4A (Expenses $ 485060863 including grants of $ 281000) (Revenue $ 672643680)
ASPIRUS WAUSAU HOSPITAL, INC. PROVIDES HOSPITAL SERVICES FOR RESIDENTS OF WAUSAU, STEVENS POINT AND THE SURROUNDING COMMUNITIES REGARDLESS OF THEIR ABILITY TO PAY.

ASPIRUS WAUSAU HOSPITAL, INC.
PART V, SECTION B, LINE 5: YES. WE CONDUCTED A COMMUNITY SURVEY DEVELOPED AND IMPLEMENTED BY THE UW RIVER FALLS SURVEY RESEARCH CENTER. 1434 SURVEYS WERE MAILED TO RANDOM HOUSEHOLDS IN MARATHON COUNTY WITH 25% OF SURVEYS TARGETING UNDERREPRESENTED POPULATIONS. 100 SURVEYS WERE DISTRIBUTED TO SELECTED MARATHON COUNTY NON-PROFIT PARTNERS BY UNITED WAY OF MARATHON COUNTY. A COMMUNITY ADVISORY COMMITTEE TO LOOK AT THE DATA AND PROVIDE INPUT. ATTENDEES INCLUDE: GWEN TAYLOR, GIRLS SCOUTS OF THE NORTHWESTERN GREAT LAKESJONETTE ARMS, AGING & DISABILITY RESOURCE CENTER OF CENTRAL WIRYAN GALLAGHER, ROCKET INDUSTRIALBRAD SIPPEL, CITY OF WAUSAUCARRIE SANN, CRYSTAL FINISHING SYSTEMS INCKALLI YAKLYVICH, WIPFLIKAYLEY MCCOLLEY, STUDENT, NORTHCENTRAL TECHNICAL COLLEGE

ASPIRUS WAUSAU HOSPITAL, INC.
PART V, SECTION B, LINE 6A: MARSHFIELD CLINIC HEALTH SYSTEM

ASPIRUS WAUSAU HOSPITAL, INC.
PART V, SECTION B, LINE 6B: HOUSING & HOMELESSNESS COALITIONWAUSAU POLICE DEPARTMENTASPIRUS HEALTH PLANASPIRUS HEALTHGREATER WAUSAU CHAMBER OF COMMERCEHOMME HEIGHTS, INC.MARATHON COUNTY CONSERVATION, PLANNING AND ZONING DEPARTMENTMARATHON COUNTY HUNGER COALITIONMARATHON COUNTY PUBLIC LIBRARYMARATHON COUNTY SPECIAL EDUCATIONDC EVEREST SCHOOL DISTRICTWAUSAU SCHOOL DISTRICTNORTH CENTRAL TECHNICAL COLLEGEMARATHON COUNTY SHERIFF'S OFFICEUNITED WAY OF MARATHON COUNTYMARSHFIELD CLINIC HEALTH SYSTEM MARATHON COUNTY HEALTH DEPARTMENTNORTHCENTRAL HEALTH CARE CENTERBRIDGE COMMUNITY HEALTH CLINICEO JOHNSON BUSINESS TECHNOLOGIES

