETT PHARMACY DIRECTOR 40.00 X 131507 0 12325 KEN ENGEL PHARMACIST 40.00 X 130239 0 15162 PATRICK MCCANN MD ER MEDICAL DIRECTOR 40.00 X 237536 0 35049 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 40.00 X 162982 0 32421 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 40.00 X 159718 0 32714 938633 0 144436 7 0 1 0 BWBR ARCHITECTS 380 ST PETER STREET SUITE 600 SAINT PAUL MN 55102 ARCHITECT FEES 1095831 WAPITI MEDICAL GROUP-WOOD RIVER LLC 107 FLYNN DRIVE STE 600 MILBANK SD 57252 ER PHYSICIAN COVERAGE 908249 HEALTHTECH MANAGEMENT SERVICES 5110 MARYLAND WAY STE 200 BRENTWOOD TN 37027 MANAGEMENT FEES 535018 SHARED MEDICAL TECHNOLOGY INC 202 W NEWTON ST RICE LAKE WI 54868 DIAGNOSTIC RADIOLOGY 519283 CPSI PO BOX 850309 MOBILE AL 36685 COMPUTER SUPPORT 243854 9 7814 21903 504 30221 PATIENT SERVICE REV. 621400 19576856 19576856 19576856 253999 253999 70565 25762 44803 44803 44803 5400000 500 4043637 0 1356363 500 1356863 1356863 7315 7814 9029 -1714 -1714 MISCELLANEOUS 900099 22941 22941 22941 21283969 19576856 0 1676892 X 5796 5796 135418 135418 6988766 6088542 900224 169856 147977 21879 1305268 1137136 168132 500216 435783 64433 601307 601307 132796 132796 50714 50714 2368752 2323364 45388 209812 209812 213854 110639 103215 271009 81542 189467 643641 624145 19496 112892 87415 25477 52697 44618 8079 11363 11363 1774409 1774409 89903 89903 DRUGS 1052781 1052781 MEDICAL SUPPLIES 804362 754937 49425 BAD DEBT EXPENSE 545588 331648 213940 DUES/SUBSCRIPTIONS 81339 29544 51795 51270 51270 18173809 13267230 4906579 0 630 700 2877378 26802135 2830773 2562238 13923 0 181832 219312 228212 147267 22475594 14627111 5274153 7848483 14436427 9550217 435 560711 25843763 47691063 2574210 2621106 34753 21200000 847778 0 92000 92000 3548741 23913106 X 21643897 23764332 651125 13625 22295022 23777957 25843763 47691063 X 3110160 -1049725 -577500 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 984772 984772 7486236 5958628 1527608 9739664 8668483 1071181 4264922 4264922 7848483 ASSET RETIREMENT OBLIGATION 92000 92000 X 20523455 -760514 -760514 21283969 0 21283969 17353295 -60000 -60000 17413295 760514 760514 18173809 PART X, LINE 2: THE ORGANIZATION IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS SUBJECTED TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2012 TO 2014 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS -760,514. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVERSAL OF PRIOR YEAR GRANT TO BLCS THAT DID NOT GET PAID -60,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 760,514. SHS GOLF OUTING 15129 7814 7315 2651 3207 1457 1714 15129 7814 7315 2651 3207 1457 1714 9029 -1714 1 1 X 1 X 1 X 1 1 1 0 1 1 238265 238265 0.01370 3363593 1707414 1656179 0.09510 0 3601858 1707414 1894444 0.10880 15166 47680 10314 37366 0.00210 57 19591 19591 0.00110 297 599219 341455 257764 0.01480 0 50311 50311 0.00290 15520 716801 351769 365032 0.02090 15520 4318659 2059183 2259476 0.12970 0 1 723 723 0.00000 2 8 11621 11621 0.00070 1 