4A (Expenses $ 153974491 including grants of $ 3234) (Revenue $ 186507897)
ASPIRUS RHINELANDER HOSPITAL IS A 63-BED HOSPITAL CAMPUS, AND ASPIRUS TOMAHAWK HOSPITAL IS A 15-BED CAMPUS, BOTH OF WHICH PROVIDE SERVICES WITHOUT REGARD TO PATIENT RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY. DURING FISCAL YEAR 2022, ASPIRUS RHINELANDER & TOMAHAWK HOSPITALS SERVICED THE COMMUNITY THROUGH A TOTAL OF APPROXIMATELY 12,232 PATIENT DAYS OF SERVICE. THE HOSPITAL ALSO PROVIDED SERVICES FOR APPROXIMATELY 101,146 OUTPATIENT VISITS, WHICH INCLUDED APPROXIMATELY 3,700 OUTPATIENT SURGERIES AND APPROXIMATELY 15,633 EMERGENCY ROOM VISITS. SEE SCHEDULE H FOR A NON-EXHAUSTIVE LIST OF COMMUNITY BENEFIT PROGRAMS AND DESCRIPTIONS.BEGINNING IN DECEMBER OF 2021, THE VARIOUS ASPIRUS CLINICS IN THE REGION WERE ALL REORGANIZED SO THAT THEY WERE INCLUDED UNDER ASPIRUS RHINELANDER HOSPITAL.

