2023-11-13T14:38:10-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 390808498 THE RICHLAND HOSPITAL INC RICH 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 ELIZABETH MOORE CHIEF FINANCIAL OFFICER 6086476321 2023-11-02 1 ELIZABETH MOORE 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2023-11-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BRUCE ROESLER 333 EAST SECOND STREET RICHLAND CENTER WI 53581 75390246 0 X WWW.RICHLANDHOSPITAL.COM X 1937 WI THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING. 10 8 508 57 2209 0 5487617 1523366 65303983 67913713 956218 458532 415537 617086 72163355 70512697 0 0 0 0 36229250 38377480 0 0 125849 25807841 28468342 62037091 66845822 10126264 3666875 90295177 90865253 8950106 8216760 81345071 82648493 THE RICHLAND HOSPITAL IS DEDICATED TO CARING, EDUCATING, AND HEALING - TO BE THE COMMUNITY'S FIRST CHOICE FOR BETTER HEATH. 0 0 51980033 0 52898068 THE RICHLAND HOSPITAL, INC. (THE HOSPITAL) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN RICHLAND CENTER, WI. PATIENTS SERVED BY THE RICHLAND HOSPITAL IN 2022 INCLUDED 3,552 ADULTS AND PEDIATRICS INPATIENT DAYS, 585 SWING BED PATIENT DAYS, 249 NEWBORN PATIENT DAYS, 58,698 TOTAL OUTPATIENT VISITS, AND 7,400 EMERGENCY ROOM VISITS. THE HOSPITAL ALSO OPERATES A PHYSICIAN CLINIC PROVIDING PRIMARY CARE PROCEDURES SUCH AS CARDIAC TESTS AND ULTRASOUNDS. THE HOSPITAL ENGAGES IN SEVERAL EFFORTS THAT ARE DESCRIBED IN DETAIL ON THE SCHEDULE H ATTACHED TO THE RETURN. 3492625 0 14724780 THE RICHLAND HOSPITAL, INC. ALSO OPERATES TWO RURAL HEALTH CLINICS LOCATED IN SPRING GREEN AND MUSCODA, WI. DURING 2022 THESE TWO CLINICS PROVIDED OVER 6,984 VISITS TO PATIENTS IN BOTH COMMUNITIES. THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL OR UNDERSERVED AREAS OF THE COUNTRY BY HEALTH CARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FARTHER DISTANCES FOR QUALITY HEALTHCARE. 55472658 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 66 0 508 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 8 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 WI X ELIZABETH MOORE 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 CHRISTINE RICHARDS MD CHIEF OF STAFF 40.00 X 318836 0 46772 KAY BALINK MD SECRETARY (& EMPLOYEE) 40.00 X X 182161 0 41890 MARILYN RINEHART CHAIR 3.00 X X 0 0 0 JOHN ANNEAR VICE-CHAIR 2.00 X X 0 0 0 STEVE BAUER TREASURER 2.00 X X 0 0 0 JERRY GANDER DIRECTOR - THRU 04/22 1.50 X 0 0 0 JERRY MCCAULEY DIRECTOR - THRU 04/22 1.50 X 0 0 0 LAURA MELBY DIRECTOR 1.50 X 0 0 0 TRACI PETERSON DIRECTOR 1.50 1.00 X 0 0 0 JOHN POOLE DIRECTOR 1.00 X 0 0 0 SHELLY SCHMIDT DIRECTOR 1.50 X 0 0 0 PETER WALSH DIRECTOR 1.50 X 0 0 0 BRUCE ROESLER CEO 40.00 X 341140 0 45015 ELIZABETH MOORE CFO 40.00 1.00 X 202663 0 46244 THOMAS BECK ORTHOPEDIC SURGEON 40.00 X 568643 0 33456 BRYAN MCCARVEL CRNA 40.00 X 447313 0 54157 CRYSTAL LUMI GENERAL SURGEON 40.00 X 414379 0 32478 SHAWN O' BRIEN ER DOCTOR 40.00 X 390534 0 56606 ANDREW WRIGHT FAMILY PHYSICIAN 40.00 X 379911 0 49862 3245580 0 406480 9 0 1 0 FASTAFF LLC 5700 S QUEBEC ST SUITE 300 GREENWOOD VILLAGE CO 80111 CONTRACTED LABOR-NURSING 2113596 RURAL PHYSICIANS GROUP 5575 DTC PKWY STE 225 GREENWOOD VILLAGE CO 80111 HOSPITALIST PROVIDER 868895 HURON CONSULTING SERVICES LLC 550 W VAN BUREN STREET CHICAGO IL 60607 MT EXPANSE SOFTWARE CONSULTING 708646 PSYCHIATRIC MEDICAL CARE LLC 4322 HARDING PIKE 417 NASHVILLE TN 37205 PSYCHIATRIC