2024-05-15T09:50:31-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 260806477 ASPIRUS ONTONAGON HOSPITAL INC ASPI 9068848000 601 SEVENTH STREET ONTONAGON MI 49953 JERRY M YANG SVP - CHIEF FINANCIAL OFFICER 9068848000 2024-05-14 1 JERRY YANG 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MATTHEW HEYWOOD 2200 WESTWOOD DRIVE WAUSAU WI 54401 11495519 0 X WWW.ASPIRUS.ORG X 2007 MI WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 14 7 78 6 0 0 94311 1239616 12055078 10054931 -4597 50282 70210 69279 12215002 11414108 1000 5061 0 0 6183316 5424869 0 0 0 7932896 7551683 14117212 12981613 -1902210 -1567505 7267316 6154218 6547737 4859172 719579 1295046 X WE HEAL PEOPLE, PROMOTE HEALTH AND STRENGTHEN COMMUNITIES. 0 0 8568339 5061 10117721 ASPIRUS ONTONAGON HOSPITAL, INC. (AOH) OPERATES SEVERAL HEALTHCARE SERVICE LINES INCLUDING AN 18-BED CRITICAL ACCESS HOSPITAL AND A PHYSICIAN CLINIC. AOH STRIVES TO OFFER THE BEST CARE POSSIBLE TO THE RESIDENTS OF ONTONAGON COUNTY AND THE SURROUNDING AREA. AOH IS COMMITTED TO KEEPING HEALTHCARE DECISIONS LOCAL TO PROVIDE A SUCCESSFUL COMMUNITY HOSPITAL FOR GENERATIONS TO COME. FOR THE YEAR ENDED JUNE 30, 2023, AOH SERVICED THE COMMUNITY THROUGH 285 INPATIENT DAYS, 403 SWING BED INPATIENT DAYS, AND 12,323 OUTPATIENT VISITS. IN ADDITION, THE FAMILY PRACTICE CLINIC HAD 4,173 VISITS AND THE ONCOLOGY CLINIC HAD 143 VISITS.AOH PROVIDES A SIGNIFICANT AMOUNT OF SERVICES TO PATIENTS UNDER ITS CHARITY CARE POLICY OR TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS. THESE PROGRAMS OFTEN REIMBURSE AOH AT RATES WELL BELOW THE COST OF CARING FOR THESE INDIVIDUALS. ADDITIONAL INFORMATION ON THE COST OF PROVIDING THIS CARE CAN BE FOUND IN SCHEDULE H TO THE FORM 990. 8568339 1 1 0 1 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 1 1 0 0 1 0 0 78 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JERRY M YANG 7158472250 2200 WESTWOOD DRIVE WAUSAU WI 54401 X JOHN PIETILA BOARD MEMBER/RADIOLOGIST 1.00 40.00 X 0 876739 57266 JESSE TISCHER SVP & PRESIDENT-REGIONAL MARKETS 1.00 50.00 X 0 781575 128595 DANIEL LUKES DO BOARD MEMBER/PHYSICIAN 1.00 50.00 X 0 802805 46236 JENNIFER REDMAN-SCHELL VICE CHAIR/SVP & PRESIDENT-AMG 1.00 50.00 X X 0 641148 101726 JONATHAN BRUEGGEMAN BOARD MEMBER/DIRECTOR REGIONAL MED 1.00 50.00 X 0 450639 55802 PATRICK TINCHER JR BOARD MEMBER/VP FINANCE-REGIONAL OPS 1.00 50.00 X 0 336475 56521 KRISTEN D MESKE NP-C DIRECTOR/NURSE PRACTITIONER 1.00 50.00 X 0 136910 5756 JOHN D MATONICH CHAIR 1.00 3.00 X X 0 0 0 STEVEN J TINTI TREASURER 1.00 3.00 X X 0 0 0 KATIE L CLARK SECRETARY 1.00 3.00 X X 0 0 0 RICHARD J KOUBEK BOARD MEMBER 1.00 3.00 X 0 0 0 ROBIN MENEZUGGO BOARD MEMBER 1.00 3.00 X 0 0 0 JAMES R RICHARDSON BOARD MEMBER 1.00 3.00 X 0 0 0 KIRK R SCHOTT BOARD MEMBER/PHYSICIAN 1.00 3.00 X 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 2.00 50.00 X 0 1799938 311110 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 2.00 50.00 X 0 1911464 144118 CHRISTINE HARFF (NV) PRESIDENT-REGIONAL UP 1.00 50.00 X 0 459422 103257 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 2.00 50.00 X 0 672916 123676 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 2.00 50.00 X 0 539401 110893 TODD RICHARDSON SVP & CHIEF INFO. OFF. (THRU 06/23) 2.00 50.00 X 0 534868 104438 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP 2.00 50.00 X 0 519926 106843 CONSTANCE BRADLEY SVP-SYSTEM CHIEF NURSING EXECUTIVE 2.00 50.00 X 0 502032 95550 DEBRA BALL SVP & CHIEF HR OFFICER 2.00 50.00 X 0 458839 103553 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 2.00 50.00 X 0 321116 49427 SCOTT REMMICH VP- CHIEF COMPLIANCE OFFICER 2.00 50.00 X 0 304493 45336 ANDREW COSTIC VP-FINANCE UP REGION 2.00 50.00 X 0 272701 24274 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 2.00 50.00 X 0 348443 48718 KASEY BURKE NURSE PRACTITIONER 40.00 X 103126 0 41794 RYON HOKENS MANAGER-THERAPY SERVICES 40.00 X 105102 0 34031 SHELLY DINSMOORE REGISTERED NURSE 40.00 X 113988 0 19025 DIVIS KHAIRA PHYSICIAN 40.00 X 0 626739 52556 WENDY ANGELO FORMER BOARD MEMBER/VP-CMO-POP. HEALTH 2.00 50.00 X 0 323910 45979 322216 13622499 2016480 3 1 1 0 WAPITI MEDICAL GROUP LIMITED 107 FLYNN DRIVE SUITE 600 MILBANK SD 57252 CONTRACTED ER PHYSICIANS 907377 MICHAEL BRAD CLEARLOCK 7501 BEACHVIEW DRIVE SOUTH HAVEN MI 49090 CONTRACTED ER PHYSICIANS 387953 HAMMEL GREEN AND ABRAHAMSON INC 410 DEWEY STREET WISCONSIN RAPIDS WI 544958080 ARCHITECTURE AND ENGINEERING 224381 RENOVO SOLUTIONS LLC 4 EXECUTIVE