2015-02-13T07:34:16-06:00 2014-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2013-07-01 390806429 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN LANG 7156232331 112 EAST FIFTH AVENUE ANTIGO WI 54409 PAT TINCHER CFO 7156232331 2015-02-11 1 KATHLEEN J LABRAKE CPA P00164006 7158323407 2015-02-11 2013 2016-03-07 17:11:31Z LANGLADE HOSPITAL PAT TINCHER 112 EAST FIFTH AVENUE ANTIGO WI 54409 89940759 0 X WWW.LANGLADEHOSPITAL.ORG X 1933 WI THE COMMUNITY BENEFIT CONTRIBUTION OF LANGLADE HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW:HISTORYTHE HOSPITAL WAS OPENED ON MARCH 21, 1933, AND WAS DEDICATED AS A MEMORIAL TO THE SERVICEMEN FROM LANGLADE COUNTY WHO SACRIFICED THEIR LIVES DURING WORLD WAR I. IT IS OWNED AND OPERATED BY THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH.THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH ARE A RELIGIOUS ORDER OF CATHOLIC SISTERS WHOSE ROOTS AS A RELIGIOUS CONGREGATION GO BACK TO 17TH CENTURY FRANCE. IN 1659, THEIR FOUNDER, JEROME LEROYER, A LAYMAN AND FATHER OF FIVE CHILDREN, CAME TO MONTREAL, CANADA, AND ESTABLISHED THE CONGREGATION OF THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH. 18 16 558 203 308314 -18965 541221 119806 82933352 85957576 384788 1426324 13097 22456 83872458 87526162 0 0 0 0 39324140 41896110 0 0 0 32203253 36007638 71527393 77903748 12345065 9622414 126777539 137550554 38307537 37398232 88470002 100152322 X AS A MINISTRY OF JESUS, WE HEAL, PROMOTE HEALTH, AND ENRICH LIVES. 0 0 42988337 68968865 ACUTE GENERAL CARE HOSPITAL WITH BOTH INPATIENT AND OUTPATIENT RELATED SERVICES AND SUPPORTIVE HOMECARE SERVICES FOR ELDERLY CLIENTS.- INPATIENTS - 829 ADMISSIONS WITH 3,359 PATIENT DAYS AND 220 BIRTHS.- OUTPATIENTS - 54,593 OUTPATIENT VISITS, INCLUDING 10,936 EMERGENCY VISITS, 26,826 IMAGING PROCEDURES.- SURGICAL SERVICES - 1,308 TOTAL PATIENTS TREATED. 16898689 14505936 PHYSICIAN CLINIC SERVICES - URGENT CARE, PRIMARY CARE, AND VARIOUS SPECIALTIES.- CLINIC VISITS - 76,134 1430395 1104589 ELDERLY HOUSING AND SUPPORT SERVICES- INDEPENDENT LIVING - 12,111 RESIDENT DAYS- ASSISTED LIVING - 5,535 RESIDENT DAYS- ADULT DAY CARE - 1,048 TREATMENT DAYS- HOSPICE - 3,261 PATIENT DAYS 823331 296212 PROVIDING DAYCARE, PATHOLOGY SERVICES, AND MEALS. 823331 296212 62140752 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 1 739 0 558 1 1 1 0 0 0 0 0 0 0 0 0 X 18 16 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 BOARD MEMBER 1.00 X 0 0 0 LYNNE HENRICKS BOARD MEMBER 1.00 X 0 0 0 SISTER JEAN BRICCO BOARD MEMBER 10.00 X 40994 0 0 JOE SVEDA BOARD MEMBER 1.00 X 0 0 0 CHARLES HEUSS MD BOARD MEMBER 1.00 X 0 0 0 DAWN OFSTHUN 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 0 0 F DEAN DANNER JR BOARD MEMBER 1.00 X 0 0 0 SCOTT GARAVET BOARD MEMBER 1.00 X 0 0 0 SISTER ROSE-MARIE DUFAULT BOARD MEMBER 1.00 X 0 0 0 RENEE M SMITH MD BOARD MEMBER 1.00 X 0 0 0 DENNIS MCFADDEN DO BOARD MEMBER 1.00 X 0 0 0 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 VICE CHAIRMAN 1.00 X X 0 0 0 SISTER DOLORES DEMULLING SECRETARY/TREASURER 1.00 X X 67356 0 0 DAVID SCHNEIDER CEO 40.00 X 350382 0 40578 PATRICK TINCHER CFO 40.00 X 208593 0 42139 MARK SZMANDA DO PHYSICIAN 40.00 X 257442 0 44874 RUTH RISLEY-GRAY DIRECTOR - PATIENT SERVICE 40.00 X 163760 0 39881 DOUGLAS ARMATO MD PHYSICIAN 40.00 X 196755 0 20726 KENNETH BOWMAN MD PHYSICIAN 40.00 X 201377 0 22462 MICHAEL OLSON MD PHYSICIAN 40.00 X 203528 0 20165 1690187 0 230825 14 0 1 0 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 9552920 MIRON CONSTRUCTION INC 500 1ST STREET WAUSAU WI 54403 CONSTRUCTION 4695028 ASPIRUS WAUSAU HOSPITAL 333 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 3979908 MCKESSON DRUG CO 12748 COLLECTION CENTER DRIVE CHICAGO