ASPIRUS RHINELANDER HOSPITAL
"PART V, SECTION B, LINE 2: A HOSPITAL ORGANIZATION THAT ACQUIRES A HOSPITAL FACILITY (THROUGH MERGER OR ACQUISITION) MUST MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO THE ACQUIRED HOSPITAL FACILITY BY THE LAST DAY OF THE ORGANIZATION'S SECOND TAXABLE YEAR BEGINNING AFTER THE DATE ON WHICH THE HOSPITAL FACILITY WAS ACQUIRED. THE FILING HOSPITAL WAS ACQUIRED BY A NEW PARENT (ASPIRUS INC - 45-3358926) ON 08/01/2021 (TAX YEAR 2022). THE CHNA WILL BE DUE THE LAST DAY OF THE SECOND TAXABLE YEAR WHICH WILL BE 06/30/2024.THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT EFFORTS IN FY22 WERE SIGNIFICANTLY IMPACTED BY A NUMBER OF FACTORS, INCLUDING: THE TRANSITION OF THE HOSPITAL FROM ASCENSION HEALTH TO ASPIRUS HEALTH IN AUGUST 2021; THE SUBSEQUENT CHANGES IN PROCESSES, TEAM STRUCTURE AND RELATED IMPACTS; COVID-19 AND ITS RIPPLE EFFECT ON COMMUNITY OUTREACH AND PUBLIC EVENTS / PROGRAMS.ASPIRUS RHINELANDER IS IN RURAL NORTHERN WISCONSIN. BECAUSE OF THAT SETTING, COMMUNITY HEALTH EFFORTS ARE FREQUENTLY COMPLETED WITH OTHER REGIONAL PARTNERS, INCLUDING OTHER ASPIRUS HOSPITALS. THE FOLLOWING DESCRIPTIONS ARE REFLECTIVE OF ASPIRUS RHINELANDER, ASPIRUS EAGLE RIVER AND HOWARD YOUNG MEDICAL CENTER (ALSO WITH ASPIRUS) UNLESS OTHERWISE INDICATED. MENTAL HEALTH AND SUBSTANCE USE IN PART DUE TO THE KNOWLEDGE AND CAPACITY THAT THE RHINELANDER-BASED KOELLER BEHAVIORAL HEALTH UNIT (PART OF ASPIRUS) BRINGS TO THE AREA, THE HOSPITALS ARE A STRONG AND VALUED RESOURCE. STAFF EXPERTISE IS SHARED INTERNALLY AS WELL AS EXTERNALLY. THIS WORK INCLUDES: - TRAINING AND COACHING: STAFF EXPERTS PROVIDE TRAINING AND COACHING ON AN IN-KIND BASIS. IN FY22, STAFF TRAINED OR COACHED THE HUMAN SERVICE CENTER STAFF, CAMP COUNSELORS AND LEADERS, NEW HORIZONS HOME VISITING STAFF, 25-30 ASPIRUS WELLNESS STAFF. ASPIRUS STAFF ALSO PROVIDED QUESTION, PERSUADE, REFER (QPR) SUICIDE PREVENTION TRAINING FOR LOCAL HIGH SCHOOL STAFF AND GRADES 9-12 HEALTH CLASSES, AS WELL AS COACHED NEW QPR TRAINERS (WHICH IMPROVES THE ACCESSIBILITY OF QPR TRAININGS IN THE REGION). - COALITION: ASPIRUS STAFF PARTICIPATES IN THE COMMUNITY OUTREACH PREVENTION EDUCATION (COPE) COALITION, WHICH IS THE REGION'S MENTAL HEALTH PROMOTION AND SUBSTANCE USE PREVENTION COALITION. ASPIRUS STAFF LED THE COALITION'S SUB-COMMITTEE ON SUICIDE PREVENTION AND MENTAL HEALTH. INCLUDED IN THIS WORK WAS THE CREATION AND DISTRIBUTION OF STICKERS PROMOTING THE NEW 988 CRISIS LINE WITH THE QR CODE FOR MENTAL AND HEALTH AND SUBSTANCE USE/ABUSE SUPPORT AVAILABLE 24/7. - PUBLIC EDUCATION: ASPIRUS STAFF WERE FREQUENTLY ASKED TO PROVIDE PUBLIC SERVICE MESSAGES ABOUT MENTAL HEALTH ISSUES SUCH SEASONAL AFFECTIVE DISORDER AND TEEN MENTAL HEALTH. IN NOVEMBER, A NEWS INTERVIEW WAS COMPLETED ON ""MOVEMEBER"" TO BRING AWARENESS TO MEN'S MENTAL HEALTH. ASPIRUS HOSTED A FILM/PRESENTATION ON MILWAUKEE'S DANIEL HOAN MEMORIAL BRIDGE; MULTIPLE PEOPLE HAVE ATTEMPTED SUICIDE BY JUMPING OFF THE BRIDGE. THE PRESENTER ALSO SHARED WAYS TO REDUCE SUICIDE RISK. STAFF FROM KOLLER BEHAVIORAL HEALTH WERE AVAILABLE TO PROVIDE SUPPORT TO THOSE WHO MAY BE IN NEED AFTER THE PRESENTATION.- COMMUNITY RESPONSE: ASPIRUS STAFF RESPOND TO LOCAL, SPECIFIC MENTAL HEALTH CRISES (E.G., THE DEATH OF A CHILD) AND PARTICIPATE ON COUNTY DEATH REVIEW TEAMS.- INTERNAL SYSTEMS: ASPIRUS STAFF IDENTIFIED OPPORTUNITIES TO REDUCE THE RISK OF BEHAVIORAL HEALTH PATIENTS WHO DIED BY SUICIDE AFTER BEING DISCHARGED. ASPIRUS HEALTH CONTRACTS WITH AN OUTSIDE AGENCY TO PROVIDE RECOVERY COACHING SERVICES THROUGHOUT THE SYSTEM'S WISCONSIN FOOTPRINT. ASPIRUS IS WORKING TO BUILD RELATIONSHIPS AND STRUCTURES IN ALL WISCONSIN HOSPITALS TO SUPPORT HAVING A RECOVERY COACH AVAILABLE WITHIN AN HOUR OR TWO TO THOSE PATIENTS INTERESTED IN WORKING WITH A COACH. CHRONIC DISEASETHE HOSPITALS OFFERED 'FIT FOR LIFE' EXERCISE CLASSES IN A SUPERVISED SETTING FOR CARDIAC REHAB PATIENTS WHO HAVE COMPLETED THEIR TREATMENT PLAN. THE HOSPITALS OFFER THE CLASSES AT A REDUCED RATE, INCURRING LOSSES ON THE OFFERING.ASPIRUS HEALTH, PRIMARILY THROUGH CARE MANAGEMENT, IMPLEMENTS A FRUIT AND VEGETABLE PRESCRIPTION (FVRX) PROGRAM ACROSS THE SYSTEM. PATIENTS WITH CHRONIC DISEASE ARE SCREENED FOR FOOD INSECURITY AND 'PRESCRIBED' FRUITS AND VEGETABLES. THE FVRX CAN BE USED LIKE CASH AT THE LOCAL FARMERS MARKET. FOR ASPIRUS RHINELANDER HOSPITAL, COMMUNITY HEALTH IMPROVEMENT STAFF ORGANIZED HOSPITAL AND CLINIC VOLUNTEERS FOR THE LOCAL FOOD PANTRY. FOR THE PURPOSES OF THIS CHNA, THE HOSPITAL CHOSE TO FOCUS ITS EFFORTS ON THE PRIORITIES LISTED ABOVE (MENTAL HEALTH, AODA, CHRONIC DISEASE). IN THE PRIORITIZATION PROCESS, THE FOLLOWING HEALTH ISSUES WERE RANKED LOWER: CHILD ABUSE AND GRADUATION RATES. THESE WERE NOT NAMED AS PRIORITIES SO EFFORTS COULD BE FOCUSED ON THE TOP THREE SELECTED. IN ADDITION, IT WAS SUGGESTED THAT THE YOUTH COMPONENTS SHOULD BE WOVEN INTO THE SELECTED PRIORITIES WHEN POSSIBLE, WHICH COULD HAVE AN IMPACT ON CHILD ABUSE AND GRADUATION RATES."