CIRCLE SUITE 185 IRVINE CA 92614 EQUIPMENT MAINTENANCE 182333 STAFFENCY 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACTED X-RAY TECH 116699 5 1235042 4574 1239616 NET PATIENT REVENUE 621110 9961168 9961168 CONTRACT SERVICE REVENUE 621110 46340 46340 340B REVENUE 456110 30953 30953 16470 16470 10054931 79351 79351 6489 0 6489 6489 6489 52342 81411 -29069 -29069 -29069 FOOD SERVICE REVENUE 722514 62790 62790 62790 11414108 10117721 0 56771 X 5061 5061 4304149 3392203 911946 99271 83557 15714 731093 518155 212938 290356 223931 66425 181567 181567 1110 1110 2320861 2171924 148937 50567 117 50450 7686 4193 3493 49778 37655 12123 267057 43065 223992 47900 27151 20749 83430 80270 3160 842148 818551 23597 88134 88134 CORPORATE ALLOCATION 1935856 22119 1913737 MEDICAL SUPPLIES 782610 731406 51204 REPAIRS & MAINTENANCE 335040 277695 57345 HOSPITAL ASSESSMENT PAY 282855 282855 275084 131286 143798 12981613 8568339 4413274 0 1857130 2525921 137722 193873 1568347 1411129 105244 15421 91945 90266 8927214 7017001 2548688 1910213 958240 7395 7267316 6154218 2028205 1523479 1961038 1957819 58486 0 2500008 1377874 6547737 4859172 X 707550 1271011 12029 24035 719579 1295046 7267316 6154218 X -1567505 2142972 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1110 1110 0 PART II-B, LINE 1: ASPIRUS ONTONAGON HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND MICHIGAN HOSPITAL ASSOCIATION (MHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND MHA HAVE NOTIFIED ASPIRUS ONTONAGON HOSPITAL THAT APPROXIMATELY $1,110 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 46125 46125 2738719 1420732 1317987 5769386 5596269 173117 372984 372984 1910213 RELATED PARTY PAYABLES 2 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1200000 MEDICARE REFUNDABLE ADVANCES 3860 FINANCE LEASE LIABILITY 16617 OPERATING LEASE LIABILITY 3268 ASBESTOS LIABILITY 150000 DEFERRED EXECUTIVE COMPENSATION 4127 1377874 X PART X, LINE 2: ASPIRUS HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND CONCLUDED THAT NO MATERIAL LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS AT JUNE 30, 2023. 1 1 X 1 X 1 X 1 1 1 0 1 1 68380 68380 0.00530 2070606 801346 1269260 0.09850 2138986 801346 1337640 0.10380 1007 1007 0.00010 585480 496364 89116 0.00690 5061 5061 0.00040 591548 496364 95184 0.00740 2730534 1297710 1432824 0.11120 1 52243 0 3496357 3521614 -25257 X 1 1 1 1 ASPIRUS ONTONAGON HOSPITAL INC 601 S SEVENTH STREET ONTONAGON MI 49953 WWW.ASPIRUS.ORG 1060000116 X X X X PHYSICIAN CLINIC, SKILLED NURSING FACILITY, FITNESS CENTER ASPIRUS ONTONAGON HOSPITAL INC 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS X 1 21 1 WWW.ASPIRUS.ORG/COMMUNITY-REPORTS-NEEDS 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X WWW.ASPIRUS.ORG/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 5: THE FOLLOWING DESCRIPTION IS FOR THE CHNA COMPLETED IN FY22 (SPRING 2022). THROUGHOUT THE PLANNING AND PRODUCTION OF THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT, A STEERING COMMITTEE OF COMMUNITY LEADERS AND SUBJECT MATTER EXPERTS MET REGULARLY TO DIRECT THE REPORTING PROCESS, WHICH INCLUDED THE CREATION AND DISTRIBUTION OF A SURVEY TO A RANDOM SELECTION OF RESIDENTS. FOR ASPIRUS ONTONAGON, THIS INCLUDES INPUT FROM THE WESTERN UPPER PENINSULA HEALTH DEPARTMENT AS WELL AS OTHER ASPIRUS UP HOSPITALS. REPRESENTATIVES FROM EACH ORGANIZATION COMMUNICATED IN REGULAR MEETINGS. THE KEY DATA ELEMENT IN THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT IS THE COMMUNITY SURVEY, WHICH IDENTIFIED IMPORTANT ISSUES REGARDING QUALITY OF LIFE THAT HAD NOT BEEN MEASURED BEFORE THE SURVEY WAS CONDUCTED. THE SURVEY WAS MAILED TO THOUSANDS OF HOUSEHOLDS ACROSS THE ENTIRE UPPER PENINSULA, WITH NEARLY 5,000 RESPONSES BACK FROM RESIDENTS. THE UPPER PENINSULA 2021 REGIONAL HEALTH ASSESSMENT ALSO INCLUDES A SIGNIFICANT AMOUNT OF DATA INDICATORS ACROSS MULTIPLE CATEGORIES RELATING TO HEALTH AND HEALTH FACTORS. THIS DATA WAS COMPILED FROM A WIDE ARRAY OF PUBLISHED SOURCES AND FROM HEALTH CARE PROVIDERS. PUBLISHED SOURCES INCLUDED THE U.S. CENSUS, THE AMERICAN COMMUNITY SURVEY, AND STATISTICS COMPILED BY THE MICHIGAN DEPARTMENT OF COMMUNITY HEALTH AND OTHER GOVERNMENT AND PRIVATE AGENCIES. ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 6A: FOR THE CHNA COMPLETED IN FY22 (SPRING 2022), THE HOSPITAL COLLABORATED WITH ASPIRUS IRON RIVER HOSPITAL, ASPIRUS IRONWOOD HOSPITAL, ASPIRUS KEWEENAW HOSPITAL. ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 6B: FOR THE CHNA COMPLETED IN FY22 (SPRING 2022), ASPIRUS ONTONAGON HOSPITAL COLLABORATED WITH THE WESTERN UPPER PENINSULA HEALTH DEPARTMENT. ASPIRUS ONTONAGON HOSPITAL'S CHNA WAS AUTHORED BY ASPIRUS ONTONAGON HOSPITAL. ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 11: IN FY23, ASPIRUS HEALTH CONTINUED TO COME TOGETHER AS A SYSTEM. THE ADDITION OF SEVEN HOSPITALS IN FY22 RESULTED IN CHANGES IN PROCESSES, TEAM STRUCTURE AND RELATED IMPACTS. ASPIRUS HEALTH IS WORKING TO STRATEGICALLY BUILD STRONG, EFFECTIVE COMMUNITY HEALTH EFFORTS THAT MEET LOCAL NEEDS WHILE ACCOMMODATING ECONOMIC AND OTHER PRESSURES FACING HEALTH SYSTEMS. ASPIRUS ONTONAGON HOSPITAL IS ONE OF FOUR ASPIRUS HOSPITALS IN THE UPPER PENINSULA OF MICHIGAN. THE AREA IS VERY RURAL. ASPIRUS ONTONAGON IMPLEMENTED STRATEGIES LOCALLY AND REGIONALLY, WITH THE HELP OF STAFF MEMBERS, BUT ALSO PARTNERING WITH OTHERS IN THE COMMUNITY. THE HOSPITAL'S SIGNIFICANT NEEDS ARE: MENTAL HEALTH; SUBSTANCE USE; CHRONIC DISEASES. THE HOSPITAL FACILITATES REFERRALS TO LOCAL NON-PROFIT BEHAVIORAL HEALTH SERVICES ORGANIZATIONS FOR PATIENTS WITH SIGNIFICANT MENTAL HEALTH AND SUBSTANCE USE ISSUES. THE HOSPITAL PROVIDED FUNDING FOR A LOCAL RUN, OFFERING A LOCAL OPPORTUNITY FOR PHYSICAL ACTIVITY. THE HOSPITAL PROVIDED FINANCIAL SUPPORT FOR THE ONTONAGON COUNTY CANCER ASSOCIATION THROUGH A LOCAL FUNDRAISER (LAKE TROUT CLASSIC). THE HOSPITAL PROVIDED FUNDING FOR CAMP JOSH, WHICH SERVES INDIVIDUALS WITH DISABILITIES AND VETERANS. THE HOSPITAL PARTICIPATED IN THE U.P. TOGETHER WITH VETERANS EVENT. THE HOSPITAL PARTICIPATED IN CAMP 911. CAMP 911 IS A COMMUNITY PROGRAM THAT TEACHES SCHOOL CHILDREN SEVERAL DIFFERENT SAFETY AND EMERGENCY SERVICES.THE HOSPITAL CONTRIBUTED FUNDS TO THE SUPERIOR HEALTH FOUNDATION. THE SUPERIOR HEALTH FOUNDATION'S MISSION IS 'TO ASSIST WITH UNMET HEALTHCARE NEEDS, WITH HEALTH EDUCATION, AND WITH PROGRAMS AND RESEARCH ON PREVENTING ILLNESS AND PROMOTING HEALTH IN THE UPPER PENINSULA.'- - - - - - - - - FROM THE COMMUNITY SURVEY, THE TOP-SELECTED ISSUES WERE: - HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES- DRUG ABUSE- LACK OF HEALTH INSURANCE- UNEMPLOYMENT, WAGES AND ECONOMIC CONDITIONSFROM THIS LIST, THE HOSPITAL IS ADDRESSING DRUG ABUSE (SUBSTANCE USE). THE OTHER THREE ISSUES WERE NOT SELECTED FOR THE FOLLOWING REASONS. - THE LACK OF AFFORDABLE HEALTH INSURANCE IS OF HIGH CONCERN FOR MANY PEOPLE IN THE UPPER PENINSULA. ASPIRUS PROVIDES FINANCIAL ASSISTANCE FOR PATIENTS WHO STRUGGLE TO AFFORD CARE. ASPIRUS HOSPITALS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE THE AVAILABILITY AND THE AFFORDABILITY OF HEALTH INSURANCE, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. - UNEMPLOYMENT, WAGES AND ECONOMIC CONDITIONS ARE IMPORTANT ISSUES FOR ASPIRUS. ASPIRUS WORKS TO PAY FAIR WAGES AND PROVIDE REASONABLE BENEFITS PACKAGES. ASPIRUS HOSPITALS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE ECONOMIC CONDITIONS, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE. ASPIRUS ONTONAGON HOSPITAL, INC. PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY. 1 1 - AOH FAMILY PRACTICE CLINIC 601 SOUTH SEVENTH STREET ONTONAGON MI 49953 CLINIC PART I, LINE 3C: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF THE FOLLOWING (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY): PRIMARY RESIDENCE IS EXEMPT FOR PATIENTS UNDER 200% FEDERAL POVERTY GUIDELINES. FOR THOSE OVER 200% EQUITY ALLOWANCE IS $75,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G., DAIRY FARM) IS EVALUATED INDIVIDUALLY ON A CASE-BY-CASE BASIS. CASH ASSETS IN EXCESS OF $4,000 AT THE TIME OF APPLICATION (EXCEPT FOR BALANCES INCURRED AT HOSPITALS THAT PARTICIPATE IN THE NATIONAL HEALTH SERVICE CORPS PROGRAM (NHSC) AND/OR MICHIGAN STATE LOAN REPAYMENT PROGRAM (MSLRP) WHERE THIS CRITERIA DOES NOT APPLY). SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS WHERE RETIREMENT WITHDRAWALS HAVE NOT BEGUN AND IRREVOCABLE BURIAL TRUST FUNDS. TOTAL NET ASSETS CANNOT EXCEED 800% OF FEDERAL POVERTY GUIDELINES. THIS INCLUDES ALL ASSETS INCLUDING CASH ASSETS ABOVE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990, 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 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDED THE INPATIENT UNIT WITH COSTS OF $585,480 AND DIRECT OFFSETTING REVENUE OF $496,364. THE SUBSIDIZED HEALTH SERVICES COSTS WERE ESTIMATED USING AN OVERALL COST TO CHARGE RATIO. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $90,732. PART III, LINE 2: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLES ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES. THE COSTING METHODOLOGY USED WAS THE PATIENT CARE COST TO CHARGE RATIO WHICH WAS DERIVED FROM THE CALCULATION ON IRS WORKSHEET 2. PART III, LINE 3: THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. PART III, LINE 4: THE PROVISION FOR BAD DEBTS IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTION CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON THESE TRENDS. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. ACCOUNTS RECEIVABLES ARE WRITTEN OFF AFTER ALL COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH ASPIRUS' POLICIES.BAD DEBT POLICY AND PROCEDURE:POLICY: I. ASPIRUS' FINANCIAL POLICY REQUIRES SETTLEMENT OF A PATIENT SELF-PAY BILL OR ACCOUNT WILL BE REFERRED FOR OUTSIDE COLLECTION. II. FAILURE TO MEET THESE REQUIREMENTS IN ASPIRUS POLICY WILL RESULT IN THE ACCOUNT BEING CONSIDERED FOR BAD DEBT ONCE ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED. THE ACCOUNT WILL BE REMOVED FROM ACCOUNTS RECEIVABLE AND TURNED OVER TO AN OUTSIDE AGENCY OR LAW FIRM FOR COLLECTION. PRIOR TO THIS HAPPENING, THE FOLLOWING CRITERIA MUST BE MET: A. PATIENT FINANCIAL SERVICES STAFF WILL MAKE REASONABLE COLLECTION EFFORTS BY WAY OF: 1. MONTHLY STATEMENTS 2. COLLECTION LETTERS INCLUDING PLAIN LANGUAGE SUMMARY (PLS) 3. COLLECTION PHONE CALLS 4. VERIFICATION THAT CHARITY CARE WAS OFFERED WITHIN THE PAST 12-MONTHS AS RECORDED IN THE ELECTRONIC HEALTH RECORD (EMR) WITH STAFF HAVING THE DISCRETION TO OFFER AGAIN WITHIN THE 12-MONTHS. III. ALL COLLECTION ACTIVITY AND PATIENT CONTACTS WILL BE DOCUMENTED ON THE INDIVIDUAL ACCOUNTS. IV. ALL COLLECTION ACCOUNTS ARE TO BE TREATED THE SAME REGARDLESS OF PAYOR TYPE: SELF-PAY, GENERAL INSURANCE, MEDICARE, OR MEDICAL ASSISTANCE. V. PATIENT FINANCIAL SERVICES STAFF WILL USE SOUND BUSINESS JUDGMENT WHEN WORKING WITH THE ACCOUNT. AT THE DISCRETION OF THE FINANCIAL COUNSELOR, CREDIT REPORTS WILL BE REQUESTED FROM THE CREDIT BUREAU AND PROPERTY VERIFICATION OBTAINED THROUGH THE COUNTY TREASURER'S OFFICE. PROCEDURE: VI. THE FINAL STEP IS TO SUBMIT THE ACCOUNT TO A COLLECTION AGENCY OR LAW FIRM. EACH ACCOUNT IS REVIEWED TO DETERMINE IF THE ACCOUNT HAS MET THE BAD DEBT CRITERIA. ONCE IT HAS BEEN DETERMINED THAT ALL REQUIREMENTS HAVE BEEN MET, THE ACCOUNT IS TRANSFERRED FROM ACCOUNTS RECEIVABLE TO BAD DEBT BY THE FINANCIAL COUNSELOR. SPECIFIC PROCEDURES PERTAINING TO THE DETAILED PROCEDURAL STEPS FOR TRANSFERRING TO THE AGENCY CAN BE FOUND IN THE INTERNAL POLICY. A. ADDITIONAL INFORMATION REGARDING MEDICARE BAD DEBTS: 1. THE DEBT MUST BE RELATED TO COVERED SERVICES AND DERIVED FROM DEDUCTIBLE AND COINSURANCE AMOUNTS. 2. THE HOSPITAL MUST PROVIDE REASONABLE COLLECTION EFFORTS. 3. THE DEBT IS NOT COLLECTABLE (AT LEAST 120 DAYS OUTSTANDING FROM THE DATE OF THE LAST PATIENT PAYMENT.) 4. SOUND BUSINESS JUDGMENT ESTABLISHES THAT THERE WAS NO LIKELIHOOD OF RECOVERY AT ANY TIME IN THE FUTURE. B. BAD DEBT RECOVERIES 1. PAYMENTS ON MONTHLY REMITTANCE ADVICES FROM OUTSIDE COLLECTION AGENCIES WILL BE POSTED TO EACH INDIVIDUAL ACCOUNT. 2. PAYMENTS MADE DIRECTLY TO ASPIRUS BUT INTENDED FOR COLLECTION ACCOUNTS WILL BE POSTED TO THE APPROPRIATE ACCOUNT AND REPORTED DAILY/WEEKLY TO COLLECTION AGENCIES FOR RECONCILIATION OF THEIR RECORDS. 3. INVOICES FOR COMMISSIONS DUE TO COLLECTION AGENCIES WILL BE PROCESSED MONTHLY. INVOICE AND REMITTANCE ADVICE WILL BE REVIEWED BY THE FINANCIAL COUNSELOR TEAM LEAD AND APPROVED BY THE MANAGER/DIRECTOR, THEN SUBMITTED TO FISCAL SERVICES FOR CHECK PROCESSING AND PAYMENT TO AGENCIES FOR COMMISSIONS DUE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULES AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND SURGICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND THEREFORE THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2023 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: PATIENT FINANCIAL SERVICES (PFS) PROACTIVELY IDENTIFIES UNINSURED PATIENTS AND UNDER-INSURED PATIENTS AND SCREENS THEM FOR FINANCIAL ASSISTANCE AND COUNSELING WITHOUT REGARD TO RACE, ETHNICITY, GENDER, RELIGION, OR NATIONAL ORIGIN. THESE SERVICES ARE PROVIDED AT NO CHARGE. PFS COUNSELORS WORK WITH UNINSURED AND UNDER-INSURED PATIENTS TO HELP THEM UNDERSTAND THE SYSTEM'S FINANCIAL ASSISTANCE/DISCOUNTING POLICIES AND HOW THEY CAN QUALIFY FOR ASSISTANCE AND/OR DISCOUNTS INCLUDING A REFERRAL TO PUBLIC AND PRIVATE PROGRAMS TO DETERMINE ELIGIBILITY. PART VI, LINE 2: IN ADDITION TO ASSESSING NEEDS THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL:- SYSTEMATICALLY REVIEWS PATIENT EXPERIENCE DATA TO UNDERSTAND OPPORTUNITIES TO ADDRESS PATIENT CONCERNS. - MAINTAINS AN INVOLVED LOCAL BOARD OF DIRECTORS, WHICH MEETS NEARLY MONTHLY. HOSPITAL BOARD MEMBERS ARE FROM MULTIPLE SECTORS, INCLUDING ACADEMIC, LAW AND MEDICAL FIELDS.