ASPIRUS WAUSAU HOSPITAL, INC.
PART V, SECTION B, LINE 11: HEALTH NEEDS THAT ASPIRUS WAUSAU HOSPITAL PLANS TO ADDRESS:BEHAVIORAL HEALTH:VISION: PROMOTE WELL-BEING BY PREVENTING OR INTERVENING IN MENTAL ILLNESS SUCH AS DEPRESSION OR ANXIETY, ALONG WITH PREVENTING OR INTERVENING IN SUBSTANCE ABUSE OR OTHER ADDICTIONS.GOAL STATEMENTS: -INCREASE THE PUBLIC'S AWARENESS OF THE IMPORTANCE OF GOOD MENTAL WELL-BEING AND COMMUNITY SERVICES AVAILABLE TO SUPPORT THEIR MENTAL WELL-BEING. -IMPROVE ALCOHOL & OTHER DRUG ABUSE AND MENTAL HEALTH TREATMENT SERVICES -FURTHER INTEGRATE BEHAVIORAL HEALTH WITHIN THE DELIVERY OF HEALTH CAREASPIRUS WAUSAU HOSPITAL CONTRIBUTED TO THE FOLLOWING INITIATIVES RELATED TO BEHAVIORAL HEALTH: - SUPPORTED THE YOUTH DIVERSION PILOT PROGRAM, INCREASING MENTAL HEALTH RESOURCES IN THE AREA HIGH SCHOOLS. - SUPPORTED MENTAL HEALTH FIRST AID TRAINING IN THE SCHOOLS FOR STAFF. - SUPPORTED A VIDEO SERIES FOCUSING ON YOUTH MENTAL HEALTH TO CREATE AWARENESS. - SUPPORTED THE PEACE OF MIND WEBSITE TO HELP COMMUNITY MEMBERS FIND AND NAVIGATE MENTAL HEALTH RESOURCES. - SUPPORTED AND HELPED TO EXPAND RAISE YOUR VOICE CLUBS IN AREA HIGH SCHOOLS, EMPOWERING YOUTH TO IDENTIFY AND HAVE CONVERSATIONS WITH THEIR PEERS AROUND MENTAL HEALTH. - SUPPORTED AND PRESENTED AT THE DCE MENTAL HEALTH DAY, IMPACTING STUDENTS IN 10-12TH GRADES. ALCOHOL & OTHER DRUG MISUSE AND ABUSE:VISION: CREATING A CULTURE IN COMMUNITIES WHERE ALCOHOL IS USED RESPONSIBLY AND OTHER DRUGS (TOBACCO, PRESCRIPTION, AND ILLICIT) ARE NOT MISUSED.GOAL STATEMENTS: -CHANGE SOCIAL NORMS, ATTITUDES, AND BEHAVIORS AROUND SUBSTANCE USE -STRENGTHEN COMMUNITY COLLABORATION AROUND SUBSTANCE ABUSE PREVENTION -INCREASE FUNDING FOR AODA PREVENTION, TREATMENT, AND ENFORCEMENTHEALTHY START FOR CHILDREN:VISION: PREVENTING OR REDUCING THE IMPACT OF POTENTIALLY TRAUMATIC EVENTS THAT CAN HAVE NEGATIVE, LASTING EFFECTS ON HEALTH AND WELL-BEING. THESE EXPERIENCES RANGE FROM PHYSICAL, EMOTIONAL, OR SEXUAL ABUSE TO PARENTAL DIVORCE OR THE INCARCERATION OF A PARENT OR GUARDIAN.ASPIRUS WAUSAU HOSPITAL CONTRIBUTED TO THE FOLLOWING INITIATIVES RELATED TO AODA: - SUPPORTED ONGOING EDUCATION IN PARTNERSHIP WITH THE MARATHON COUNTY ALCOHOL AND OTHER DRUG PARTNERSHIP. - CO-FOUNDED AND PROVIDES CONTINUAL SUPPORT TO RISE UP, WITH THE MISSION TO HEAL, STRENGTHEN AND UNIFY THE COMMUNITY THROUGH ART WORKING WITH THOSE EXPERIENCING ADDICTION AND OTHER MENTAL HEALTH ISSUES. TO ADD TO THESE HEALTH PRIORITIES, ASPIRUS WAUSAU HOSPITAL PIVOTED TO FOCUS ON THE IMMEDIATE NEEDS OF THE COMMUNITY THAT WERE HIGHLIGHTED DURING THE PANDEMIC THAT FOCUSED ON THE SOCIAL DETERMINANTS OF HEALTH (SDOH). ASPIRUS WAUSAU HOSPITAL CONTRIBUTED TO THE FOLLOWING INITIATIVES RELATED TO SDOH: - IMPLEMENTATION OF THE FIND HELP COMMUNITY RESOURCE PLATFORM TO HELP STAFF, PATIENTS AND COMMUNITY MEMBERS FIND AND CONNECT TO LOW OR NO COST RESOURCES. - CONTINUAL SUPPORT OF THE MARATHON COUNTY START RIGHT PROGRAM, GIVING OUR YOUNGEST COMMUNITY MEMBERS AND THEIR FAMILIES A GOOD START THROUGH USING A PARENT AS FIRST TEACHERS MODEL. - SUPPORT FOR THE ASSOCIATION OF HISPANIC AMERICANS, PARTNERING TO UNDERSTAND AND ADDRESS THE NEEDS WITHIN THE HISPANIC POPULATION INCLUDING FOOD, TRANSPORTATION AND PREVENTIVE CARE. - CONTINUAL SUPPORT OF AN ONSITE FARMERS MARKET, THE FRUIT AND VEGGIE PRESCRIPTION PROGRAM, AND IMPLEMENTATION OF A VERTICAL GARDEN TO INCREASE ACCESS TO FRESH, LOCAL PRODUCE FOR THOSE EXPERIENCING FOOD INSECURITY, LACK OF ACCESS, AND CHRONIC HEALTH CONDITIONS.