ASPIRUS TOMAHAWK HOSPITAL
PART V, SECTION B, LINE 2: THE HOSPITAL WAS ACQUIRED BY ASPIRUS INC DURING THE FISCAL YEAR. MORE DETAILS ARE PROVIDED THROUGHOUT THE FORM 990.

ASPIRUS TOMAHAWK HOSPITAL
PART V, SECTION B, LINE 5: RECOGNIZING ITS VITAL IMPORTANCE IN UNDERSTANDING THE HEALTH NEEDS AND ASSETS OF THE COMMUNITY, THE HOSPITAL INVITED THE INPUT OF COMMUNITY MEMBERS-AT-LARGE AS WELL AS A RANGE OF PUBLIC HEALTH AND SOCIAL SERVICE PROVIDERS THAT REPRESENT THE BROAD INTERESTS OF LINCOLN COUNTY. A CONCERTED EFFORT WAS MADE TO ENSURE THAT THE INDIVIDUALS AND ORGANIZATIONS REPRESENTED THE NEEDS AND PERSPECTIVES OF: 1) PUBLIC HEALTH PRACTICE; 2) INDIVIDUALS WHO ARE MEDICALLY UNDERSERVED, HAVE LOW INCOME, OR ARE CONSIDERED AMONG THE MINORITY POPULATIONS SERVED BY THE HOSPITAL; AND 3) THE BROADER COMMUNITY AT LARGE AND THOSE WHO REPRESENT THE BROAD INTERESTS AND NEEDS OF THE COMMUNITY SERVED. TWO METHODS WERE USED TO GATHER COMMUNITY INPUT: A COMMUNITY SURVEY AND KEY INFORMANT INTERVIEWS. THE PROCESS AND RESULTS ARE OUTLINED BELOW. COMMUNITY SURVEY: AN ELECTRONIC/ONLINE SURVEY WAS CREATED AND DISTRIBUTED VIA EMAIL THROUGH LOCAL NETWORKS IN AUGUST-OCTOBER 2020. INITIAL DISTRIBUTION WAS CONDUCTED THROUGH COMMUNITY COALITION MEMBERS, THE HEALTH DEPARTMENT, THE HOSPITAL FOUNDATIONS AND EXISTING COMMUNITY MEMBER EMAIL LISTS OF THE HOSPITALS' COMMUNITY HEALTH IMPROVEMENT ASSOCIATES. THE SURVEY ASKED COMMUNITY MEMBERS ABOUT THEIR OPINION OF THE COMMUNITY'S TOP HEALTH ISSUES ACROSS MULTIPLE CATEGORIES OF HEALTH FACTORS. MORE THAN 270 INDIVIDUALS RESPONDED. DATA WERE ANALYZED AS A WHOLE AS WELL AS BY HOUSEHOLD INCOME (UNDER $50K ANNUALLY) AND ETHNICITY.KEY INFORMANT INTERVIEWS: ELEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED VIRTUALLY INOCTOBER AND NOVEMBER 2020. RESPONDENTS REPRESENTED THE FOLLOWING ORGANIZATIONS:LINCOLN COUNTY HEALTH DEPARTMENT (COUNTY-WIDE)AGING AND DISABILITY RESOURCE CENTER (COUNTY-WIDE)COMMUNIDAD HISPANA (COUNTY-WIDE)*COMMUNITY ACTION PROGRAM (CAP) SERVICES (COUNTY-WIDE)*UW EXTENSION (COUNTY-WIDE)KINSHIP (TOMAHAWK)TOMAHAWK SCHOOL DISTRICTHEAD START (TOMAHAWK)*SENIOR DINING SITE (TOMAHAWK)ST. VINCENT DE PAUL (MERRILL)*MERRILL COMMUNITY FOOD PANTRY** REPRESENTED INDIVIDUALS WHO ARE MEDICALLY UNDERSERVED, HAVE LOW-INCOME, OR ARE CONSIDERED AMONG THE MINORITY POPULATIONS SERVED BY THE HOSPITAL.INTERVIEWEES WERE ASKED TO REVIEW THE COMMUNITY SURVEY, BE PREPARED TO SPEAK TO THEIR PERCEPTIONS OF THE COMMUNITY'S TOP HEALTH ISSUES AND DESCRIBE THEIR REASONING. THE INTERVIEWS WERE CONDUCTED BY TWO HOSPITAL ASSOCIATES AND ONE STATEWIDE (ASPIRUS WISCONSIN) ASSOCIATE WHO LEAD COMMUNITY HEALTH IMPROVEMENT EFFORTS. A QUALITATIVE REVIEW AND RESULTING SUMMARY WAS CONDUCTED BY TWO STATEWIDE (ASCENSION WISCONSIN) COMMUNITY HEALTH IMPROVEMENT ASSOCIATES.COMMUNITY INPUT SUMMARY: THE RESULTS OF THE COMMUNITY SURVEY AND THE KEY INFORMANT INTERVIEWS WERE COMBINED INTO A GRID TO IDENTIFY SIMILARITIES, DIFFERENCES AND PATTERNS. NOTE SOME DATA IS SEPARATED BY INCOME AND BY ETHNICITY AS A WAY TO BETTER UNDERSTAND DIFFERING PRIORITIES.

