4A (Expenses $ 49716174 including grants of $ 772) (Revenue $ 72000385)
ASPIRUS IRONWOOD HOSPITAL AND CLINICS IS A 25-BED CRITICAL ACCESS HOSPITAL WHICH PROVIDES HEALTH CARE SERVICES TO RESIDENTS OF IRONWOOD, MICHIGAN AND ITS SURROUNDING COMMUNITIES. SOME OF THE SERVICES PROVIDED BEYOND TRADITIONAL INPATIENT HOSPITALIZATIONS INCLUDE SURGERY, EMERGENCY CARE, RADIOLOGY, LABORATORY, THERAPIES, EYE CARE, ONCOLOGY, SLEEP LAB, AND CARDIOLOGY, AMONG VARIOUS OTHER HEALTH CARE SERVICES.ASPIRUS IRONWOOD HOSPITAL AND CLINICS PROVIDES HEALTH CARE SERVICES TO ALL PEOPLE, REGARDLESS OF THEIR ABILITY TO PAY. FOR THOSE INDIVIDUALS UNABLE TO PAY FOR THEIR HEALTH CARE NEEDS, ASPIRUS IRONWOOD HOSPITAL AND CLINICS OFFERS SERVICES FOR FREE OR AT A REDUCED PRICE THROUGH THE FINANCIAL AID DISCOUNT POLICY. PLEASE REFER TO SCHEDULE H OF THE FORM 990 FOR ADDITIONAL INFORMATION ON THE COST OF FINANCIAL AID DISCOUNTS PROVIDED TO PATIENTS DURING FISCAL YEAR 2022.ASPIRUS IRONWOOD HOSPITAL AND CLINICS ALSO PROVIDES HEALTH CARE SERVICES TO INDIVIDUALS COVERED UNDER GOVERNMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID WHICH OFTEN REIMBURSE THE HOSPITAL AT AMOUNTS SUBSTANTIALLY LOWER THAN THE USUAL AND CUSTOMARY CHARGE. THOSE PEOPLE COVERED BY THESE TYPES OF PROGRAMS NEED ACCESS TO HEALTH CARE BUT ARE OFTEN TIMES UNABLE TO TRAVEL LONG DISTANCES TO RECEIVE THIS CARE. ASPIRUS IRONWOOD HOSPITAL AND CLINICS PROVIDES THIS LOCAL, QUALITY HEALTH CARE TO MANY ELDERLY AND LOW-INCOME INDIVIDUALS THAT ARE IN NEED OF HEALTH CARE. DURING FISCAL YEAR 2022, MORE THAN 69.5% OF THE HOSPITAL'S GROSS PATIENT SERVICE REVENUE WAS FROM BENEFICIARIES OF MEDICARE AND MEDICAID.

ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
PART V, SECTION B, LINE 5: 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 IRONWOOD, 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, THE WISCONSIN DIVISION OF PUBLIC HEALTH, AND OTHER GOVERNMENT AND PRIVATE AGENCIES.

ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:- ASPIRUS ONTONAGON HOSPITAL, INC.- U.P. HEALTH SYSTEM - BARAGA COUNTY MEMORIAL HOSPITAL- ASPIRUS KEWEENAW HOSPITAL- ASPIRUS IRON RIVER HOSPITAL- COPPER COUNTRY MENTAL HEALTH SERVICES- GOGEBIC COUNTY COMMUNITY MENTAL HEALTH- UPPER GREAT LAKES FAMILY HEALTH CENTER

ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
PART V, SECTION B, LINE 6B: WESTERN U.P. HEALTH DEPARTMENT

ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A AND LINE 10A:HTTPS://WWW.ASPIRUS.ORG/COMMUNITY-RESOURCES

ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
PART V, SECTION B, LINE 11: USING A SET OF CATEGORIES AND THE DATA WITHIN, ASPIRUS IRONWOOD, ALONG WITH THE OTHER 3 ASPIRUS UPPER MICHIGAN HOSPITALS, IDENTIFIED THREE MAJOR PRIORITY AREAS THAT IMPACT EACH OF THE UPPER PENINSULA COUNTIES AND IRON COUNTY, WI. FOR THE PURPOSES OF THE ASPIRUS IRONWOOD CHNA, AND TO FULFILL THE REQUIREMENTS SET FORTH BY THE PPACA, ASPIRUS IRONWOOD HAS TAKEN THE THREE OVERALL PRIORITIES AND WILL BE ADDRESSING THESE NEEDS AND LOOKING TO MAKE AN IMPACT ON THE FUTURE OF OUR COMMUNITIES. THE THREE MAJOR PRIORITY AREAS THAT WILL BE THE FOCUS ARE:1. MENTAL HEALTH ASPIRUS HOSPITALS IN THE U.P. PLAN TO ADDRESS MENTAL HEALTH THROUGH PREVENTION TRAININGS, ANTI-STIGMA CAMPAIGN, SENIOR WELLNESS PROGRAM, AND SUPPORT GROUPS THROUGH COLLABORATION WITH SEVERAL LOCAL MENTAL HEALTH AGENCIES AND RECOVERY CENTERS.2. SUBSTANCE ABUSE THE FOLLOWING STRATEGIES ARE PLANNED: EDUCATION AND OUTREACH, SELF-REFERRAL PROCESS, SUPPORT GROUPS, PROVISION OF SUBOXONE, AND PEER RECOVERY COACHING. PLANNED COLLABORATION WITH SEVERAL LOCAL MENTAL HEALTH AGENCIES AND RECOVERY CENTERS WILL ASSIST WITH THE PLAN.3. CHRONIC DISEASES - STRATEGIES ARE PLANNED FOR PREVENTION, PROMOTION, AND TREATMENT. PREVENTION/PROMOTION WILL INCLUDE FITNESS FACILITIES AND CLASSES, OUTREACH INCLUDING SCHOOLS, FOOD GLEANING, VERTICAL GARDENS, AND FOOD AS MEDICINE PROGRAM. TREATMENT WILL INCLUDE REFERRAL-BASED FITNESS PROGRAM, SUPPORT GROUPS (I.E. DIABETES), AND FRUIT AND VEGETABLE PRESCRIPTION PROGRAM.BASED ON THE CHNA, THE FOLLOWING ARE THE OTHER IDENTIFIED ISSUES NOT BEING ADDRESSED AND THE ASSOCIATED REASONS WHY: 1. HEALTH INSURANCE IS EXPENSIVE OR HAS HIGH COSTS FOR CO-PAYS AND DEDUCTIBLES ASPIRUS PROVIDES FINANCIAL ASSISTANCE FOR PATIENTS WHO STRUGGLE TO AFFORD CARE. 2. LACK OF HEALTH INSURANCE ASPIRUS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE THE AVAILABILITY AND AFFORDABILITY OF HEALTH INSURANCE, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE.3. UNEMPLOYMENT, WAGES, AND ECONOMIC CONDITIONS ASPIRUS WORKS TO PAY FAIR WAGES AND PROVIDE REASONABLE BENEFITS PACKAGES. ASPIRUS MAY CONTRIBUTE TO EFFORTS THAT IMPROVE ECONOMIC CONDITIONS, HOWEVER, THEIR PRIMARY FOCUS IS TO DELIVER HIGH QUALITY MEDICAL CARE.

ASPIRUS IRONWOOD HOSPITAL & CLINICS, 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 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 6A:
ASPIRUS IRONWOOD HOSPITAL & CLINICS PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE MICHIGAN HOSPITAL ASSOCIATION (MHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC THROUGH MHA'S DATABASE AND WEBSITE.

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 EXPENSES 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 FROM THE FORM 990.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES AT ASPIRUS IRONWOOD HOSPITAL & CLINICS INCLUDE THE OPERATION OF THE HOSPITAL'S INPATIENT MEDICAL/SURGICAL NURSING UNIT AS WELL AS THE INTENSIVE CARE UNIT. THE HOSPITAL INPATIENT AND INTENSIVE CARE UNITS OPERATE 24 HOURS PER DAY SEVEN DAYS PER WEEK AND ARE STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL INPATIENT AND INTENSIVE CARE UNITS COME FROM THE HOSPITAL'S EMERGENCY DEPARTMENT WHICH IS OPERATED TO PROVIDE EMERGENCY CARE TO PATIENTS OF THE COMMUNITY AND SURROUNDING AREAS. THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF ASPIRUS IRONWOOD HOSPITAL & CLINICS AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF ASPIRUS IRONWOOD HOSPITAL & CLINICS TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE INPATIENT UNIT REPORTED COMMUNITY BENEFIT COSTS OF $1,958,907 WITH DIRECT OFFSETTING REVENUE OF $1,917,995. THE INTENSIVE CARE UNIT REPORTED COMMUNITY BENEFIT COSTS OF $153,483 WITH DIRECT OFFSETTING REVENUE OF $150,277.

PART I, LN 7 COL(F):
IN CALCULATING THE PERCENTAGES IN PART 1, LINE 7 BAD DEBT EXPENSE OF $1,083,519 WAS EXCLUDED FROM THE DENOMINATOR.

PART II, COMMUNITY BUILDING ACTIVITIES:
AIW 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 BENEFIT WHICH IS NOT QUANTIFIED. AIW, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WOULD NOT BE AVAILABLE LOCALLY WITHOUT THE HOSPITAL. THE BOARD ALSO CONTAINS COMMUNITY REPRESENTATIVES. THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, NURSING HOME SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, ONCOLOGY, AND WOMEN'S SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED.

