2014-02-12T16:07:52-06:00 2013-06-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS/PO BOX 690 EAU CLAIRE WI 547020690 990 2012-07-01 390806429 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN LANG 7156232331 112 E FIFTH AVE ANTIGO WI 54409 PAT TINCHER 7156232331 2014-02-12 1 KATHLEEN J LABRAKE CPA P00164006 7158323407 2014-02-12 2012 2015-11-30 17:44:51Z LANGLADE HOSPITAL PAT TINCHER 112 E FIFTH AVE ANTIGO WI 54409 85472125 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 THE 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 12 563 204 424015 -76258 750788 541221 75516469 82933352 509738 384788 6165 13097 76783160 83872458 0 0 0 0 38356668 39324140 0 0 0 29157693 32203253 67514361 71527393 9268799 12345065 95522195 126777539 19679637 38307537 75842558 88470002 X AS A MINISTRY OF JESUS, WE HEAL, PROMOTE HEALTH, AND ENRICH LIVES. 0 0 40224725 66621174 ACUTE GENERAL CARE HOSPITAL WITH BOTH INPATIENT AND OUTPATIENT RELATED SERVICES, AND SUPPORTIVE HOMECARE SERVICES FOR ELDERLY CLIENTS.- INPATIENTS - 829 ADMISSIONS WITH 3,584 PATIENT DAYS AND 215 BIRTHS.- OUTPATIENTS - 58,440 OUTPATIENT VISITS, INCLUDING 11,195 EMERGENCY VISITS, 26,986 IMAGING PROCEDURES.- SURGICAL SERVICES - 1,303 TOTAL PATIENTS TREATED. 14181429 13953249 PHYSICIAN CLINIC SERVICES - URGENT CARE, PRIMARY CARE, AND VARIOUS SPECIALTIES.- CLINIC VISITS - 69,688 1269925 1056906 ELDERLY HOUSING AND SUPPORT SERVICES- INDEPENDENT LIVING - 12,531 RESIDENT DAYS- ASSISTED LIVING - 5,477 RESIDENT DAYS- ADULT DAY CARE - 984 TREATMENT DAYS- HOSPICE - 3,849 PATIENT DAYS 691027 415582 PROVIDING DAYCARE, PATHOLOGY SERVICES, AND MEALS. 691027 415582 56367106 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 0 0 0 1 640 0 1 563 1 1 1 0 0 0 0 0 0 0 0 0 X 18 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 X MIKE TURNEY 1.00 X 0 0 0 SISTER DOLORES DEMULLING 1.00 X 79269 0 0 MIKE WINTER 1.00 X 0 0 0 LYNNE HENRICKS 1.00 X 0 0 0 SISTER JEAN BRICCO 1.00 X 50565 0 0 JOE SVEDA 1.00 X 0 0 0 CHARLES HEUSS MD 1.00 X 0 0 0 DAWN OFSTHUN 1.00 X 0 0 0 RICHARD HIGLEY 1.00 X 0 0 0 TOM BRADLEY 1.00 X 0 0 0 SID SCZYGELSKI 1.00 51.00 X 0 0 0 F DEAN DANNER JR 1.00 40.00 X 0 0 0 SCOTT GARAVET 1.00 40.00 X 0 0 0 SISTER ROSE-MARIE DUFAULT 1.00 X 0 0 0 RENEE M SMITH 1.00 40.00 X 0 192699 29789 DENNIS S MCFADDEN 1.00 40.00 X 0 397527 32985 NOEL DEEP MD 1.00 40.00 X 0 394705 35321 KRISTINE FLOWERS MD 1.00 X 0 0 0 DAVID SCHNEIDER 40.00 X 374674 0 40501 PATRICK TINCHER 40.00 X 196047 0 42349 STACY BROWNELL 40.00 X 135089 0 27911 JAMES LEEK MD 40.00 X 415005 0 25904 MARK SZMANDA MD 40.00 X 256462 0 46801 JANELLE A MARKGRAF 40.00 X 135460 0 30646 RUTH RISLEY-GRAY 40.00 X 153785 0 40135 1796356 984931 352342 12 0 1 0 ASPIRUS CLINICS INC 425 