ASPIRUS TOMAHAWK HOSPITAL
PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES:- ASPIRUS MERRILL HOSPITAL

ASPIRUS TOMAHAWK HOSPITAL
PART V, SECTION B, LINE 11: THE HOSPITAL'S COMMUNITY HEALTH IMPROVEMENT EFFORTS IN FY22 WERE SIGNIFICANTLY IMPACTED BY A NUMBER OF FACTORS, INCLUDING: THE TRANSITION OF THE HOSPITAL FROM ASCENSION HEALTH TO ASPIRUS HEALTH IN AUGUST 2021; THE SUBSEQUENT CHANGES IN PROCESSES, TEAM STRUCTURE AND RELATED IMPACTS; COVID-19 AND ITS RIPPLE EFFECT ON COMMUNITY OUTREACH AND PUBLIC EVENTS / PROGRAMS.NUTRITION AND HEALTHY FOOD ASPIRUS TOMAHAWK PARTICIPATED IN THE LINCOLN COUNTY NUTRITION COALITION. ASPIRUS HEALTH, PRIMARILY THROUGH CARE MANAGEMENT, IMPLEMENTS A FRUIT AND VEGETABLE PRESCRIPTION (FVRX) PROGRAM ACROSS THE SYSTEM. PATIENTS WITH CHRONIC DISEASE ARE SCREENED FOR FOOD INSECURITY AND 'PRESCRIBED' FRUITS AND VEGETABLES. THE FVRX CAN BE USED LIKE CASH AT THE LOCAL FARMERS MARKET. THE HOSPITAL OFFERED 'FIT FOR LIFE' EXERCISE CLASSES IN A SUPERVISED SETTING FOR CARDIAC REHAB PATIENTS WHO HAVE COMPLETED THEIR TREATMENT PLAN. THE HOSPITAL OFFERS THE CLASSES AT A REDUCED RATE, INCURRING LOSSES ON THE OFFERING.ORAL HEALTH NO ORAL HEALTH ACTIVITIES WERE CONDUCTED. MENTAL HEALTH AND ALCOHOL AND OTHER DRUG USEAS PART OF THE COALITION, ASPIRUS TOMAHAWK HELPED PROMOTE PUBLIC AWARENESS AND SOCIAL NORMS CAMPAIGNS (E.G., HOPELINE, SMALL TALKS, KNOW METH, ADVERSE CHILDHOOD EXPERIENCES [ACES], PARENT PACT, SOCIAL HOST AWARENESS). THE HOSPITAL ALSO HELPED PROMOTE PRESENTATIONS AND INFORMATIONAL MATERIALS AND SUPPORTED FAMILY FUN PACKS (A COVID-RESPONSE STRATEGY). ASPIRUS HEALTH CONTRACTS WITH AN OUTSIDE AGENCY TO PROVIDE RECOVERY COACHING SERVICES THROUGHOUT THE SYSTEM'S WISCONSIN FOOTPRINT. ASPIRUS IS WORKING TO BUILD RELATIONSHIPS AND STRUCTURES IN ALL WISCONSIN HOSPITALS TO SUPPORT HAVING A RECOVERY COACH AVAILABLE WITHIN AN HOUR OR TWO TO THOSE PATIENTS INTERESTED IN WORKING WITH A COACH. ADDITIONALLY, THE HOSPITAL SPENT TIME IMPROVING COMMUNITY SAFETY, INCLUDING A BIKE RODEO AND LAYING THE GROUNDWORK FOR SOME BICYCLE PATH SIGNAGE. ALL SIGNIFICANT NEEDS WERE PRIORITIZED BY THE HOSPITAL.