SERVICES 564319 MERITER KEALTH ENTERPRISES DBA MERITER L 36 SOUTH BROOKS STREET MADISON WI 53715 LABORATORY TESTING SERVICES 430251 8 79483 1443883 1523366 PATIENT SERVICE REVENUE 621990 66888168 66885959 2209 PHARMACY 340B REVENUE 456110 736889 736889 MEALS 722320 138756 138756 CONTRACTED THERAPY 621990 135586 135586 14314 14314 67913713 447264 447264 625274 29797 595477 595477 595477 4859020 4831350 16402 27670 -16402 11268 11268 BAD DEBT RECOVERIES 900099 21609 21609 21609 70512697 67622848 2209 1364274 X 1224721 1224721 29147724 25023549 4025467 98708 972354 793082 175979 3293 5070386 4105768 947568 17050 1962295 1544836 411044 6415 142531 142531 103160 103160 9895 9895 10565000 8908628 1656342 30 121575 121575 354747 201514 152880 353 583808 583808 879940 875512 4428 58704 42116 16588 290177 139214 150963 3149337 2716483 432854 163437 163437 SUPPLIES 7992905 7567652 425253 BAD DEBT EXPENSE 2230978 2230978 EQUIPMENT RENTAL & MAIN 1032017 1023960 8057 STATE HOSPITAL ASSESSME 466271 466271 323860 299366 24494 66845822 55472658 11247315 125849 1488 1638 29933448 28014118 11024020 11874810 2104042 2251829 353883 310499 72871412 46842118 26099046 26029294 18163195 16186428 319926 0 2296129 6196637 90295177 90865253 6049745 5209868 15079 2444075 2900361 547738 8950106 8216760 X 81178059 82504002 167012 144491 81345071 82648493 90295177 90865253 X 3666875 -2334543 -28910 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 9895 9895 0 PART II-B, LINE 1: THE RICHLAND HOSPITAL, INC. (THE "HOSPITAL") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAD NOTIFIED THE HOSPITAL THAT APPROXIMATELY $2,557 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE HOSPITAL PAYS MEMBERSHIP FEES TO RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN SECURING GRANT FUNDING FOR NEW OR EXISTING HEALTHCARE PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, RWHC ALSO DOES PROVIDE ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON BEHALF OF THE MEMBER ORGANIZATIONS. IT WAS DETERMINED THAT APPROXIMATELY $2,029 OF THE FEES PAID BY THE HOSPITAL IN 2022 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. THE HOSPITAL IS ALSO A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) IN WHICH $5,308 OF THEIR MEMBERSHIP DUES IS DEVOTED TO LOBBYING AND ADVOCATION AT A NATIONAL LEVEL. 75411 -504 74907 76264 -853 75411 75098 1166 76264 72416 2682 75098 71496 920 72416 0.00000 0.80000 0.20000 0 0 2243992 2243992 46071226 30437757 15633469 609073 609073 0 21160782 15795288 5365494 2786339 2786339 26029294 INVESTMENT IN UNCONSOLIDATED AFFILIATE 255275 INTEREST IN NET ASSETS OF SUPPORTING ORGANIZATIONS 1339494 DEFERRED COMPENSATION PLAN ASSETS 547738 RIGHT OF USE ASSETS - OPERATING LEASES 2508937 AMOUNTS RECEIVABLE FROM THIRD-PART REIMBURSEMENT PROGRAMS 1545193 6196637 DEFERRED COMPENSATION PLAN LIABILITY 547738 547738 65909675 -2334543 79767 -2254776 68164451 2348246 2348246 70512697 64606352 29797 29797 64576555 2269267 2269267 66845822 PART V, LINE 4: THE ENDOWMENT FUNDS MAINTAINED BY THE RICHLAND HOSPITAL, INC. HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED IN PERPETUITY, THE INCOME OF WHICH IS EXPENDABLE TO SUPPORT SCHOLARSHIP PROGRAMS OF THE HOSPITAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 29,797. CHANGE IN NET ASSETS OF UNCONSOLIDATED AFFILIATES 49,970. PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER EXPENSES NET AGAINST REVENUE ON FINANCIAL STATEMENTS 38,289. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 2,230,978. INVESTMENT INCOME RECORDED TO UNRESTRICTED NET ASSETS -504. CONTRIBUTIONS FROM FOUNDATION 79,483. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 29,797. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER EXPENSES NET AGAINST REVENUE ON FINANCIAL STATEMENTS 38,289. PROVISION FOR BAD DEBTS NET AGAINST REVENUE ON FINANCIAL STATEMENTS 2,230,978. 1 1 X 1 X 1 X 1 1 1 0 1 1 163906 163906 0.00250 10436834 6157478 4279356 0.06620 10600740 6157478 4443262 0.06870 34850 34850 0.00050 650318 650318 0.01010 5387546 4353151 1034395 0.01600 32228 32228 0.00050 6104942 4353151 1751791 0.02710 16705682 10510629 6195053 0.09580 813259 813259 0.01260 813259 813259 0.01260 0 1038489 519245 22089735 22124624 -34889 X 1 1 1 1 THE RICHLAND HOSPITAL INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 WWW.RICHLANDHOSPITAL.COM 1045 X X X X THE RICHLAND HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V, SECTION C, LINE 7D X 1 22 1 SEE PART V, SECTION C, LINE 7D 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 5: IN 2022, THE RICHLAND HOSPITAL'S DIRECTOR OF COMMUNITY RELATIONS AND MARKETING, RICHLAND COUNTY PUBLIC HEALTH'S LOCAL HEALTH OFFICER, UW-MADISON DIVISION OF EXTENSION RICHLAND COUNTY EXTENSION EDUCATOR, RICHLAND COUNTY DRUG-FREE COMMUNITIES PROJECT DIRECTOR, AND RICHLAND CENTER HIGH SCHOOL PUPIL SERVICES PRINCIPAL PARTNERED TO CONDUCT A COMBINED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPROVEMENT PLAN. THIS GROUP IS KNOWN AS THE HEALTH ASSESSMENT AND WELLNESS COMMISSION (HAWC).MEMBERS OF THIS COMMISSION INCLUDED: 1. SHAWNA CONNOR, RICHLAND HOSPITAL, DIRECTOR OF COMMUNITY RELATIONS & MARKETING2. CINDY CHICKER, PRESIDENT, PARTNERS OF THE RICHLAND HOSPITAL3. CHELSEA WUNNICKE, UW-MADISON DIVISION OF EXTENSION RICHLAND COUNTY, EXTENSION EDUCATOR4. ROSE KOHOUT, RICHLAND COUNTY HEALTH AND HUMAN SERVICES, PUBLIC HEALTH, COUNTY OFFICER5. ELIZABETH PERKINS, PUPIL SERVICES PRINCIPAL, RICHLAND CENTER HIGH SCHOOL6. CARLENE SHAW, PUBLIC HEALTH NURSE, RICHLAND COUNTY HEALTH & HUMAN SERVICES7. BETSY ROESLER, DRUG-FREE COMMUNITIES PROJECT DIRECTOR, PARTNERS FOR PREVENTION COALITION OF RICHLAND COUNTY8. MEGAN RYAN, RICHLAND HOSPITAL, ADMINISTRATIVE ASSISTANT DATA COLLECTION METHODOLOGY:AT EARLY MEETINGS OF THE HAWC'S IT WAS DETERMINED BY CONSENSUS TO COLLECT CHNA DATA IN 3 WAYS. THE COMMISSION ENVISIONED THIS AS A 3-LEGGED STOOL THAT WOULD SUPPORT OUR RECOMMENDATIONS OF THE TOP HEALTH NEEDS.1. SECONDARY DATA - PURPOSE: UNDERSTAND THE HEALTH ENVIRONMENT & DOCUMENTED REALITIES. HAWC MEMBERS CURATED PUBLISHED & PRIVATE HEALTH DATA.2. COMMUNITY SURVEY - PURPOSE: COLLECT OPINIONS THAT CAN STATISTICALLY REPRESENT RICHLAND COUNTY. THIS SURVEY WAS AVAILABLE ELECTRONICALLY AND IN PRINT; IN BOTH ENGLISH AND SPANISH.3. STAKEHOLDER DATA WALK AND FOCUS GROUPS - PURPOSE: MULTI-SECTOR STAKEHOLDERS REVIEW COUNTY DATA, THE RESULTS OF THE COMMUNITY SURVEY AND PRIORITIZE NEEDS. BOTH MEETINGS WERE OPEN TO THE PUBLIC. THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 6B: RICHLAND COUNTY HEALTH AND HUMAN SERVICES THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 7D: SCHEDULE H, PART V, LINE 7AHTTPS://WWW.RICHLANDHOSPITAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/SCHEDULE H, PART V, LINE 10AHTTPS://WWW.RICHLANDHOSPITAL.COM/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENT/ THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 11: IN PLANNING TO MEET COMMUNITY NEEDS, THE HOSPITAL WORKS CLOSELY WITH KEY COMMUNITY STAKEHOLDERS TO ASSESS HOW COMMUNITY HEALTH NEED PRIORITIES IDENTIFIED IN THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT ARE BEING ADDRESSED. THE RICHLAND HOSPITAL CREATED AND ADOPTED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) THAT SERVES AS A ROAD MAP FOR THE ORGANIZATION TO MAINTAIN A KEEN EYE ON THOSE PRIORITIES. THE HOSPITAL'S COMMUNITY RELATIONS AND MARKETING DEPARTMENT, ALONG WITH HAWC MEMBERS, OVERSEES THE CHIP. THE THREE PRIORITIES IDENTIFIED IN THE COMMUNITY INCLUDED: 1. MENTAL HEALTH 2. SUBSTANCE ABUSE TREATMENT AND PREVENTION 3. OBESITY TREATMENT AND PREVENTIONTRHC INTENDS TO ENACT ELEMENTS OF THIS PLAN IN COOPERATION WITH THE AFOREMENTIONED COUNTY AND AREA AGENCIES, NON-PROFIT ORGANIZATIONS, SCHOOL DISTRICTS, AND THE GREATER RICHLAND COUNTY COMMUNITY. M - ADDRESSING MENTAL HEALTH1. INCREASE MENTAL HEALTH SERVICESM1A = EXPLORE EXPANSION OF MENTAL HEALTH SERVICES AT THE RICHLAND HOSPITAL AND CLINICS (TRHC)M1B = CONTINUE TO GROW THE SENIOR LIFE SOLUTIONS (SLS) PROGRAMM1C = IMPROVE ACCESS TO INFORMATION ABOUT EXISTING LOCAL MENTAL HEALTH RESOURCES2. INCREASE MENTAL HEALTH CONTINUING EDUCATIONM2A = FACILITATION AND SUPPORT FOR CONTINUING EDUCATION OF THE RICHLAND HOSPITAL AND CLINICS' (TRHC) PROVIDERS, STAFF, AND MEMBERS OF THE GREATER COMMUNITY SEEKING ADDITIONAL FORMAL EDUCATION REGARDING MENTAL ILLNESS/HEALTHM2B = SUPPORT THE 2023 PATIENT SAFETY PLAN (PHASE 1)M2C = SUPPORT THE 2023 PATIENT SAFETY PLAN (PHASE 2)S - ADDRESSING SUBSTANCE ABUSE TREATMENT AND PREVENTION1. INCREASE AND SUPPORT MAINTAINING AND CREATING MORE ACCESS TO RESOURCES FOR THOSE BATTLING SUBSTANCE ABUSE. S1A = SUPPORT/PROMOTE THE AVAILABILITY OF NARCOTICS ANONYMOUS IN RICHLAND CENTERS1B = PROVIDE ADDICTION MEDICINE IN PRIMARY CARE SETTINGS AT THE RICHLAND HOSPITAL AND CLINICS (TRHC)S2A = INCREASE AWARENESS OF THE ISSUES SURROUNDING SUBSTANCE ABUSE AND HELP CREATE AN ENVIRONMENT OF COLLABORATION FOR INCREASED CHANGE. O - ADDRESSING OVERWEIGHT & OBESITY TREATMENT AND PREVENTION 1. PROVIDE OPPORTUNITIES FOR THE RICHLAND HOSPITAL AND CLINICS' (TRHC) STAFF AND THEIR FAMILIES TO BE PHYSICALLY ACTIVE AND EAT HEALTHY. 2. ENCOURAGE INCREASED PHYSICAL ACTIVITY AND HEALTHY EATING THROUGHOUT THE GREATER RICHLAND COUNTY COMMUNITIESO2A = SUPPORT SUMMER ATHLETIC PROGRAMSO2B = HOST/PARTICIPATE IN/VOLUNTEER FOR COMMUNITY EDUCATION OPPORTUNITIES THAT PROMOTE ACTIVITY OR HEALTHY EATING THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 13H: IN ADDITION TO THE FEDERAL POVERTY GUIDELINES, THE RICHLAND HOSPITAL, INC. CONSIDERS THE FOLLOWING WHEN DETERMINING ELIGIBILITY FOR PROVIDING "FREE OR "DISCOUNTED" CARE TO INDIVIDUALS:- PATIENT IS HOMELESS- PATIENT IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED- PATIENT IS ELIGIBLE FOR ASSISTANCE UNDER THE CRIME VICTIMS ACT OR SEXUAL ASSAULT ACT- PATIENT IS DECEASED, AND WITHOUT A SPOUSE, AND NO ESTATE HAS BEEN FILED WITH THE COURT SYSTEM WITHIN 12 MONTHS OF EXPIRATION OR IF IT DETERMINED PATIENT DOES NOT HAVE ASSETS REQUIRING THE FILING OF AN ESTATE- PATIENT RECEIVES A BANKRUPTCY DETERMINATION WITHIN THE SIX MONTHS IMMEDIATELY PRECEDING THE APPLICATION DATE IF APPLICANT IS LOOKING FOR CONSIDERATION ON ANY ACTIVE ACCOUNT NOT DISCHARGED AS A PART OF THE BANKRUPTCY DETERMINATION- PATIENT'S VALID ADDRESS IS CONSIDERED LOW INCOME OR SUBSIDIZED HOUSING AND PATIENT AUTHORIZES THE APPLICABLE HOUSING AUTHORITY TO VALIDATE INCOME LEVEL DIRECTLY TO THE HOSPITAL- ACCOUNTS RETURNED BY COLLECTION AGENCY- ACCOUNTS CLOSED AS A RESULT OF A COURT-ORDER-PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM THE RICHLAND HOSPITAL, INC. PART V, SECTION B, LINE 16J: PLAIN LANGUAGE SUMMARY IS INCLUDED IN WRITTEN ACCOUNT COMMUNICATION, PLAIN LANGUAGE SUMMARY IS OFFERED AT REGISTRATION, PLAIN LANGUAGE SUMMARY IS INCLUDED ON STATEMENTS. 