513 513 0.00000 2 128 669 669 0.00000 1 1499 1499 0.00010 0 1 186 14838 14838 0.00090 0 8 322 29863 29863 0.00170 1 760514 0 7336930 7716150 -379220 X 1 1 1 1 SPOONER HEALTH SYSTEM INC 819 ASH STREET SPOONER WI 54801 WWW.SPOONERHEALTHSYSTEM.COM 1024 X X X X HOME HEALTH AGENCY SPOONER HEALTH SYSTEM 1 0 0 1 X X X X X X 12 1 0 1 1 X WWW.SPOONERHEALTHSYSTEM.COM X 1 12 0 0 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X WWW.SPOONERHEALTHSYSTEM.COM/BILLINGINSURANCEPOLICY/TABID/130/DEFAULT.ASPX X X X X 1 0 X X X X 1 X 0 0 SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 5: A SURVEY INSTRUMENT WAS DEVELOPED IN COOPERATION WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER (THE CENTER) AND SPOONER HEALTH SYSTEM (SHS) TO ASSESS THE HEALTH CARE NEEDS AND PREFERENCES IN THE SERVICE AREA. THE SURVEY INSTRUMENT WAS DESIGNED TO BE EASILY COMPLETED BY RESPONDENTS. THE SURVEY WAS DESIGNED TO ASSEMBLE INFORMATION FROM LOCAL RESIDENTS REGARDING: DEMOGRAPHICS OF RESPONDENTS, UTILIZATION AND PERCEPTION OF LOCAL HEALTH SERVICES, AND PERCEPTION OF COMMUNITY HEALTH. ZIP CODES WITH THE GREATEST NUMBER OF ADMISSIONS WERE STRATIFIED IN THE INITIAL SAMPLE SELECTION. EACH AREA WOULD BE REPRESENTED IN THE SAMPLING PROPORTIONATELY TO BOTH THE OVERALL SERVED POPULATION AND THE NUMBER OF PAST ADMISSIONS. EIGHT HUNDRED RESIDENTS WERE SELECTED RANDOMLY FROM PRIME NET DATA SOURCE, A MARKETING ORGANIZATION. THE COMMUNITY HEALTH NEEDS ASSESSMENT, A COVER LETTER ON SPOONER HEALTH SYSTEM'S LETTERHEAD, AND A POSTAGE PAID REPLY ENVELOPE WERE MAILED FIRST CLASS TO 800 RANDOMLY SELECTED RESIDENTS IN THE TARGETED REGION. A PRESS RELEASE WAS SENT TO LOCAL NEWSPAPERS PRIOR TO THE SURVEY DISTRIBUTION ANNOUNCING THAT SPOONER WOULD CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT THROUGHOUT THE REGION IN COOPERATION WITH THE CENTER. ONE HUNDRED THIRTY-NINE OF THE MAILED SURVEYS WERE RETURNED PROVIDING A 19% RESPONSE RATE. IN ADDITION, SHS HAD THE CENTER CONDUCT FOCUS GROUPS TO PROVIDE QUALITATIVE DATA AS A SUPPLEMENT TO THE COMMUNITY SURVEY. THE PURPOSE OF THE FOCUS GROUPS WAS TO HEAR DIRECTLY FROM LOCAL RESIDENTS ON THE STRENGTHS AND NEEDS OF HEALTH SERVICES IN THE SPOONER AREA. FOCUS GROUP PARTICIPANTS WERE IDENTIFIED AS PEOPLE LIVING IN SPOONER AND THE SURROUNDING AREA. INVITATIONS WERE MAILED WITH THE FOCUS GROUP QUESTIONS ATTACHED. THIRTY PEOPLE PARTICIPATED IN TOTAL. THE FOCUS GROUPS WERE DESIGNED TO REPRESENT VARIOUS CONSUMER GROUPS OF LOCAL HEALTH SERVICES INCLUDING SENIOR CITIZENS, CAREGIVERS, BUSINESS OWNERS AND HEALTH CARE PROVIDERS. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 11: 1) LACK OF ACCESS TO DENTAL CARE - SPOONER HEALTH SYSTEM IS NOT ADDRESSING THIS IDENTIFIED NEED BECAUSE WE DO NOT HAVE EXPERTISE IN THE DENTISTRY AREA. IT'S SIMPLY OUT OF OUR SCOPE OF PRACTICE. DUE TO OTHER HEALTH PRIORITIES, WE DO NOT HAVE THE FINANCES TO SUPPORT DENTAL CARE AS WELL. 2) NO 24-HOUR PHARMACY - SPOONER HEALTH SYSTEM IS NOT ADDRESSING THIS IDENTIFIED NEED FOR THE FOLLOWING REASONS:- WE DO NOT CURRENTLY DO RETAIL PHARMACY AND DON'T WANT TO BEGIN COMPETING WITH OTHERS IN THE COMMUNITY WHO DO.