IL 60693 PHARMACEUTICALS 3715227 ADVANTAGE PURCHASING LLC 500 1ST STREET WAUSAU WI 54403 CONSTRUCTION MANAGEMENT 2023834 41 33680 47262 38864 119806 ACUTE HOSPITAL SERVICES-INPATIENT 621990 68413606 68413606 PHYSICIAN CLINICS 621110 14505936 14505936 MISCELLANEOUS 621990 1069872 1069872 ROSALIA GARDENS 623990 640583 640583 CONGREGATE HOUSING 623990 464006 464006 863573 555259 308314 85957576 692373 692373 112433 89977 22456 22456 22456 3058571 2324620 733951 733951 733951 87526162 84579390 308314 2518652 X 641693 641693 31834262 27324875 4509387 1408939 1209360 199579 5964466 5119587 844879 2046750 1756824 289926 53544 53544 75798 75798 22269 22235 34 12607237 9372307 3234930 148731 148731 849 787 62 898118 141715 756403 988174 766200 221974 302102 168269 133833 6567461 2868670 3698791 469676 161792 307884 MEDICAL/PROFESSIONAL 8826914 8794684 32230 BAD DEBT EXPENSE 2369483 2369483 MAINTENANCE AND REPAIR 1357632 1287849 69783 MINOR EQUIPMENT 895781 639592 256189 423869 136523 287346 77903748 62140752 15762996 0 6087148 9441260 18884477 10857063 13017396 14287116 1245322 1579513 723949 893897 87646927 30149808 60654254 57497119 22851016 40376564 366334 355520 2947643 2262502 126777539 137550554 10363064 9878010 26130000 25720000 951136 863337 1800222 38307537 37398232 X 88048448 99755835 421554 396487 88470002 100152322 126777539 137550554 X 9622414 2008653 51253 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 5654 5654 0 PART II-B, LINE 1: 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 LANGLADE HOSPITAL THAT APPROXIMATELY $3,141 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. 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 $2,513 OF THE FEES PAID BY LANGLADE HOSPITAL IN FY2014 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 894171 894171 51801370 10908896 40892474 4559100 1317117 3241983 30324454 17923795 12400659 67832 67832 57497119 UNAMORTIZED BOND PREMIUM 834317 DEFERRED COMPENSATION 793163 OTHER LONG-TERM LIABILITIES 172742 1800222 X 89591112 2008653 89977 2098630 87492482 33680 33680 87526162 77993725 89977 89977 77903748 0 77903748 PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, LANGLADE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. LANGLADE HOSPITAL HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF JUNE 30, 2014 OR 2013. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2011, AND BEYOND, REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS). PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE ON FORM 990 89,977. PART XI, LINE 4B - OTHER ADJUSTMENTS: FOUNDATION CONTRIBUTION 33,680. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE ON FORM 990 89,977. 1 1 1 X 1 X 1 1 1 0 1 1 1763834 1763834 0.02340 11184998 7949059 3235939 0.04280 12948832 7949059 4999773 0.06620 1264399 874822 389577 0.00520 29788 500 29288 0.00040 17690 17690 0.00020 1311877 875322 436555 0.00580 14260709 8824381 5436328 0.07200 399723 301990 97733 0.00130 399723 301990 97733 0.00130 0 1172426 586213 20372029 21015825 -643796 X 1 1 1 1 LANGLADE HOSPITAL 112 E 5TH AVENUE ANTIGO WI 54409 1055 X X X LANGLADE HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X HTTP://ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMEN X X X X X X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X X X 1 X 1 X X X X X 1 X 0 0 LANGLADE HOSPITAL PART V, SECTION B, LINE 3: THE LANGLADE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS A COLLABORATIVE EFFORT LED BY 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. LANGLADE HOSPITAL PART V, SECTION B, LINE 5D: A COPY OF THE CHNA AND IMPLEMENTATION STRATEGY IS ATTACHED TO THE FORM 990. LANGLADE HOSPITAL PART V, SECTION B, LINE 7: LANGLADE HOSPITAL REVIEWED THE NEEDS