ASPIRUS WAUSAU HOSPITAL, INC.
PART V, SECTION B, LINE 13B: THIRD PARTY SEGMENTATION AND PROPENSITY TO PAY.

PART I, LINE 3C:
THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF:- 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. SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA AND PENSION PLANS 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 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSE, LESS MEDICAID PROVIDER TAXES DIVIDED BY GROSS PATIENT SERVICE REVENUES. 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 ORGANIZATION. THE ORGANIZATION 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 ORGANIZATION.

PART I, LINE 7G:
THE COSTS OF SUBSIDIZED HEALTH SERVICES ARE RELATED TO THE TRAUMA UNIT, PALLIATIVE (COMFORT CARE) UNIT, OUTPATIENT DIALYSIS, AND HOSPICE HOUSE. ASPIRUS WAUSAU HOSPITAL UTILIZED AN INTERNAL DEPARTMENTAL FINANCIAL STATEMENT TO REPORT THE COST AND DIRECT OFFSETTING REVENUE THAT CALCULATES THE COMMUNITY BENEFIT EXPENSE. THE TRAUMA UNIT REPORTED COSTS OF 2,349,037 WITH OFFSETTING REVENUE OF 1,683,509. THE PALLIATIVE CARE UNIT REPORTED COSTS OF 4,903,136 WITH OFFSETTING REVENUE OF 1,923,772. THE OUTPATIENT DIALYSIS UNIT REPORTED COSTS OF 4,872,040 WITH OFFSETTING REVENUE OF 3,818,745.

PART I, LN 7 COL(F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24E, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN IS $3,821,469 .

PART II, COMMUNITY BUILDING ACTIVITIES:
"AS ANY GOOD CORPORATE CITIZEN, ASPIRUS WAUSAU HOSPITAL IS INVOLVED IN A WIDE RANGE OF COMMUNITY BUILDING ACTIVITIES. SOME OF THESE ARE UNDERTAKEN SIMPLY BECAUSE THERE IS A COMMUNITY NEED AND ASPIRUS IS IN A POSITION TO HELP, OTHERS ARE UNDERTAKEN FOR MUCH MORE SPECIFIC REASONS. THE GOAL OF ASPIRUS WAUSAU HOSPITAL'S COMMUNITY BENEFITS ACTIVITIES IS TO ADDRESS KEY COMMUNITY HEALTH ISSUES AS IDENTIFIED BY THE COMMUNITY NEEDS ASSESSMENT: THE MARATHON COUNTY LIFE REPORT SPEARHEADED BY THE UNITED WAY OF MARATHON COUNTY. THE FOLLOWING IS A LIST OF ""COMMUNITY BUILDING"" ACTIVITIES REPORTED IN PART II AND BRIEF DESCRIPTIONS OF THEM. ECONOMIC DEVELOPMENT (F2) CENTRAL WAUSAU PROGRESS: THIS IS ANOTHER COMMUNITY DEVELOPMENT PROGRAM THAT COMBINES THE VISION, RESOURCES, AND EFFORTS OF MANY PARTNERS THROUGHOUT THE WAUSAU AREA. MCDEVCO: MARATHON COUNTY ECONOMIC DEVELOPMENT CORPORATION, IN PRIVATE AND PUBLIC PARTNERSHIP WITH MARATHON COUNTY GOVERNMENT AND THE WAUSAU REGION CHAMBER OF COMMERCE, PROVIDES LEADERSHIP FOR REVIEWING AND RECOMMENDING ALL INITIATIVES RELATED TO EDUCATION AND ECONOMIC DEVELOPMENT. MCDEVCO IS COMMITTED TO BUSINESS GROWTH, AS WELL AS PROVIDING A HIGH QUALITY OF LIFE AND BUILDING STRONG COMMUNITIES IN THE MARATHON COUNTY REGION. WAUSAU REGION CHAMBER: THE LOCAL MEMBER OF THE US CHAMBER OF COMMERCE, THE WAUSAU REGION CHAMBER DEDICATES ITSELF TO IMPROVING THE LOCAL BUSINESS COMMUNITY AND ECONOMY THROUGH ADVOCACY, GROWTH/DEVELOPMENT, MARKETING, AND PROFESSIONAL DEVELOPMENT. ASPIRUS WAUSAU HOSPITAL IS A LONGTIME CHAMBER MEMBER AND PROVIDES A LEADERSHIP ROLE IN MULTIPLE WAYS. COMMUNITY SUPPORT (F3) BOY SCOUTS OF AMERICA: BSA HAS A THRIVING COUNCIL, THE SAMOSET, LOCATED IN WAUSAU. THIS ORGANIZATION ENCOURAGES THE PHYSICAL, CIVIC, SOCIAL, AND EDUCATIONAL DEVELOPMENT OF BOYS AND ASPIRUS WAUSAU HOSPITAL SUPPORTS ITS EFFORTS. BSA ACTIVITIES HELP ADDRESS THE FOLLOWING MARATHON COUNTY LIFE REPORT KEY CALLS TO ACTION: ALCOHOL AND DRUG MISUSE, AND OVERWEIGHT AND OBESITY. ROTARY: ROTARY IS A WORLDWIDE ORGANIZATION OF BUSINESS AND PROFESSIONAL LEADERS THAT PROVIDES HUMANITARIAN SERVICE, ENCOURAGES HIGH ETHICAL STANDARDS IN ALL VOCATIONS, AND HELPS BUILD GOODWILL AND PEACE IN THE WORLD. THE OBJECT OF ROTARY IS TO ENCOURAGE AND FOSTER THE IDEAL OF SERVICE AS A BASIS OF WORTHY ENTERPRISE. THE LOCAL CLUB HAS ABOUT 85 MEMBERS AND TRULY BENEFITS THE COMMUNITY. UNITED WAY: ASPIRUS WAUSAU HOSPITAL HAS DEEP AND LONGSTANDING INVOLVEMENT WITH THE LOCAL UNITED WAY. AS A PACESETTER ORGANIZATION, ASPIRUS DEMONSTRATES LEADERSHIP IN ITS INTERNAL SUPPORT CAMPAIGN TO BENEFIT THE UNITED WAY, WHICH HAS RESTRUCTURED TO FOLLOW A ROAD MAP TO COMMUNITY SUCCESS THAT DIRECTS ITS SUPPORT TO ORGANIZATIONS THAT IMPROVE EDUCATION, HEALTH, AND INCOME IN THE COMMUNITY."