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:
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 3:
A SUMMARY OF FINANCIAL ASSISTANCE CONTACT INFORMATION IS AVAILABLE IN THE FORM OF A BROCHURE IN THE WAITING AREAS THROUGHOUT ASPIRUS IRONWOOD HOSPITAL & CLINICS. PATIENT FINANCIAL SERVICES PERSONNEL ARE AVAILABLE TO DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE PROCEDURES AND PROGRAMS WITH PATIENTS. ASPIRUS IRONWOOD HOSPITAL & CLINICS ALSO HAS A SECTION ON ITS WEBSITE THAT PROVIDES CONTACT INFORMATION FOR FINANCIAL ASSISTANCE FOR THOSE HAVING DIFFICULTY MEETING THEIR FINANCIAL OBLIGATIONS.

PART VI, LINE 4:
THE COMMUNITIES THAT ASPIRUS IRONWOOD HOSPITAL & CLINICS SERVE COVER AN APPROXIMATE 50-MILE RADIUS SURROUNDING THE IRONWOOD, MICHIGAN AREA. THIS AREA INCLUDES PORTIONS OF THE UPPER PENINSULA GOGEBIC COUNTY, UP TO THE ONTONAGON COUNTY REGION, INTO WISCONSIN COVERING IRON COUNTY, PARTS OF ASHLAND COUNTY, AND PARTS OF VILAS COUNTY. THE GEOGRAPHIC AREA THAT ASPIRUS IRONWOOD HOSPITAL & CLINICS SERVE INCLUDES AN ECONOMICALLY DEPRESSED AREA THAT IS BASED ON A MAJORITY OF FAMILIES THAT DO NOT HAVE HEALTH INSURANCE, OR THAT ARE UTILIZING MEDICAID.

PART VI, LINE 5:
ASPIRUS IRONWOOD HOSPITAL & CLINICS HAVE NUMEROUS CONTINUING EDUCATION EVENTS THAT ARE SET UP TO HELP IMPROVE THE MEDICAL CARE AND KNOWLEDGE OF THE LOCAL POPULATION. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. ASPIRUS IRONWOOD HOSPITAL & CLINICS CONTINUE TO REINVEST IN EQUIPMENT, TRAINING, AND RESEARCH AREAS IN ORDER TO IMPROVE PATIENT CARE IN THE COMMUNITIES THAT IT SERVES, AS WELL AS PROVIDING RESEARCH TO HELP THE LOCAL COMMUNITIES.

PART VI, LINE 6:
ASPIRUS IRONWOOD HOSPITAL & CLINICS IS AN AFFILIATED HEALTH SYSTEM WHICH SERVES THE COMMUNITY SURROUNDING IRONWOOD, MICHIGAN. AFFILIATES OF ASPIRUS IRONWOOD HOSPITAL & CLINICS PROMOTE THE HEALTH OF THE COMMUNITY BY FULFILLING ASPIRUS' MISSION. ASPIRUS IRONWOOD HOSPITAL & CLINICS PROVIDES PHYSICIAN SERVICES IN AN OUTPATIENT CLINIC. ASPIRUS IRONWOOD HOSPITAL & CLINICS IS ALSO AN AFFILIATE OF ASPIRUS, INC. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTH CARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES DEDICATED TO IMPROVING THE HEALTH OF ALL WE SERVE. WE WORK COLLABORATIVELY WITH OTHERS WHO SHARE OUR PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE.

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 IRONWOOD 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 VI, LINE 7, REPORTS FILED WITH STATES
MI

PART VI, LINE 2:
ASPIRUS IRONWOOD HOSPITAL & CLINICS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES BY EXAMINING THE NEEDS OF THE PATIENT. THIS IS DONE THROUGH ANALYSIS OF PATIENT VOLUMES IN DEPARTMENTS, SPECIALISTS, AND THE DIFFERENT CLINIC LOCATIONS WITHIN THE ORGANIZATION'S AREAS OF SERVICE. INFORMATION IS ALSO GATHERED DIRECTLY FROM THE PATIENTS TO SEE WHAT AREAS THEY WOULD LIKE TO SEE ADDITIONAL SUPPORT. INFORMATION REGARDING THE NEEDS OF THE GENERAL COMMUNITY IS OBTAINED FROM THE MICHIGAN HOSPITAL ASSOCIATION AND THE WISCONSIN HOSPITAL ASSOCIATION AND ANALYZED FOR POTENTIAL NEW SERVICE AREAS. ASPIRUS IRONWOOD HOSPITAL & CLINICS HAS COLLABORATED WITH OTHER AREA HOSPITALS TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IS AN IMPORTANT TOOL IN IDENTIFYING THE HEALTH NEEDS OF THE COMMUNITY AND RESULTS OF THE PROJECT ASSIST IN PRIORITIZING HEALTH NEEDS THAT LEAD TO THE ALLOCATION OF APPROPRIATE RESOURCES AND THE CREATION OF NEW PARTNERSHIPS TO IMPROVE THE HEALTH OF THE POPULATION.