OUTLINED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND DETERMINED WHICH OF THESE NEEDS WERE APPLICABLE TO THE COMMUNITIES AND AREAS SERVED BY LANGLADE HOSPITAL AND THEN REVIEWED THE ITEMS TO ENSURE THAT THEY WERE FEASIBLE AT THE PRESENT TIME FOR THE HOSPITAL TO PROVIDE TO PATIENTS IN THE COMMUNITY. A KEY FACTOR IN THIS REVIEW WAS DETERMINING HOW TO ALLOCATE THE FINANCIAL DOLLARS AVAILABLE TO MEET ADDITIONAL NEEDS IN THE COMMUNITY, WHICH WOULD PROVIDE THE GREATEST BENEFIT TO THE MOST INDIVIDUALS. LANGLADE HOSPITAL ALSO CONSIDERED STAFFING RESOURCES IN ADDITION TO FINANCIAL CONSIDERATIONS TO ENSURE THAT THERE ARE ENOUGH PERSONNEL RESOURCES AVAILABLE FOR ANY PROGRAMS THAT MAY NOT CURRENTLY BE OFFERED BY THE HOSPITAL. DUE TO THE FINANCIAL AND STAFFING CONSTRAINTS, THE HOSPITAL HAS DETERMINED THE TOP FOUR PRIORITIES THAT THEY WILL FOCUS THEIR ATTENTION ON, AS THESE ISSUES WERE THE MOST CRITICAL AND SIGNIFICANT WORK NEEDS TO BE DONE IN THESE AREAS. OVER THE NEXT THREE YEARS AS THE IMPLEMENTATION STRATEGY IS IMPLEMENTED, THE HOSPITAL PLANS TO CONTINUALLY EVALUATE THE BENEFITS PROVIDED TO COMMUNITY MEMBERS TO ENSURE THAT HEALTH NEEDS ARE MET WHENEVER POSSIBLE. LANGLADE HOSPITAL PART V, SECTION B, LINE 14G: REFERRAL MAY BE MADE BY ANY MEMBER OF THE HOSPITAL STAFF, MEDICAL STAFF, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS AND/OR RELIGIOUS SPONSORS. REQUESTS MAY ALSO BE MADE BY THE PATIENT, A FAMILY MEMBER OF THE PATIENT, A CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO THE APPLICABLE PRIVACY LAWS. LANGLADE HOSPITAL PART V, SECTION B, LINE 20D: STANDARD CHARGES ARE BILLED LESS A PRE-ESTABLISHED DISCOUNT PERCENTAGE. PATIENTS MEETING THE FAP ELIGIBILITY GUIDELINES IN THE COMMUNITY CARE POLICY CAN ALSO RECEIVE A SLIDING SCALE DISCOUNT IN ADDITION TO THE STANDARD SELF-PAY DISCOUNT RATE OF 8%. 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 $ 2,369,483. 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. 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. 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 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL PATIENT ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND PROVIDES ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, 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, 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), 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, 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: 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 18 INDIVIDUALS FROM THE SURROUNDING AREA. OF THESE 18 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: LANGLADE HOSPITAL IS A PARTNER WITH ASPIRUS, INC. (ASPIRUS) A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. 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 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 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 X X X X 0 0 0 0 0 0 0 0 0 DAVID SCHNEIDER CEO 319643 0 26779 0 3960 0 12734 0 27844 0 390960 0 0 0 PATRICK TINCHER CFO 201679 0 6247 0 667 0 10180 0 31959 0 250732 0 0 0 MARK SZMANDA DO PHYSICIAN 254922 0 69 0 2451 0 12250 0 32624 0 302316 0 0 0 RUTH RISLEY-GRAY DIRECTOR - PATIENT SERVICE 152887 0 8695 0 2178 0 8120 0 31761 0 203641 0 0 0 DOUGLAS ARMATO MD PHYSICIAN 171224 0 25000 0 531 0 8769 0 11957 0 217481 0 0 0 KENNETH BOWMAN MD PHYSICIAN 175385 0 25000 0 992 0 8769 0 13693 0 223839 0 0 0 MICHAEL OLSON MD PHYSICIAN 178343 0 25000 0 185 0 6731 0 13434 0 223693 0 0 0 A WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 2013-04-12 26130000 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 A 410000 27000592 27000592 2012 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 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 IS A NONSTOCK NONPROFIT CORPORATION. 