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

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

SCHEDULE H - PART V, SECTION B, LINE 2:
RHINELANDER HOSPITAL - A HOSPITAL ORGANIZATION THAT ACQUIRES A HOSPITAL FACILITY (THROUGH MERGER OR ACQUISITION) MUST MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO THE ACQUIRED HOSPITAL FACILITY BY THE LAST DAY OF THE ORGANIZATION'S SECOND TAXABLE YEAR BEGINNING AFTER THE DATE ON WHICH THE HOSPITAL FACILITY WAS ACQUIRED. THE FILING HOSPITAL WAS ACQUIRED BY A NEW PARENT (ASPIRUS INC - 45-3358926) ON 08/01/2021 (TAX YEAR 2022). THE CHNA WILL BE DUE THE LAST DAY OF THE SECOND TAXABLE YEAR WHICH WILL BE 06/30/2024.

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. 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, 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, 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 6,718,397.

SCHEDULE H - GENERAL EXPLANATION
"IN AUGUST 2021, THE ORGANIZATION'S PARENT BECAME ASPIRUS INC, WHO IS THE SOLE PARENT MEMBER OF THE ORGANIZATIONS REPORTED ON SCHEDULE R ATTACHED. THE FIRST MONTH OF THE FISCAL YEAR (JULY) THE ORGANIZATION WAS A PART OF A RELATED PARTY STRUCTURE WITH THE OVERARCHING PARENT BEING ASCENSION HEALTH ALLIANCE (45-3358926). FURTHER DETAIL OF THIS IS PROVIDED IN SCHEDULE O AND SCHEDULE R OF THIS ACCOMPANYING 990. AT THE TIME OF THIS CHANGE, THERE WERE MANY CHANGES IMPLEMENTED THAT IMPACTED THE RESPONSES ON SCHEDULE H. FOR 11 OF THE 12 MONTHS, THE RESPONSES AS RECORDED ON SCHEDULE H WERE ACCURATE. FOR CONTEXT OF WHAT THE FIRST MONTH (JULY 2021) WAS, THE 2020 990 CAN PROVIDE MORE DETAIL, BUT SOME HIGHLIGHTS ARE BELOW OF WHAT RESPONSES WOULD BE DURING THAT ONE MONTH:SCHEDULE H, PART I, LINE 3A: 250%SCHEDULE H, PART I, LINE 3B: 400%SCHEDULE H, PART I, LINE 3C: SUBJECT TO THE OTHER PROVISIONS OF THIS FINANCIAL ASSISTANCE POLICY, A PATIENT WITH INCOME GREATER THAN 400% OF THE FPL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER A ""MEANS TEST"" FOR SOME DISCOUNT OF PATIENT'S CHARGES FOR SERVICES FROM THE ORGANIZATION BASED ON A PATIENT'S TOTAL MEDICAL DEBT. A PATIENT ELIGIBLE FOR THIS CATEGORY OF FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE THAN THE CALCULATED AGB CHARGES.THE HOSPITAL ALSO USES INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY AS FACTORS IN DETERMINING ELIGIBILITY FOR FREE AND DISCOUNTED CARESCHEDULE H, PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM: PRIOR TO AUGUST 2021, THE HOSPITAL WAS AFFILIATED WITH MINISTRY HEALTH AND ASCENSION HEALTH."