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 9B:
UPON A PATIENT'S APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENT'S ACCOUNT WITH AN EFFECTIVE AND TERMINATION DATE TO ASSURE CAPTURING ALL CHARGES FOR THE PATIENT FOR ADJUSTMENT IN A WORK QUEUE PRIOR TO ANY REMAINING BALANCE BEING MOVED TO PATIENT LIABILITY AND THEREFORE PREVENTING UNDISCOUNTED SERVICES FROM BEING BILLED TO A PATIENT.

PART VI, LINE 2:
IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, ASPIRUS WAUSAU HOSPITAL, INC. USES BOTH HOSPITAL DATA AND RELIABLE, THIRD PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THESE REPORTS PROVIDE INFORMATION ABOUT KEY HEALTH, SOCIOECONOMIC, AND DEMOGRAPHIC INDICATORS THAT POINT TO AREAS OF NEED. ASPIRUS WAUSAU HOSPITAL, INC. UTILIZES THIS INFORMATION TO DETERMINE AND DEVELOP PROGRAMS AND SERVICES TO BE PROVIDED FOR THE COMMUNITY. THESE NEEDS AND INITIATIVES ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE CONSIDERED IN DEVELOPING THE ORGANIZATION'S STRATEGY, POLICY DEVELOPMENT, AND INTERNAL FINANCIAL AND OPERATIONAL DECISIONS.

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 3. COLLECTION PHONE CALLS 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 FIRST BILLING TO THE PATIENT.) 4. SOUND BUSINESS JUDGMENT ESTABLISHES THAT THERE WAS NO LIKELIHOOD OF RECOVERY AT ANY TIME IN THE FUTURE. II. BAD DEBT RECOVERIES A. PAYMENTS ON MONTHLY REMITTANCE ADVICES FROM OUTSIDE COLLECTION AGENCIES WILL BE POSTED TO EACH INDIVIDUAL ACCOUNT. B. 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. C. 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 ASPIRUS WAUSAU HOSPITAL INC. 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, 2022 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 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 SELF-PAY PATIENTS THAT ARE INPATIENT OR PRESENT TO THE ED TO ASSIST WITH MEDICAL ASSISTANCE APPLICATIONS.