- SUPPORTS ITS STAFF IN PARTICIPATING ON COMMUNITY BOARDS AND COMMITTEES THAT PROVIDE INSIGHT ON LOCAL CIRCUMSTANCES.- REVIEWS FUNDING REQUESTS TO THE HOSPITAL AND THE HOSPITAL FOUNDATION AS AN INDICATOR OF LOCAL NEEDS.- INITIATED A SOCIAL NEEDS SCREENING PROCESS THAT, OVER TIME, WILL PROVIDE INSIGHT INTO PATIENT NEEDS IN ADDITION TO THEIR IMMEDIATE CARE. PART VI, LINE 3: ALL PATIENT STATEMENTS PROVIDE INFORMATION REGARDING THE ASPIRUS FINANCIAL AID PROGRAM. THIS INCLUDES A TELEPHONE NUMBER TO REQUEST IN-PERSON ASSISTANCE, INFORMATION ABOUT THE PROGRAM AS WELL AS TO REQUEST AN APPLICATION. THE STATEMENT ALSO PROVIDES THE WEB ADDRESS WHICH DIRECTS PATIENTS TO OUR FINANCIAL AID POLICY AS WELL AS THE APPLICATION AND PLAIN LANGUAGE SUMMARY. LETTERS FROM CENTRAL BILLING OFFICE STAFF INFORM PATIENTS THAT ASPIRUS HAS A FAP. THE FAP IS OFFERED AT THE TIME OF REGISTRATION ANNUALLY TO ALL PATIENTS. IF ASPIRUS FINANCIAL COUNSELORS NOTICE THE PATIENT HAS NOT BEEN OFFERED AN APPLICATION WITHIN THE PAST YEAR, THEY WILL ALSO ASK IF THE PATIENT WOULD LIKE ONE MAILED OR IF THE PATIENT SHOWS FINANCIAL DISTRESS. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS, WHEN APPLICABLE. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. ELEVATE PFS (CONTRACTED ENTITY) IS USED TO REVIEW ALL PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS. PART VI, LINE 4: ASPIRUS ONTONAGON HOSPITAL IS ONE OF FOUR ASPIRUS SYSTEM HOSPITALS IN A 5-COUNTY RURAL REGION OF THE UPPER PENINSULA OF MICHIGAN. THE 5-COUNTY REGION INCLUDES HOUGHTON, KEWEENAW, ONTONAGON, IRON AND GOGEBIC COUNTIES. ASPIRUS ONTONAGON HOSPITAL IS LOCATED IN ONTONAGON COUNTY. ONTONAGON COUNTY COVERS 1311 SQUARE MILES, WITH 5.2 PEOPLE PER SQUARE MILE AND AN OVERALL POPULATION OF 5868 PEOPLE. HERE ARE SOME DETAILS ABOUT ITS POPULATION: PERSONS UNDER AGE 18: 12.5%PERSONS 65 YEARS AND OVER: 37.7%WHITE PERSONS: 96.0%AFRICAN AMERICAN PERSONS: 0.3%AMERICAN INDIAN PERSONS: 1.5%ASIAN PERSONS: 0.6%TWO OR MORE RACES: 1.6%HISPANIC OR LATINO: 1.6%LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME: 1.6%ADULTS AGES 25 AND OVER WITH A HIGH SCHOOL DIPLOMA OR EQUIVALENT: 92.6% PERSONS IN POVERTY: 14.7%MEDIAN HOUSEHOLD INCOME: $41,776PERCENT UNINSURED: 8%PERCENT USING PUBLIC INSURANCE (MEDICAID, MEDICARE, VETERANS BENEFITS, ETC.): 59.4% NUMBER OF HOSPITALS IN THE COUNTY: 1 (ONLY ASPIRUS) THE COUNTY IS A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY CARE, MENTAL HEALTH AND DENTAL HEALTH. THE COUNTY IS ALSO DESIGNATED AS MEDICALLY UNDERSERVED. PART VI, LINE 5: THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH ITS COMMUNITY HEALTH AND COMMUNITY BENEFIT WORK. ADDITIONALLY, THE HOSPITAL: - MAINTAINS A REGIONAL BOARD OF DIRECTORS THAT REFLECTS THE COMMUNITY AND THE REGION. - BRINGS ITS EXPERTISE INTO THE COMMUNITY THROUGH PROGRAMS, SCREENINGS, AND COMMUNITY BOARD AND ADVISORY COMMITTEE MEMBERSHIP.- PROVIDES HIGH QUALITY SERVICES AND IMPLEMENTS ONGOING QUALITY IMPROVEMENT INITIATIVES. - BUDGETS FOR CUTTING EDGE TECHNOLOGIES AND EQUIPMENT THAT SUPPORT PATIENT HEALTH.- OFFERS RESOURCES AND/OR REFERRALS FOR TRANSPORTATION ASSISTANCE FOR PATIENTS AS APPROPRIATE. - FACILITATES BLOOD DRIVES. AS PART OF A LARGER NETWORK OF ASPIRUS HEALTHCARE FACILITIES, THE HOSPITAL HAS ACCESS TO: - LOW-COST TEMPORARY LODGING AT ASPIRUS' FLAGSHIP TERTIARY CARE HOSPITAL PARTNER (IN WAUSAU, WI) SO THAT PATIENTS AND/OR THEIR FAMILY NEEDING EXTENDED SPECIALTY CARE HAVE ACCOMMODATIONS. - PROFESSIONAL DEVELOPMENT FOR STAFF, ASSURING THE CARE PROVIDED INCORPORATES THE MOST UP-TO-DATE BEST PRACTICES. - CROSS-TRAINING OPPORTUNITIES. FOR INSTANCE, A WAUSAU-BASED BEREAVEMENT COORDINATOR TRAINS STAFF ACROSS THE SYSTEM ON NORMAL GRIEF RESPONSE, RESILIENCE AND HOSPICE CARE AND SUPPORT. THE COORDINATOR TRAINS THROUGH THE NURSE RESIDENCY PROGRAM AS WELL AS IN UNIT/DEPARTMENT MEETINGS. UNIT/DEPARTMENT LEADERS CAN REQUEST BEREAVEMENT INFORMATION AND SUPPORT FOR THEIR TEAM. SIMILARLY, HOSPITALS HAVE ACCESS TO INJURY PREVENTION EXPERTISE AND RESOURCES THROUGH THE LEVEL 2 TRAUMA CENTER IN WAUSAU. - A