-WE'VE LOOKED AT MEDICINE VENDING OPTIONS. HOWEVER, IT IS NOT FEASIBLE DUE TO LOW VOLUMES AND MINIMUM REQUIREMENTS.- WE DO NOT THINK IT IS IN THE BEST INTEREST OF OUR COMMUNITY TO PULL RESOURCES FROM OTHER IDENTIFIED NEEDS AND PRIORITIES TO PROVIDE THIS SERVICE.3) NO MINUTE CLINIC - SPOONER HEALTH SYSTEM IS NOT ADDRESSING THIS IDENTIFIED NEED FOR THE FOLLOWING REASONS:- WE DO NOT EMPLOY THE PHYSICIANS.- SPACE CONSTRAINTS.NOTE THAT WE ARE CONSIDERING URGENT CARE WITH POSSIBLE FUTURE BUILDING PROJECT. SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 16I: ALTHOUGH THE ACTUAL POLICY AND PROCEDURE IS NOT ON THE WEBSITE, BASIC INFORMATION IS POSTED REGARDING THE FACT THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE INFORMATION ON THE WEBSITE EXPLAINS EXACTLY WHAT TO DO IN ORDER TO APPLY FOR FINANCIAL ASSISTANCE. THE APPLICATION FORM IS ALSO AVAILABLE ON THE WEBSITE AND AT REGISTRATION. FINANCIAL ASSISTANCE APPLICATION AND LETTER IS SENT OUT TO PATIENTS WHO ARE NOT ABLE TO PAY THEIR BALANCES DUE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY SPOONER HEALTH SYSTEM PART V, SECTION B, LINE 16B WEBSITE: WWW.SPOONERHEALTHSYSTEM.COM/BILLINGINSURANCEPOLICY/TABID/130/DEFAULT.ASPX PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7A-C WERE COMPUTED USING THE COST TO CHARGE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H, IRS INSTRUCTIONS. THE AMOUNTS REPORTED IN LINES 7E-I WERE REPORTED BASED ON DIRECT COSTS INCURRED BY SHS. PART I, LINE 7G: INCLUDED IN PART I, LINE 7G IS THE MEMORY CLINIC, WHICH IS A PHYSICIAN CLINIC. IT IS LISTED AS A SUBSIDIZED HEALTH SERVICE BECAUSE IT IS OPERATED BY SHS IN ORDER TO PROVIDE A SERVICE THAT IS NEEDED IN THE COMMUNITY, BUT CANNOT BE SUSTAINED ON ITS OWN. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR THE MEMORY CLINIC WAS $17,096 WITH DIRECT OFFSETTING REVENUE OF $14,398 RESULTING IN NET COMMUNITY BENEFIT EXPENSE OF $2,698. PART I, LN 7 COL(F): THE HOSPITAL IS REPORTING $760,514 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24B. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $17,418,872. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: SPOONER HEALTH SYSTEM (SHS) IS PARTNERED WITH WASHBURN COUNTY AND THE STATE OF WISCONSIN IN THEIR EMERGENCY PREPAREDNESS EFFORTS THROUGH INVOLVEMENT WITH THE NORTHWEST WISCONSIN HEALTH CARE COALITION AND REGIONAL TRAUMA ADVISORY COUNCIL. SHS IS ALSO PARTNERED WITH THE FOLLOWING ORGANIZATIONS THAT DIRECTLY PROMOTE HEALTH OF PERSONS LIVING IN WASHBURN AND BURNETT COUNTIES: DRUG ENDANGERED CHILDREN M TEAM, WASHBURN COUNTY SAFETY COALITION, ELDER ABUSE INTERDISCIPLINARY TEAM, WASHBURN COUNTY AND POLK BURNETT COUNTY CARE TRANSITION COALITION, FAITH IN ACTION, TIME OUT SHELTER, AND BURNETT CRISIS OVERSIGHT COMMITTEE. PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT AND RESIDENT RECEIVABLES, NET" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY 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. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS 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), THE SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS 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 OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS."THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS.A PORTION OF THE BAD DEBT EXPENSE REPORTED IN LINE 2 WOULD BE CONSIDERED CHARITY CARE IF THE PROPER PAPERWORK WAS COMPLETED, HOWEVER THIS AMOUNT CANNOT BE QUANTIFIED. PART III, LINE 8: FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2015 FILED MEDICARE COST REPORT.FROM PART III, LINE 7, SPOONER HEALTH SYSTEM BELIEVES THAT THE SHORTFALL OF $379,220 SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THESE ARE THE COSTS OF PROVIDING MEDICALLY NECESSARY SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IF THE HOSPITAL DIDN'T PROVIDE THESE SERVICES, NO OTHER ORGANIZATION IN THE COMMUNITY WOULD. PART III, LINE 9B: AFTER FINANCIAL ASSISTANCE IS PROVIDED, SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. SPOONER HEALTH SYSTEM MAKES ALL REASONABLE ATTEMPTS TO CONFIRM THAT PATIENTS ARE NOT ELIGIBLE FOR OTHER ASSISTANCE PROGRAMS PRIOR TO COLLECTION AGENCY ASSIGNMENT. PRIOR TO TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND STATEMENTS AND COLLECTION LETTERS TO THE PATIENT AT THE ADDRESS PROVIDED BY THE PATIENT. STATEMENTS AND COMMUNICATIONS WILL INFORM THE PATIENT OF THEIR FINANCIAL RESPONSIBILITY AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN. PART VI, LINE 2: SPOONER HEALTH SYSTEM (SHS) PARTICIPATED IN A COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS ADMINISTRATED BY THE NATIONAL RURAL HEALTH RESOURCE CENTER (THE CENTER) IN DULUTH, MINNESOTA. THIS PROCESS INCLUDED THE DEVELOPMENT AND DISTRIBUTION OF A STRATIFIED, RANDOM SAMPLE MAILED COMMUNITY HEALTH NEEDS SURVEY, FACILITATION OF FOCUS GROUPS AND ANALYSIS OF SECONDARY DATA. THESE METHODS ENABLED SHS THE OPPORTUNITY TO LISTEN AND RESPOND TO THE HEALTH NEEDS OF THE COMMUNITY. RESULTS OF THE ASSESSMENT FINDINGS WERE USED TO IDENTIFY LOCAL HEALTH PRIORITIES AND ESTABLISH HEALTH GOALS AND AN ACTION PLAN FOR THE PURPOSES OF:- IMPROVING OVERALL COMMUNITY HEALTH- PROMOTING COLLABORATION AND PARTNERSHIPS WITHIN SPOONER AND THE SURROUNDING AREA TO ADDRESS TOP COMMUNITY HEALTH NEEDS- IMPROVING COMMUNICATION ACROSS HEALTH SECTORS- CREATING AWARENESS OF THE COMPREHENSIVE, HIGH QUALITY HEALTH CARE SERVICES AVAILABLE LOCALLY- REINFORCING A COMMITMENT TO THE PEOPLE OF SPOONER AND THE SURROUNDING AREA THAT THEIR HEALTH IS THE HOSPITAL'S TOP PRIORITY PART VI, LINE 3: PATIENTS WITHOUT INSURANCE ARE GIVEN THE FINANCIAL ASSISTANCE (FA) APPLICATION. OUR FINANCIAL COUNSELOR CALLS THEM AFTER DISCHARGE AND EXPLAINS WHAT ASSISTANCE (FROM THE GOVERNMENT OR SHS) MAY BE AVAILABLE TO THEM. SHE ASKS THEM TO FILL IT OUT AND MAKES AN APPOINTMENT WITH