2 1 - MUSCODA HEALTH CENTER 1075 NORTH WISCONSIN AVENUE MUSCODA WI 53573 RURAL HEALTH CLINIC 2 - SPRING GREEN MEDICAL CENTER 150 EAST JEFFERSON STREET SPRING GREEN WI 53588 RURAL HEALTH CLINIC PART I, LINE 3C: ADDITIONALLY, THE RICHLAND HOSPITAL, INC. MAY REFER TO OR RELY ON EXTERNAL SOURCES AND/OR OTHER PROGRAM ENROLLMENT RESOURCES IN THE CASE OF PATIENTS LACKING DOCUMENTATION THAT SUPPORTS ELIGIBILITY OR INDIVIDUAL CIRCUMSTANCE. AT ITS SOLE DISCRETION, WHEN A PATIENT IS UNABLE TO PROVIDE NECESSARY DOCUMENTATION TO SUPPORT AN ELIGIBILITY DETERMINATION, THE RICHLAND HOSPITAL, INC. MAY PROVIDE FREE OR DISCOUNTED SERVICES UNDER THIS PROGRAM WHEN PATIENT: - IS HOMELESS - IS ELIGIBLE FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED - IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH PROGRAM - IS ELIGIBLE FOR ASSISTANCE UNDER THE CRIME VICTIMS ACT OR SEXUAL ASSAULT ACT - IS DECEASED, WITHOUT A SPOUSE, AND NO ESTATE HAS BEEN FILED WITH THE COURT SYSTEM WITHIN 12 MONTHS OF EXPIRATION OR AT THE TIME IT CAN BE DETERMINED PATIENT DOES NOT HAVE ASSETS REQUIRING THE FILING OF AN ESTATE. - RECEIVES A BANKRUPTCY DETERMINATION WITHIN THE SIX MONTHS IMMEDIATELY PRECEDING THE APPLICATION DATE IF APPLICANT IS LOOKING FOR CONSIDERATION ON ANY ACTIVE ACCOUNT NOT DISCHARGED AS A PART OF THE BANKRUPTCY DETERMINATION. - VALID ADDRESS IS CONSIDERED LOW INCOME OR SUBSIDIZED HOUSING AND PATIENT AUTHORIZES THE APPLICABLE HOUSING AUTHORITY TO VALIDATE INCOME LEVEL DIRECTLY TO THE HOSPITAL. PART I, LINE 6A: THE RICHLAND HOSPITAL, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'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 HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT 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 THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT THE RICHLAND HOSPITAL, INC. INCLUDES THE OPERATION OF THE HOSPITAL EMERGENCY ROOM DEPARTMENT AND THE INTENSIVE CARE INPATIENT UNIT. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH THE RICHLAND HOSPITAL, INC. AND ARE PRIMARILY UTILIZED FOR EMERGENCY SERVICES. THE EMERGENCY ROOM DEPARTMENT OPERATES 24-HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED PRIMARILY BY BOARD CERTIFIED EMERGENCY ROOM PHYSICIANS. AS PART OF THE PATIENT SERVICES PROVIDED TO THE COMMUNITY, THE HOSPITAL HAS DESIGNATED A PORTION OF ITS INPATIENT UNIT AS A CERTIFIED INTENSIVE CARE UNIT KNOWN AS THE "SPECIAL CARE UNIT." THIS UNIT REQUIRES A HIGHER ACUITY OF NURSING AND HAS DEDICATED STAFF TO PROVIDE THIS CARE TO PATIENTS. A SIGNIFICANT PORTION OF THE ADMISSIONS TO THE UNIT COME FROM EMERGENCY ADMISSIONS TO THE HOSPITAL SO IT IS CONSIDERED A SUBSIDIZED HEALTH SERVICE PROVIDED TO THE COMMUNITY BY THE HOSPITAL. IT IS THE GOAL OF THE RICHLAND HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,230,978. PART II, COMMUNITY BUILDING ACTIVITIES: THE RICHLAND HOSPITAL, INC. IS ACCREDITED THROUGH THE JOINT COMMISSION ("TJC"). THE TJC IS AN ORGANIZATION THAT EVALUATES HOSPITAL PERFORMANCE STANDARDS, FOCUSING ON THE QUALITY OF HEALTHCARE. ACCREDITATION THROUGH THE JOINT COMMISSION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY, AS IT REQUIRES RIGOROUS PERFORMANCE STANDARDS. TO EARN AND MAINTAIN ACCREDITATION, THE HOSPITAL IS EVALUATED THROUGH AN UNANNOUNCED SURVEY PROCESS COVERING NEARLY 600 STANDARDS RELATED TO QUALITY PATIENT CARE, SAFETY, INFECTION CONTROL, AND ONGOING PERFORMANCE-IMPROVEMENT ACTIVITIES, AMONG OTHERS. ALL HOSPITALS SURVEYED BY THE JOINT COMMISSION ARE EVALUATED AGAINST THE SAME CRITERIA, REGARDLESS OF SIZE OR LOCATION.THE ACTIVITIES OF THE RICHLAND HOSPITAL, INC. ARE SUPPORTED LOCALLY BY A VOLUNTEER BOARD OF DIRECTORS WHICH OVERSEE THE OPERATIONS OF THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS THAT RESIDE IN RICHLAND CENTER, WI, AND THE SURROUNDING AREA WHICH IS THE HOSPITAL'S PRIMARY PATIENT SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO A MAJORITY OF ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS WHO WISH TO BETTER SERVE THEIR PATIENTS BY PROVIDING CARE AT THE RICHLAND HOSPITAL, INC.ANY SURPLUSES IN OPERATIONS THAT ARE ACHIEVED BY THE HOSPITAL OPERATING IN AN EFFECTIVE MANNER AND CONTROLLING THE COST OF HEALTHCARE ARE PRIMARILY RESERVED FOR FUTURE BUILDING AND CAPITAL PURCHASE NEEDS. THE RICHLAND HOSPITAL, INC. RECOGNIZES THAT IT IS IMPORTANT TO SAVE THESE RESERVES DURING YEARS OF SURPLUS SO THAT IN TIMES OF ECONOMIC DOWNTURN, IF A LARGE CAPITAL ADDITION IS NEEDED, THE HOSPITAL WILL NOT HAVE TO PASS HIGHER COSTS ON TO MEMBERS OF THE COMMUNITY. THE HOSPITAL FURTHER ACHIEVES ITS GOAL OF PROVIDING TRUE COMMUNITY SUPPORT BY PROVIDING CHARITY CARE AS DESCRIBED THROUGHOUT SCHEDULE H AND PROVIDING SERVICES TO MEMBERS OF OTHER PROGRAMS WHICH OFTEN REIMBURSE THE HOSPITAL BELOW THE COST OF PROVIDING THIS CARE SUCH AS CHAMPUS, TRICARE, AND THE WISCONSIN HEALTH INSURANCE RISK SHARING PROGRAM OR "HIRSP" (THE HIRSP PROGRAM REIMBURSES THE HOSPITAL AT RATES SIMILAR TO THE MEDICAID PROGRAM AND IS FOR PATIENTS THAT HAVE PRE-EXISTING ILLNESSES WHICH MAKE IT DIFFICULT TO OBTAIN INSURANCE FROM COMMERCIAL INSURANCE CARRIERS IN THE MARKETPLACE).FINALLY, THE RICHLAND HOSPITAL, INC. COMMUNITY RELATIONS DEPARTMENT MANAGES ALL SPONSORSHIP DOLLARS ANNUALLY AND ALLOCATES TO AREA NON-PROFIT ORGANIZATIONS BASED ON THAT ORGANIZATION'S OR EVENT'S POSITIVE IMPACT ON OUR IDENTIFIED COMMUNITY HEALTH NEEDS. LIKEWISE, ADVERTISING DOLLARS AND EARNED MEDIA PROMOTIONS POSITIVELY AFFECTING IDENTIFIED COMMUNITY HEALTH NEEDS TAKE PRECEDENCE OVER GENERAL 'AWARENESS' CAMPAIGNS (MENTAL HEALTH MONTH, NUTRITION MONTH, OVERDOSE AWARENESS). PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE CONSOLIDATED 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 ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES, PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTS PATIENTS WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE RICHLAND HOSPITAL, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND, AS SUCH, A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES ONLY A PORTION OF THE TOTAL MEDICARE REVENUE OF THE HOSPITAL. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, RADIOLOGIST SERVICES, AND SURGICAL ANESTHESIA SERVICES AT THE RICHLAND HOSPITAL, INC. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND, AS SUCH, THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE RICHLAND HOSPITAL, INC. PROVIDES TO THE COMMUNITIES IT SERVES. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES AND THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: AT THE TIME OF PATIENT PRESENTATION, THE RICHLAND HOSPITAL, INC. WILL GATHER DEMOGRAPHIC AND INSURANCE INFORMATION THAT SUPPORTS THE TIMELY GENERATION AND RELEASE OF INSURANCE CLAIM FORMS AND /OR SELF-PAY STATEMENTS FOR SERVICES RENDERED. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, THE RICHLAND HOSPITAL, INC. MAY TAKE ANY AND ALL LEGAL ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS (ECA'S), TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED. THE RICHLAND HOSPITAL, INC. WILL NOT ENGAGE IN ECA'S, EITHER DIRECTLY OR BY ANY DEBT COLLECTIONS AGENCY OR OTHER PARTY TO WHICH THE HOSPITAL HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL^) IS ELIGIBLE FOR ASSISTANCE UNDER THE COMMUNITY CARE PROGRAM, FINANCIAL ASSISTANCE POLICY. AT THE POINT A RESPONSIBLE INDIVIDUAL REQUESTS A COMMUNITY CARE PROGRAM APPLICATION, THE ABOVE PROCEDURE WILL CEASE, AND THE FOLLOWING PROCEDURE WILL TAKE EFFECT.UPON REQUEST, A COMMUNITY CARE PROGRAM APPLICATION WILL BE SENT/GIVEN TO THE RESPONSIBLE INDIVIDUAL ALONG WITH A COVER LETTER DETAILING DOCUMENTATION REQUIRED TO PROCESS THE APPLICATION.APPLICATION MUST BE RETURNED WITHIN 30 DAYS FROM THE DATE THE RESPONSIBLE INDIVIDUAL IS GIVEN OR MAILED THE APPLICATION.IF INCOMPLETE OR INSUFFICIENT DOCUMENTATION IS RECEIVED, RESPONSIBLE INDIVIDUAL WILL BE NOTIFIED IN WRITING OF THE MISSING OR INCOMPLETE DOCUMENTATION. RESPONSIBLE INDIVIDUAL WILL HAVE 30 DAYS FROM THE DATE OF THE NOTIFICATION TO PROVIDE THE MISSING INFORMATION OR DOCUMENTATION. FAILURE TO SUBMIT A COMPLETED APPLICATION OR SUBSEQUENTLY REQUESTED DOCUMENTATION WITHIN 30 DAYS MAY RESULT IN THE APPLICATION BEING DENIED, THE ACCOUNT BEING REFERRED TO AN EXTERNAL COLLECTION AGENCY AND ECA'S MAY COMMENCE. IF A COMMUNITY CARE PROGRAM APPLICATION IS RECEIVED AFTER AN ACCOUNT HAS BEEN REFERRED TO AN EXTERNAL COLLECTION AGENCY, BUT PRIOR TO 240 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT, THE EXTERNAL COLLECTION AGENCY WILL BE INSTRUCTED TO DISCONTINUE COLLECTION ACTIVITY UNTIL THE COMMUNITY CARE PROGRAM APPLICATION HAS BEEN PROCESSED. IF THE APPLICATION IS APPROVED FOR A FULL OR PARTIAL DISCOUNT, THE EXTERNAL COLLECTION AGENCY WILL BE NOTIFIED AND INSTRUCTED TO REMOVE OR REVERSE ANY ECAS THAT MAY HAVE BEEN TAKEN AND THE ACCOUNT WILL BE REFERRED BACK TO THE RICHLAND HOSPITAL, INC.RESPONSIBLE INDIVIDUALS APPROVED FOR A PARTIAL DISCOUNT WILL BE NOTIFIED IN WRITING OF THEIR APPROVAL FOR A PARTIAL DISCOUNT AND AN UPDATED STATEMENT REFLECTING THE NEW DISCOUNTED AMOUNT DUE WILL BE INCLUDED. RESPONSIBLE INDIVIDUALS DETERMINED TO BE INELIGIBLE FOR A COMMUNITY CARE PROGRAM DISCOUNT WILL BE NOTIFIED IN WRITING OF THEIR INELIGIBILITY. THE NOTIFICATION TO RESPONSIBLE INDIVIDUALS DETERMINED TO BE INELIGIBLE FOR A COMMUNITY CARE PROGRAM DISCOUNT OR ELIGIBLE FOR A PARTIAL DISCOUNT WILL INCLUDE A PAYMENT PLAN AGREEMENT. RESPONSIBLE INDIVIDUAL WILL BE PROVIDED 30 DAYS TO COMPLETE AND RETURN THE PAYMENT PLAN AGREEMENT. FAILURE TO RETURN A COMPLETED PAYMENT PLAN AGREEMENT WITHIN 30 DAYS COULD RESULT IN THE ACCOUNT BEING REFERRED TO AN EXTERNAL COLLECTION AGENCY AND ECAS MAY COMMENCE. HOSPITAL AND EXTERNAL COLLECTION AGENCIES MAY ALSO TAKE ANY AND ALL LEGAL ACTIONS INCLUDING BUT NOT LIMITED TO