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 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 RHINELANDER & TOMAHAWK HOSPITAL & CLINICS 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 III, LINE 9B:
UPON A PATIENTS APPROVAL FOR FINANCIAL ASSISTANCE, THIS IS LOADED AS AN INSURANCE COVERAGE TO THE PATIENTS 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 V, SECTION B, LINE 7A - ST. MARY'S HOSPITAL
HTTPS://WWW.ASPIRUS.ORG/UPLOADS/PUBLIC/DOCUMENTS/CHNAS/2021%20SACRED%20HEART%20HOSPITAL%20CHNA.PDF

PART VI, LINE 2:
IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL USE 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 RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL UTILIZE 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 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. FINANCIAL COUNSELORS OFFER FAP TO PATIENTS DURING COLLECTION CALLS. ASPIRUS HAS CERTIFIED APPLICATION COUNSELORS THAT ARE AVAILABLE TO ASSIST WITH MARKETPLACE ENROLLMENT AT WELL AS MEDICAL ASSISTANCE APPLICATIONS. CARDON OUTREACH 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 RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL PRIMARILY SERVE THE RESIDENTS OF LINCOLN COUNTY AND ONEIDA COUNTY AND SURROUNDING COUNTIES IN RURAL NORTHERN WISCONSIN.ASPIRUS RHINELANDER: THE POPULATION OF ONEIDA COUNTY IS APPROXIMATELY 37,800, WITH 7.9% OF RESIDENTS LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS NEARLY $56,800. APPROXIMATELY 5% OF INDIVIDUALS LIVING IN THE COUNTY ARE UNINSURED AND 15% RECEIVE MEDICAID. ONEIDA COUNTY INCLUDES DESIGNATED MENTAL HEALTH, DENTAL HEALTH AND PRIMARY CARE PROVIDER SHORTAGE AREAS. THERE ARE THREE HOSPITALS (ASPIRUS RHINELANDER HOSPITAL, HOWARD YOUNG MEDICAL CENTER, AND MARSHFIELD MEDICAL CENTER-MINOCQUA) IN ONEIDA COUNTY. ASPIRUS RHINELANDER HOSPITAL IS A DISPROPORTIONATE SHARE HOSPITAL. (DISPROPORTIONATE SHARE HOSPITALS SERVE A SIGNIFICANTLY DISPROPORTIONATE NUMBER OF LOW-INCOME PATIENTS AND RECEIVE PAYMENTS FROM THE CENTERS FOR MEDICAID AND MEDICARE SERVICES TO COVER THE COSTS OF PROVIDING CARE TO UNINSURED PATIENTS.)ASPIRUS TOMAHAWK HOSPITAL PRIMARILY SERVES THE RESIDENTS OF LINCOLN COUNTY AND SURROUNDING COUNTIES IN RURAL NORTH CENTRAL WISCONSIN. THE POPULATION IS APPROXIMATELY 28,000, WITH 9% LIVING AT OR BELOW THE FEDERAL POVERTY THRESHOLD. THE MEDIAN HOUSEHOLD INCOME IS $56,600. SIX PERCENT OF INDIVIDUALS ARE UNINSURED AND 16% RECEIVE MEDICAID. LINCOLN COUNTY INCLUDES A DESIGNATED MENTAL HEALTH, DENTAL AND PRIMARY CARE SHORTAGE AREA. THERE ARE TWO HOSPITALS IN LINCOLN COUNTY; ASPIRUS MERRILL HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL.