THEM IN THE OFFICE IF THEY NEED ASSISTANCE WITH THE FA APPLICATION OR GOING TO WWW.ACCESS.GOV TO APPLY FOR GOVERNMENTAL ASSISTANCE. WHEN THEY COME IN, SHE WILL ASSIST THEM WITH THE APPLICATION PROCESS AS MUCH AS SHE CAN. IF THEY NEED FURTHER ASSISTANCE, ARE OF RETIREMENT AGE, OR IF THERE IS A DISABILITY INVOLVED, SHE REFERS THEM TO THE WASHBURN COUNTY AGING AND DISABILITY RESOURCE CENTER WHERE THEY WILL HELP THE PATIENTS IN GETTING ADDITIONAL ASSISTANCE. OUR FINANCIAL COUNSELOR ALSO REFERS PATIENTS TO THE COUNTY'S PUBLIC HEALTH DEPARTMENT IF THEY NEED FAMILY OR WOMEN'S HEALTH ASSISTANCE. PART VI, LINE 4: SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURN COUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 30TH LARGEST COUNTY BY LAND AREA IN WISCONSIN WITH AN ESTIMATED POPULATION OF 15,686 (PER 2013 US CENSUS BUREAU). THE MEDIAN HOUSEHOLD INCOME IS $41,924 WITH 13.8% OF PERSONS BELOW POVERTY LEVEL (PER 2009-2013 DATA). WASHBURN COUNTY HAD A 5.3% UNEMPLOYMENT RATE IN APRIL 2015 PER DWD, BUREAU OF WORKFORCE TRAINING. PART VI, LINE 6: SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 TUITION REIMBURSEMENT 1 5796 PART I, LINE 2: SPOONER HEALTH SYSTEM ALSO OFFERS TUITION ASSISTANCE FOR EMPLOYEES THAT ARE FURTHERING THEIR EDUCATION TO ENHANCE THEIR JOB RELATED SKILLS, KNOWLEDGE AND IMPROVE THEIR POTENTIAL FOR PROMOTION OR CAREER DEVELOPMENT OPPORTUNITIES. TO RECEIVE TUITION REIMBURSEMENT FROM THE HOSPITAL, AN EMPLOYEE MUST SUBMIT A TUITION ASSISTANCE IN EXCHANGE FOR SERVICE FROM THE HUMAN RESOURCES DEPARTMENT ALONG WITH THE APPROPRIATE DOCUMENTATION. THIS INCLUDES WRITTEN PROOF OF SUCCESSFUL COMPLETION OF THE COURSE PER THE COURSE REQUIREMENTS AND ITEMIZED BILLS, RECEIPTS OR STATEMENTS WITH PROOF OF PAYMENT FOR EXPENSES. X X X 0 0 0 0 0 0 0 0 0 PATRICK MCCANN MD ER MEDICAL DIRECTOR 237536 0 0 0 0 0 7344 0 27705 0 272585 0 0 0 ANNE MENTELE CRNA CERT. NURSE ANESTHETIST 162982 0 0 0 0 0 4716 0 27705 0 195403 0 0 0 TIMOTHY SCHMIDT CRNA CERT. NURSE ANESTHETIST 159718 0 0 0 0 0 5009 0 27705 0 192432 0 0 0 A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-10-23 21200000 CONSTRUCTING REPLACEMENT HOSPITAL 0 0 0 A 21200000 328189 546865 579078 19745868 2017 0 0 0 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE AN EXERCISE AND POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 SPOONER HEALTH SYSTEM CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 IS REVIEWED WITH BOARD MEMBERS WHO APPROVE IT. THE 990 IS THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ANY OFFICER, BOARD MEMBER, OR KEY EMPLOYEE OF THE ORGANIZATION ON AN ANNUAL BASIS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE PERSON WITH THE CONFLICT SHALL LEAVE MEETINGS DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,323,364. MANAGEMENT AND GENERAL EXPENSES 45,388. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,368,752. FORM 990, PART XI, LINE 9: CAPITAL REPAIR FUND -637,500. REVERSAL OF PRIOR YEAR GRANT TO BLCS THAT NEVER GOT PAID 60,000.