PART VI, LINE 4:
"ASPIRUS WAUSAU HOSPITAL IS THE FLAGSHIP OF THE ASPIRUS SYSTEM THAT SERVES PATIENTS IN 14 COUNTIES ACROSS NORTHERN AND CENTRAL WISCONSIN, AS WELL AS THE UPPER PENINSULA OF MICHIGAN. FOR PURPOSES OF THE CHNA, THE HOSPITAL'S SERVICE AREA INCLUDES MARATHON COUNTY AS WELL AS PORTIONS OF SURROUNDING COUNTIES. A RANGE OF HEALTH ISSUES WERE EXAMINED FOR THE IDENTIFIED AREA AS WELL AS SOCIAL DETERMINANTS KNOWN TO IMPACT THE HEALTH OF A POPULATION SUCH AS SOCIOECONOMIC, ENVIRONMENTAL, AND CULTURAL CONDITIONS. ACCORDING TO THE U.S. CENSUS BUREAU, MARATHON COUNTY HAD A POPULATION OF 137,201. ASIDE FROM WAUSAU, THE COUNTY SEAT CLASSIFIED BY THE U.S. CENSUS BUREAU AS A ""METROPOLITAN STATISTICAL AREA,"" MARATHON COUNTY IS LARGELY RURAL. WITH A TOTAL AREA OF 1,576 SQUARE MILES, IT IS THE LARGEST COUNTY IN WISCONSIN BY LAND AREA. HERE ARE SOME DETAILS ABOUT ITS POPULATION: ABOUT MARATHON COUNTY:PERSONS PER SQUARE MILE 89.3PERSONS UNDER 5 YEARS OLD 5.6%PERSONS UNDER 18 YEARS OLD 22.7%PERSONS 65 YEARS AND OVER 18.6%WHITE PERSONS 89.6%ASIAN PERSONS 6.15%HISPANIC OR LATINO 3.3%PERSONS PER HOUSEHOLD 2.42PERSONS BELOW POVERTY LEVEL 6.7%MEDIAN HOUSEHOLD INCOME $71,307"

PART VI, LINE 5:
THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING:- THE ORGANIZATION'S GOVERNING BOARD CONSISTS PRIMARILY OF PERSONS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA WHO ARE NOT EMPLOYEES OF THE ORGANIZATION.- AS MENTIONED, THE ORGANIZATION PROVIDES SEVERAL SERVICES WHICH ARE NOT OTHERWISE AVAILABLE BEING IN A RURAL SETTING.- BASED ON THE ORGANIZATION'S MISSION, EMERGENCY ROOMS ARE MADE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY.- THE ORGANIZATION ALSO PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONAL THROUGH INTERNSHIP PROGRAMS.THE HOSPITAL PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, TRICARE). THE HOSPITAL OFFERS VOLUNTEER OPPORTUNITIES TO THE COMMUNITY. VARIOUS FINANCIAL PROGRAMS ARE AVAILABLE TO PATIENTS OF ASPIRUS WAUSAU HOSPITAL. THEY INCLUDE DISCOUNTED AND/OR FREE CARE DEPENDING ON INDIVIDUAL CIRCUMSTANCES. THE FACILITY ALSO OFFERS PAYMENT PLANS FOR THOSE SELF-PAY PATIENTS. ASPIRUS WAUSAU HOSPITAL PROVIDES PRIMARY, SECONDARY, AND TERTIARY CARE SERVICES AS A REGIONAL REFERRAL CENTER. SPECIALTY REFERRAL SERVICE EMPHASIS EXISTS IN CARDIOLOGY AND CARDIOTHORACIC SURGERY, ORTHOPEDICS, AND CANCER. BEST KNOWN FOR ITS WORLD-CLASS CARDIOVASCULAR PROGRAM, ASPIRUS WAUSAU HOSPITAL ALSO PROVIDES LEADING EDGE CANCER, TRAUMA, WOMEN'S HEALTH, AND SPINE AND NEUROLOGICAL CARE. THE HOSPITAL IS CONTINUALLY RECOGNIZED NATIONALLY FOR THE LEVEL OF CARE IT PROVIDES. THEY ALSO PROVIDE EMERGENCY AND WALK-IN SERVICES.

PART VI, LINE 6:
ASPIRUS WAUSAU HOSPITAL IS PART OF THE ASPIRUS HEALTH SYSTEM. ASPIRUS, INC. IS A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. ASPIRUS WAUSAU HOSPITAL WORKS WITH ASPIRUS TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES THEY SERVE. AS NOTED PREVIOUSLY IN THE FORM 990, A NUMBER OF REPRESENTATIVES FROM ASPIRUS HAVE ROLES ON THE BOARD OF DIRECTORS OF ASPIRUS WAUSAU 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 ASPIRUS WAUSAU HOSPITAL WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE 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.