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 10536953 MIRON CONSTRUCTION INC 500 1ST STREET WAUSAU WI 54403 CONSTRUCTION 6370651 ASPIRUS WAUSAU HOSPITAL 333 PINE RIDGE BLVD WAUSAU WI 54401 CLINICAL SERVICES 2703031 ADVANTAGE PURCHASING LLC 500 1ST STREET WAUSAU WI 54403 CONSTRUCTION MANAGEMENT 2461394 NORTHWOODS RADIOLOGY PARTNERS PO BOX 290 ANTIGO WI 54409 RADIOLOGY SERVICES 1673263 44 417573 93573 30075 541221 ACUTE HOSPITAL SERVICES-INPATIENT 621990 66621174 66621174 PHYSICIAN CLINICS 621110 13953249 13953249 ROSALIA GARDENS 623990 591569 591569 CONGREGATE HOUSING 623990 465337 465337 MISCELLANEOUS 621990 462426 462426 839597 415582 424015 82933352 346719 346719 99493 86396 13097 13097 13097 1551340 1513271 38069 38069 38069 83872458 82046911 424015 860311 X 653571 653571 29486602 25223979 4262623 1385403 1185127 200276 5828447 4985879 842568 1970117 1653314 316803 106211 106211 82326 82326 22766 20237 2529 11839509 10156719 1682790 129350 59 129291 882 882 1008988 145310 863678 945986 721926 224060 286205 186526 99679 66715 66715 27121 27121 5228817 2687574 2541243 413863 185106 228757 MEDICAL/PROFESSIONAL 7554291 7493236 61055 BAD DEBT EXPENSE 2415884 124538 2291346 MAINTENANCE AND REPAIR 1118575 1060354 58221 MINOR EQUIPMENT 575464 429029 146435 380300 108193 272107 71527393 56367106 15160287 0 15073076 6087148 2418791 18884477 10070033 13017396 1193211 1245322 125383 723949 85487819 24833565 55268952 60654254 6994635 22851016 843572 366334 3534542 2947643 95522195 126777539 10313301 10363064 26130000 9366336 951136 0 863337 19679637 38307537 X 75102913 88048448 739645 421554 75842558 88470002 95522195 126777539 X 12345065 271040 11339 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 894171 894171 42983586 8634788 34348798 4264612 1074077 3190535 29088764 15124700 13964064 8256686 8256686 60654254 UNAMORTIZED BOND PREMIUM 863337 863337 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION 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 CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED JUNE 30, 2013 AND 2012, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE ORGANIZATION IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013 OR 2012. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2010, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 1 X 1 X 1 1 0 1 1 1167359 1167359 0.01690 10299178 7774186 2524992 0.03650 11466537 7774186 3692351 0.05340 1264255 851670 412585 0.00600 24391 24391 0.00040 7706239 0 7706239 0.11150 58847 58847 0.00090 9053732 851670 8202062 0.11880 20520269 8625856 11894413 0.17220 217836 168697 49139 0.00070 136148 105435 30713 0.00040 353984 274132 79852 0.00110 0 1136811 568405 19422619 19566154 -143535 X 0 1 1 LANGLADE HOSPITAL - AN ASPIRUS PARTNER