MARKETING/COMMUNICATIONS TEAM THAT SUPPORTS THE ONLINE ASPIRUS MEDIA CENTER FEATURING MEDICAL EXPERTS. THE TEAM DEVELOPS AND PROMOTES HEALTH EDUCATION INFORMATION (E.G., ON DIABETES, TICK BITES, SNOWMOBILE SAFETY) FOR PATIENTS AND THE GENERAL PUBLIC. PART VI, LINE 6: ASPIRUS HEALTH IS A NON-PROFIT, COMMUNITY-DIRECTED HEALTHCARE SYSTEM BASED IN WAUSAU, WISCONSIN. ITS 11,000 EMPLOYEES ARE FOCUSED ON IMPROVING THE HEALTH AND WELL-BEING OF PEOPLE THROUGHOUT WISCONSIN AND UPPER MICHIGAN. ASPIRUS SERVES COMMUNITIES THROUGH FOUR HOSPITALS IN MICHIGAN AND 13 HOSPITALS IN WISCONSIN, 75 CLINICS, HOME HEALTH AND HOSPICE CARE, PHARMACIES, CRITICAL CARE AND AIR-MEDICAL TRANSPORT, MEDICAL GOODS, NURSING HOMES AND A BROAD NETWORK OF PHYSICIANS. THE COMBINED EFFORTS ARE ABLE TO PROVIDE SMALLER COMMUNITIES WITH THE ACCESS TO CARE THAT THEY MAY NOT OTHERWISE BE ABLE TO HAVE. FOR MORE INFORMATION, VISIT ASPIRUS.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES MI 0 1 0 0 0 0 0 0 0 MATTHEW HEYWOOD PRESIDENT & CEO ASPIRUS 0 1228335 0 567185 0 4418 0 18619 0 292491 0 2111048 0 0 SIDNEY SCZYGELSKI SR. VP OF FINANCE/CFO 0 649845 0 1057600 0 204019 0 20794 0 123324 0 2055582 0 195109 JOHN PIETILA BOARD MEMBER/RADIOLOGIST 0 845370 0 26000 0 5369 0 20519 0 36747 0 934005 0 0 JESSE TISCHER SVP & PRESIDENT-REGIONAL MARKETS 0 580082 0 150199 0 51294 0 18561 0 110034 0 910170 0 50242 DANIEL LUKES DO BOARD MEMBER/PHYSICIAN 0 795483 0 0 0 7322 0 17894 0 28342 0 849041 0 0 MICHAEL HOLZHUETER SVP-GENERAL COUNSEL 0 479018 0 135622 0 58276 0 18672 0 105004 0 796592 0 55822 JENNIFER REDMAN-SCHELL VICE CHAIR/SVP & PRESIDENT-AMG 0 490009 0 148789 0 2350 0 17929 0 83797 0 742874 0 0 DIVIS KHAIRA PHYSICIAN 0 614082 0 0 0 12657 0 17894 0 34662 0 679295 0 0 JAMES MATHESON SVP-CHIEF STRATEGY OFFICER 0 386985 0 110566 0 41850 0 17683 0 93210 0 650294 0 32339 TODD RICHARDSON SVP & CHIEF INFO. OFF. (THRU 06/23) 0 378807 0 112026 0 44035 0 18079 0 86359 0 639306 0 39964 ERIC ANDERSON SVP-SERVICE LINE & PATIENT EXP 0 399954 0 117991 0 1981 0 17740 0 89103 0 626769 0 0 CONSTANCE BRADLEY SVP-SYSTEM CHIEF NURSING EXECUTIVE 0 385875 0 113420 0 2737 0 16421 0 79129 0 597582 0 0 CHRISTINE HARFF (NV) PRESIDENT-REGIONAL UP 0 338109 0 82831 0 38482 0 19524 0 83733 0 562679 0 34464 DEBRA BALL SVP & CHIEF HR OFFICER 0 349805 0 106987 0 2047 0 13179 0 90374 0 562392 0 0 JONATHAN BRUEGGEMAN BOARD MEMBER/DIRECTOR REGIONAL MED 0 410123 0 39958 0 558 0 17584 0 38218 0 506441 0 0 CRYSTAL KIRSCHLING VP-REGIONAL INTEGRATION OFFICER 0 291308 0 56573 0 562 0 12036 0 36682 0 397161 0 0 PATRICK TINCHER JR BOARD MEMBER/VP FINANCE-REGIONAL OPS 0 278727 0 49894 0 7854 0 18549 0 37972 0 392996 0 0 WILLIAM CARROLL VP-INFORMATION TECHNOLOGY 0 267466 0 51102 0 2548 0 18436 0 30991 0 370543 0 0 WENDY ANGELO FORMER BOARD MEMBER/VP-CMO-POP. HEAL 0 284641 0 37733 0 1536 0 15352 0 30627 0 369889 0 0 SCOTT REMMICH VP- CHIEF COMPLIANCE OFFICER 0 251612 0 49272 0 3609 0 17778 0 27558 0 349829 0 0 ANDREW COSTIC VP-FINANCE UP REGION 0 232506 0 37668 0 2527 0 16343 0 7931 0 296975 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, THE FILING ORGANIZATION, ASPIRUS ONTONAGON HOSPITAL, INC. RELIED ON THE RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICES, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT 457(F) DISTRIBUTION: S. SCZYGELSKI $195,109 C. HARFF $34,464 J. TISCHER $50,242 J. MATHESON $32,339 M. HOLZHUETER $55,822 T. RICHARDSON $39,964 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: 13% FOR SENIOR VICE PRESIDENT OR PRESIDENT, 15% FOR SVP & CHIEF FINANCIAL OFFICER, AND 20% FOR THE PRESIDENT & CHIEF EXECUTIVE OFFICER. IF A PARTICIPANT TERMINATES DURING THE YEAR, THE PARTICIPANT'S EXECUTIVE ALLOWANCE IS PRORATED BASED ON THE NUMBER OF FULL CALENDAR MONTHS FROM THE BEGINNING OF THE PLAN YEAR TO THE BEGINNING OF THE CALENDAR YEAR MONTH CLOSEST TO THE CHANGE OR TERMINATION OF EMPLOYMENT. DISTRIBUTIONS: CONTINUATION OF EMPLOYMENT THROUGH THE DEFERRED VESTING DATE; THE DATE ON WHICH THE PARTICIPANT'S EMPLOYMENT IS TERMINATED AS A RESULT OF DEATH OR DISABILITY; 24 MONTHS FROM THE DATE ON WHICH THE PARTICIPANT INCURS AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT REASONABLE CAUSE OR THE DATE THAT IS 24 MONTHS FOLLOWING THE PARTICIPANT'S SEPARATION FROM SERVICE, BUT ONLY IF THE PARTICIPANT'S INTEREST HAS NOT BEEN FORFEITED FOR COMPETITION DURING SUCH 24 MONTH PERIOD AND THE PARTICIPANT HAS NOT ENGAGED IN COMPETITION AFTER HIS OR HER SEPARATION FROM SERVICE AND PRIOR TO HIS OR HER DEATH, THE PARTICIPANT SHALL BE VESTED AT HIS OR HER DATE OF DEATH. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DC53 2017-11-02 2000000 NEW CONSTRUCTION 0 0 0 A 2000000 22246 1977754 2017 0 0 1 1 A 0 0 1 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 PART VI: THE PROCEEDS OF THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE BONDS, SERIES 2017 (ASPIRUS, INC. OBLIGATED GROUP) WERE BORROWED BY THE FOLLOWING ORGANIZATIONS: ASPIRUS WAUSAU HOSPITAL, INC. (EIN 39-1138241); ASPIRUS RIVERVIEW HOSPITAL & CLINICS, INC. (EIN 39-0868982); ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC. (EIN 38-2908586); AND ASPIRUS ONTONAGON HOSPITAL, INC. (EIN 26-0806477). INFORMATION REGARDING THE SERIES 2017 BONDS IS REPORTED IN THE SCHEDULE K FOR EACH ORGANIZATION. [THE INFORMATION REPORTED IN PART I, PART II AND PART III RELATES ONLY TO THE PORTION OF THE SERIES 2017 BONDS LOANED TO THE ORGANIZATION. THE INFORMATION REPORTED IN PART IV RELATES TO THE ENTIRE ISSUE OF THE SERIES 2017 BONDS.] PART III, LINE 3A AND 3B ASPIRUS, INC., THE PARENT ORGANIZATION OF ASPIRUS ONTONAGON HOSPITAL, INC., HAS POLICIES AND PROCEDURES IN PLACE TO REVIEW LEASE AGREEMENTS, MANAGEMENT, AND SERVICE CONTRACTS TO IDENTIFY AGREEMENTS THAT MAY RESULT IN PRIVATE BUSINESS USE OF BOND-FINANCED PROPERTY. ON A CONTRACT BY CONTRACT BASIS, ASPIRUS, INC. WILL SEEK HELP FROM BOND COUNSEL AS MANAGEMENT DEEMS NECESSARY. PART III, LINE 9 SUPPLEMENTAL INFORMATION ON TAX EXEMPT BONDS: POLICY STATES THAT WE WILL SEEK BOND COUNSEL OPINION ON ALL REMEDIAL ACTIONS. FORM 990, PART VI, SECTION A, LINE 6 THE PARENT ORGANIZATION, ASPIRUS, INC., IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THERE SHALL BE A MINIMUM OF 6 VOTING DIRECTORS ALLOCATED AS FOLLOWS. THERE SHALL BE THREE CLASSES OF VOTING DIRECTORS: THE ASPIRUS CLASS, COMMUNITY CLASS, AND THE PROVIDER CLASS. NO LESS THAN THREE INDEPENDENT COMMUNITY CLASS DIRECTORS, TWO ASPIRUS CLASS DIRECTORS NOMINATED AND ELECTED BY ASPIRUS, INC., ONE PROVIDER CLASS DIRECTOR NOMINATED BY THE CORPORATION'S BOARD AND ELECTED BY ASPIRUS, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE MEMBERS OF THE ORGANIZATION 1) CHANGE OR AMEND THE ARTICLES OF INCORPORATION OR BYLAWS; 2) CHANGE THE MISSION, PURPOSE, OR SCOPE OF THE CORPORATION; 3) RATIFICATION OR REMOVAL OF DIRECTORS OR OFFICER; 4) CHANGE THE FORMULA OR METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION; 5) APPROVAL OF ANNUAL OPERATING AND CAPITAL EXPENDITURE BUDGETS, STRATEGIC AND LONG-RANGE PLANS. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT ACCUMULATES ALL FORM 990 INFORMATION, INCLUDING THE UBI CALCULATIONS. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE FORM 990 IS REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND IS 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 ORGANIZATION'S CEO AND BOARD CHAIR REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTION WHERE A CONFLICT HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, ASPIRUS ONTONAGON HOSPITAL, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, NOR ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, LINE 1A, EXPLANATION FOR HOURS WORKED: SOME OFFICERS AND DIRECTORS ALSO PROVIDED SERVICE TO OTHER RELATED ORGANIZATIONS OTHER THAN ASPIRUS ONTONAGON HOSPITAL, INC. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. FORM 990, PART IX, LINE 11G LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 124,962. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 124,962. CONTRACT NURSING AND OTHER LABOR: PROGRAM SERVICE EXPENSES 1,475,907. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,475,907. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 571,055. MANAGEMENT AND GENERAL EXPENSES 148,937. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 719,992. FORM 990, PART XI, LINE 9: UNRESTRICTED NET ASSET TRANSFERS - AWH 47,235. UNRESTRICTED NET ASSET TRANSFERS - AI 1,350,984. UNRESTRICTED NET ASSET TRANSFERS - AER 32. UNRESTRICTED NET ASSET TRANSFERS - ACI 192,895. UNRESTRICTED NET ASSET TRANSFERS - VNA -1,419. UNRESTRICTED NET ASSET TRANSFERS - AIW -7,307. UNRESTRICTED NET ASSET TRANSFERS - AIR 92,644. UNRESTRICTED NET ASSET TRANSFERS - AKH 457,988. UNRESTRICTED NET ASSET TRANSFERS - ASP 9,726. UNRESTRICTED NET ASSET TRANSFERS - ARN 182. UNRESTRICTED NET ASSET TRANSFERS - HYMC 14. OTHER CHANGES IN NET ASSETS -2. ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391328331 HEALTHCARE WI 501 (C) 3 LINE 12B, II N/A 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391138241 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS BUILDINGS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391406537 PROPERTY LEASING WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS EXTENDED SERVICES INC 333 PINE RIDGE BLVD WAUSAU WI 54401 390782130 NURSING HOME SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS MEDICAL GROUP INC 333 PINE RIDGE BLVD WAUSAU WI 54401 391670223 MEDICAL SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA HOME HEALTH INC 520 N 32ND AVENUE WAUSAU WI 54401 390808511 HOME HEALTH CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS INC 1 ASPIRUS VNA EXTENDED CARE INC 520 N 32ND AVENUE WAUSAU WI 54401 391597350 PERSONAL CARE SERVICES WI 501 (C) 3 LINE 10 ASPIRUS VNA HOME HEALTH INC 1 ASPIRUS HEALTH FOUNDATION INC 425 PINE RIDGE BLVD WAUSAU WI 54401 391256656 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS IRON RIVER HOSPITAL & CLINICS INC 1400 W ICE LAKE ROAD IRON RIVER MI 49935 383236977 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS IRONWOOD HOSPITAL & CLINICS INC N 10561 GRAND VIEW LANE IRONWOOD MI 49938 382908586 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS RIVERVIEW HOSPITAL & CLINICS INC 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 390868982 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS KEWEENAW HOSPITAL 205 OSCEOLA STREET LAURIUM MI 49913 381443361 HOSPITAL MI 501 (C) 3 LINE 3 ASPIRUS INC 1 DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTGAGE WI 53901 390806250 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD HOSPITAL & CLINICS INC 135 S GIBSON STREET MEDFORD WI 54451 390964813 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MEDFORD FOUNDATION INC 135 S GIBSON STREET MEDFORD WI 54451 391777081 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 7 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL & CLINICS INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 390808443 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS STEVENS POINT HOSPITAL FOUNDATION INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 391657410 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS STANLEY HOSPITAL & CLINICS INC 1120 PINE STREET STANLEY WI 54768 390807065 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL & CLINICS INC 601 S CENTER AVENUE MERRILL WI 54452 390808503 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS MERRILL HOSPITAL FOUNDATION INC 601 S CENTER AVENUE MERRILL WI 54452 391627755 CHARITABLE FOUNDATION WI 501 (C) 3 LINE 12A, I ASPIRUS INC 1 ASPIRUS RHINELANDER & TOMAHAWK HOSPITAL & CLINICS INC 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391390638 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 ASPIRUS EAGLE RIVER HOSPITAL & CLINICS INC 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 THE HOWARD YOUNG MEDICAL CENTER INC 240 MAPLE STREET WOODRUFF WI 54568 390873606 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 HOWARD YOUNG HEALTH CARE INC 240 MAPLE STREET WOODRUFF WI 54568 391499115 HEALTHCARE WI 501 (C) 3 LINE 12B, II ASPIRUS INC 1 ASPIRUS MEDICAL GROUP - NORTHERN WISCONSIN 2251 NORTH SHORE DRIVE RHINELANDER WI 54501 391965593 HOSPITAL WI 501 (C) 3 LINE 3 ASPIRUS INC 1 WESTERN UPPER MICHIGAN EYE CARE LLC 131 W GENESEE STREET IRON RIVER MI 49935 272324957 EYE CARE SERVICES MI N/A 0 0 THE WESTWOOD CONFERENCE CENTER LLC 333 PINE RIDGE BLVD WAUSAU WI 54401 571184256 REAL ESTATE INVESTMENT WI N/A 0 0 ASPIRUS NETWORK INC 3000 WESTHILL DRIVE 202 WAUSAU WI 54401 391931678 HEALTH CARE SERVICES WI N/A C 1 ASPIRUS KEWEENAW ENTERPRISES INC 205 OSCEOLA STREET LAURIUM MI 49913 383390273 PHARMACY MI N/A C 1 ASPIRUS HEALTH VENTURES 3000 WESTHILL DR SUITE 303 WAUSAU WI 54401 474925640 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF WI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 364832569 HEALTH INSURANCE PLAN WI N/A C 1 ASPIRUS ARISE HEALTH PLAN OF MI INC 300 WESTHILL DR SUITE 303 WAUSAU WI 54401 475448266 HEALTH INSURANCE PLAN MI N/A C 1 ASPIRUS CAMPUS CONDOMINIUM OWNERS ASSOCIATION INC 2200 WESTWOOD DRIVE WAUSAU WI 54401 842513742 ASSOCIATION WI N/A C 0 0 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 ASPIRUS KEWEENAW HOSPITAL P 523207 COST ASPIRUS KEWEENAW HOSPITAL S 100000 COST ASPIRUS INC C 941632 COST ASPIRUS INC M 1949275 COST ASPIRUS INC O 5146362 COST ASPIRUS INC P 4152423 COST ASPIRUS INC S 1651758 COST ASPIRUS MEDICAL GROUP INC O 196802 COST