PART VI, LINE 5:
THE ORGANIZATION STRIVES TO FURTHER ITS EXEMPT PURPOSES BY THE FOLLOWING:(1) AS MENTIONED, THE ORGANIZATION PROVIDES SEVERAL SERVICES WHICH ARE NOT OTHERWISE AVAILABLE BEING IN A RURAL SETTING.(2) BASED ON THE ORGANIZATION'S MISSION, EMERGENCY ROOMS ARE MADE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY.(3) THE ORGANIZATION ALSO PARTICIPATES IN THE EDUCATION AND TRAINING OF HEALTHCARE PROFESSIONALS THROUGH INTERNSHIP PROGRAMS.ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL PARTICIPATE IN GOVERNMENT SPONSORED HEALTH PROGRAMS (MEDICARE, MEDICAID, CHAMPUS, TRICARE).ASPIRUS TOMAHAWK IS A CRITICAL ACCESS HOSPITAL IN TOMAHAWK, WISCONSIN AND ASPIRUS RHINELANDER IS A SOLE COMMUNITY HOSPITAL IN RHINELANDER, WISCONSIN. BOTH HOSPITALS AND HOSPITAL-BASED CLINICS SERVE POOR RURAL COMMUNITIES.ASPIRUS RHINELANDER PROVIDES INPATIENT AND OUTPATIENT MENTAL HEALTH AND AODA SERVICES AT A FINANCIAL LOSS TO THE ORGANIZATION WHICH IS SOMEWHAT UNIQUE TO SMALL RURAL COMMUNITIES. PERSONS IN NEED OF MENTAL HEALTH OR AODA SERVICES WOULD OTHERWISE HAVE TO TRAVEL SEVERAL HUNDRED MILES TO SEEK CARE.ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL SERVE FOUR NATIVE AMERICAN TRIBES IN SURROUNDING COMMUNITIES. TRIBAL SERVICES ARE PAID UNDER MEDICARE-LIKE RATE UNDER CONTRACT HEALTH SERVICES REIMBURSEMENT PROGRAM UNDER THE FEDERAL INDIAN HEALTHPROGRAM. THE ORGANIZATION ALSO PARTICIPATES IN GOVERNMENT SPONSORED HEALTH PROGRAMS SUCH AS MEDICARE, MEDICAID, AND CHAMPUS. THE ORGANIZATION STRIVES TO BE A LOW-COST PROVIDER BY CONTINUALLY REDUCING INTERNAL COSTS THROUGH EFFICIENCY MEASURES WHICH IN TURN, IS PASSED ON TO PATIENTS THROUGH MARKET-BASKET PRICES. THE UNINSURED MEMBERS OF THE COMMUNITY ACCESS HEALTHCARE THROUGH THE EMERGENCY DEPARTMENT AND MEDICAL CLINICS. ALL MEDICALLY NECESSARY MEDICAL SERVICES ARE PROVIDED IN AN INPATIENT, OUTPATIENT OR CLINIC SETTING FOR PERSONS IN NEED OF CARE REGARDLESS OF THEIR ABILITY TO PAY.ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL FUND A COMMUNITY LINK COORDINATOR WHO WORKS IN CONJUNCTION WITH OUR PATIENT FAMILY SERVICES DEPARTMENT IN MEETING THE SPECIAL NEEDS OF OUR COMMUNITY. THIS TEAM HELPS OUR COMMUNITY MEMBERS NAVIGATE THE VARIOUS GOVERNMENTAL PROGRAMS BY HELPING OUR UNINSURED POPULATION APPLY FOR STATE MEDICAID PROGRAMS AND THE ORGANIZATION'S OWN COMMUNITY CARE (CHARITY CARE) PROGRAM. THE COMMUNITY CARE PROGRAM PROVIDES FINANCIAL ASSISTANCE AND SLIDING SCALE DISCOUNTS TO PATIENTS WHO MEET CERTAIN INCOME AND ASSET CRITERIA, UP TO 300% OF THE FEDERAL POVERTY GUIDELINES.

PART VI, LINE 6:
ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL ARE PART OF THE ASPIRUS HEALTH SYSTEM. ASPIRUS, INC. IS A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. ASPIRUS RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK HOSPITAL WORK 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 RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK 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 RHINELANDER HOSPITAL AND ASPIRUS TOMAHAWK 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.