112 E 5TH AVENUE ANTIGO WI 54409

X X X LANGLADE HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 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 5 ASPIRUS GENERAL CLINIC

110 E 5TH AVE ANTIGO WI 54409

CLINIC PROVDING A WIDE RANGE OF OUTPATIENT SERVICES ASPIRUS GENERAL CLINIC

400 RAILROAD BIRNAMWOOD WI 54414

CLINIC PROVDING A WIDE RANGE OF OUTPATIENT SERVICES ASPIRUS GENERAL CLINIC

W10618 CLINIC ST ELCHO WI 54428

CLINIC PROVDING A WIDE RANGE OF OUTPATIENT SERVICES PINE MEADOWS RETIREMENT COMMUNITY

525 FLIGHT RD ANTIGO WI 54409

SENIOR HOUSING ROSALIA GARDENS ASSITED LIVING

525 FLIGHT RD ANTIGO WI 54409

ASSISTED LIVING 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 HOSPITAL'S TOTAL OPERATING EXPENSES LESS 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 FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT LANGLADE HOSPITAL INCLUDE THE OPERATION OF OUTPATIENT PHYSICIAN CLINICS. SERVICES PROVIDED AT THE CLINICS WOULD OTHERWISE NOT BE AVAILABLE LOCALLY AND WOULD REQUIRE SIGNICIANT TRAVEL BY PATIENTS IF THESE CLINICS WERE NOT AVAILABLE. PATIENTS OF THE CLINICS ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, AND ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. 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 $ 2417589. PART II: 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 ORGANIZATION 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 ORGANIZATION 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 4: COST IS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. 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 HEALTHCARE 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. 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 5C: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ON THE HOSPITAL'S WEBSITE AT: WWW.LANGLADEHOSPITAL.ORG. 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 AS DETERMINING OF THE FINANCIAL DOLLARS AVAILABLE TO MEET ADDITIONAL NEEDS IN THE COMMUNITY, WHICH WOULD PROVIDE THE GREATEST BENEFIT TO THE MOST INDIVIDUALS IN THE COMMUNITY OR THE INDIVIDUALS WITH THE GREATEST FINANCIAL NEED THAT WITHOUT THESE BENEFITS BEING PROVIDED TO THEM BY THE HOSPITAL THEY WOULD NOT HAVE THEM IN THE REGION OR WITHIN A FEASIBLE TRAVELING DISTANCE. 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%. 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 - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN (LANGLADE HOSPITAL) IS A PARTNER WITH ASPIRUS, INC. 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 HEALTHCARE 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. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X X X 0 0 0 0 0 0 0 0 0 RENEE M SMITH 0 177494 0 15205 0 0 0 4955 0 24834 0 222488 0 0 DENNIS S MCFADDEN 0 379752 0 17775 0 0 0 7939 0 25046 0 430512 0 0 NOEL DEEP MD 0 381880 0 12825 0 0 0 7939 0 27382 0 430026 0 0 DAVID SCHNEIDER 302938 0 67776 0 3960 0 12736 0 27765 0 415175 0 0 0 PATRICK TINCHER 193857 0 68 0 2122 0 10111 0 32238 0 238396 0 0 0 STACY BROWNELL 133281 0 71 0 1737 0 6830 0 21081 0 163000 0 0 0 JAMES LEEK MD 397158 0 74 0 17773 0 12250 0 13654 0 440909 0 0 0 MARK SZMANDA MD 255073 0 78 0 1311 0 12250 0 34551 0 303263 0 0 0 JANELLE A MARKGRAF 133276 0 67 0 2117 0 6960 0 23686 0 166106 0 0 0 RUTH RISLEY-GRAY 150851 0 67 0 2867 0 7963 0 32172 0 193920 0 0 0 A WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 2013-04-12 26130000 CONSTRUCT, RENOVATE, AND EQUIP FACILITIES 0 0 0 A 27000592 27000592 2012 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 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 (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 (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 ANNUAL COMPLETION OF CONFLICT OF INTEREST STATEMENTS AND BOARD MEMBERS ABSTAINING ON VOTES 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. COMPENSATION AND VOW OF POVERTY FORM 990, PART VI, LINE 1B 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. EXPLANATION FOR HOURS WORKED: FORM 990, PART VII, LINE 1A SOME OFFICERS, DIRECTORS AND KEY EMPLOYEES ALSO PROVIDED SERVICE TO OTHER RELATED ORGANIZATIONS OTHER THAN LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. OTHER FEES FORM 990, PART IX, LINE 11G PHARMACY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 753,534. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 753,534. CONTRACTED STAFFING: PROGRAM SERVICE EXPENSES 946,193. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 946,193. ANESTHESIA PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 889,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 889,000. CONTRACTED ADMINISTRATION SERVICES: PROGRAM SERVICE EXPENSES 544,915. MANAGEMENT AND GENERAL EXPENSES 1,682,790. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,227,705. EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,527,837. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,527,837. LAB & RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,729,356. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,729,356. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,765,884. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,765,884. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN FOUNDATION -318,091. FORGIVENESS OF NOTE BY AFFILIATED ORGANIZATION 329,430. AUDIT PROCESS FORM 990, PART XII, LINE 2C 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 COMMUNITY AND HEALTH FOUNDATION INC 112 E 5TH AVENUE ANTIGO WI 54409 391304761 HEALTH CARE WI 501(C)(3) LINE 7 N/A 0 ASPIRUS GENERAL CLINIC 110 E 5TH AVENUE ANTIGO WI 54409 383741338 HEALTH CARE WI 501(C)(3) LINE 7 LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN 0 0 1 1 1 0 0 0 1 0 1 0 1 1 1 1 1 1 1 1 COMMUNITY HEALTH FOUNDATION C 417573 FAIR MARKET VALUE