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 A, LINE 7A 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 A, LINE 7B SEE EXPLANATION FOR FORM 990, PART VI, LINE 7A. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE BOARD CHAIR AND VICE-CHAIR PRIOR TO SUBMISSION. IN ADDITION, THE FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND MANAGEMENT COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT AND ABSTAIN FROM VOTING ON ANY MATTERS THAT PRESENT A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT HUMAN RESOURCES/COMPENSATION CONSULTING FIRM IS UTILIZED TO CONDUCT A BENEFIT AND COMPENSATION ANALYSIS. THE BOARD OF TRUSTEES' EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE MEMBERS RELY UPON THIS INDEPENDENT COMPARABILITY DATA TO SUPPORT ANY WAGE ADJUSTMENTS AWARDED SENIOR LEADERSHIP. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES, WHO ARE INDEPENDENT OF HOSPITAL MANAGEMENT, HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS, ARE NOT RELATED TO, OR UNDER THE CONTROL OF ANY INDIVIDUAL WHOSE COMPENSATION ARRANGEMENT IS BEING REVIEWED AND HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH LANGLADE HOSPITAL. EXECUTIVE PERFORMANCE & COMPENSATION COMMITTEE MANDATE 1. DETERMINE THE COMPENSATION LEVEL FOR ALL EXECUTIVES AND OTHER DISQUALIFIED PERSONS BASED ON THESE REVIEWS A. REVIEW AND APPROVE EXECUTIVE COMPENSATION CHANGES AND TRANSACTIONS IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS B. REVIEW AND APPROVE COMPENSATION CHANGES (INCENTIVE COMPENSATION PLANS; EXECUTIVE BASE SALARIES AND RANGES; EXECUTIVE WELFARE AND RETIREMENT BENEFIT PLANS) AND OTHER EXECUTIVE FRINGE BENEFITS 2. ENGAGE INDEPENDENT, OUTSIDE ADVISORS (E.G., ATTORNEYS, COMPENSATION CONSULTANTS, ETC.) TO PROVIDE OBJECTIVE AND IMPARTIAL COMPENSATION DATA AND EXPRESS AN OPINION ON THE REASONABLENESS OF TOTAL COMPENSATION A. REVIEW PERIODICALLY THE COMPONENTS OF THE EXECUTIVES' TOTAL COMPENSATION PROGRAM TO DETERMINE WHETHER THEY ARE PROPERLY COORDINATED 3. DISCLOSURE AND REPORTING A. REPORT REGULARLY TO THE FULL BOARD ON EXECUTIVE COMPENSATION B. VERIFY THAT COMPENSATION INFORMATION IS APPROPRIATELY AND FULLY DISCLOSED FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE A PART OF THE ORGANIZATION AND ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VI, LINE 1B, COMPENSATION AND VOW OF POVERTY: BOTH SISTER DOLORES DEMULLING AND SISTER JEAN BRICCO HAVE A VOW OF POVERTY. ALL OF THE COMPENSATION PAID TO THEM GOES DIRECTLY TO THEIR ORDER, THE RELIGIOUS HOSPITALLERS OF ST. JOSEPH. FORM 990, PART IX, LINE 11G HOSPITAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,280,880. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,280,880. CLINIC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,555,146. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,555,146. ELDERLY & SUPPORT PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 511,581. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 511,581. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 24,700. MANAGEMENT AND GENERAL EXPENSES 15,496. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,196. SUPPORT PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,219,434. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,219,434. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION -125,067. FORGIVENESS OF NOTE BY AFFILIATED ORGANIZATION 210,000. NET ASSETS RELEASED FROM RESTRICTIONS -33,680. 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 MEMORIAL HOSPITAL AND COMMUNITY HEALTH FOUNDATION INC 112 EAST FIFTH AVENUE ANTIGO WI 54409 391304761 HEALTH CARE WI 501(C)(3) LINE 7 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