TELEPHONE CALLS, EMAILS, TEXTS, MAILING NOTICES AND SKIP TRACING TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED. PART VI, LINE 2: IN ADDITION TO THE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2022, THE RICHLAND HOSPITAL, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY IT SERVES BY LOOKING AT LOCAL AND SURROUNDING COMMUNITY DEMOGRAPHICS TO DETERMINE THE SERVICES THAT ARE MOST NECESSARY IN ORDER TO FULFILL ITS MISSION. THE HOSPITAL ACTIVELY SEEKS INPUT FROM MEMBERS OF THE MEDICAL STAFF REGARDING EXISTING SERVICES, THE POTENTIAL NEED FOR EXPANDED SERVICES, AND THE POTENTIAL NEED FOR NEW SERVICE LINES NOT OFFERED LOCALLY. THE HOSPITAL MONITORS THE LOSS OF SPECIALTY PROVIDERS IN THE AREA AND, COLLABORATIVELY WORKING WITH OUR RURAL HEALTH CLINICS (RICHLAND HOSPITAL CLINIC, SPRING GREEN MEDICAL CENTER, AND MUSCODA HEALTH CENTER), PARTICIPATES IN A DETERMINATION OF WHETHER AND HOW THIS NEW NEED CAN BEST BE MET. THE HOSPITAL ALSO REVIEWS HOSPITAL STATISTICS OF PATIENT VISITS TO DETERMINE WHAT TYPES OF SERVICES OFFERED BY THE HOSPITAL ARE BEING UTILIZED. PART VI, LINE 3: CONSISTENT WITH THE MISSION OF THE RICHLAND HOSPITAL, INC., HEALTH-RELATED SERVICES ARE PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL IS COMMITTED TO PROVIDING FREE OR DISCOUNTED CARE TO QUALIFIED INDIVIDUALS THAT ARE IN NEED OF MEDICALLY NECESSARY TREATMENT EVEN IF THAT PERSON IS UNINSURED, UNDERINSURED, INELIGIBLE FOR OTHER GOVERNMENT PROGRAMS, OR UNABLE TO PAY BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION. WHEN AN UNINSURED OR UNDERINSURED PATIENT REQUESTS FINANCIAL ASSISTANCE AND HAS AN ADJUSTED GROSS INCOME THAT IS AT OR BELOW 150% OF THE FEDERAL POVERTY LEVEL, THEY ARE ELIGIBLE FOR A 100% DISCOUNT ON ANY PATIENT BALANCE. WHEN AN UNINSURED PATIENT'S ADJUSTED GROSS INCOME IS 151 TO 300% OF THE FEDERAL POVERTY LEVEL, THEY ARE PROVIDED CARE AT THE AMOUNT GENERALLY BILLED OR LESS. FOR UNDERINSURED PATIENTS WITH AN ADJUSTED GROSS INCOME OF 151 TO 300%, THE AMOUNT PATIENT IS CHARGED AND RESPONSIBLE FOR PAYING (CO-INSURANCE, DEDUCTIBLES, ETC.) AFTER APPLYING DEDUCTIONS, DISCOUNTS AND PAYMENTS APPLIED BY THE THIRD PARTY PAYER WILL NOT BE GREATER THAN THE AGB. TO BE ELIGIBLE UNDER THIS PROGRAM, PATIENTS MUST COOPERATE WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE AND IF NECESSARY, INCLUDING APPLICATION OR ACTIONS NEEDED TO SECURE COVERAGE BY MEDICARE, MEDICAID, AND THE MARKETPLACE. PATIENTS WILL BE REQUIRED TO PROVIDE NECESSARY INFORMATION AND DOCUMENTATION WHEN APPLYING FOR A PROGRAM DISCOUNT, OR FOR OTHER PRIVATE OR PUBLIC PAYMENT PROGRAMS. THE FACILITY'S FINANCIAL COUNSELOR IS AVAILABLE TO ASSIST PATIENTS WITH THE APPLICATION PROCESS. APPLICATIONS AND ALL SUPPORTING DOCUMENTATION IS REVIEWED BY THE FACILITY'S FINANCIAL COUNSELOR FOR ELIGIBILITY AND APPROVED BY THE PATIENT ACCOUNTING SUPERVISOR. FREE RADIOLOGY, LABORATORY, AND OTHER DIAGNOSTIC ANCILLARY SERVICES ARE ALSO PROVIDED TO PATIENTS WHO ARE REFERRED TO THE HOSPITAL BY THE RICHLAND CENTER FREE CLINIC. THE HOSPITAL ALSO OFFERS A 20% PROMPT PAY DISCOUNT FOR UNINSURED PATIENTS.THE RICHLAND HOSPITAL, INC. COMMUNICATES THE AVAILABILITY AND TERMS OF THE PROGRAM TO ALL PATIENTS, THROUGH MEANS WHICH INCLUDE, BUT ARE NOT LIMITED TO:1. POSTED SIGNS WITHIN WAITING ROOMS, EMERGENCY ROOMS, AND PATIENT ACCOUNTING AREAS.2. COMMUNITY CARE PROGRAM APPLICATION AND PLAIN LANGUAGE SUMMARY OFFERED TO INDIVIDUALS AT TIME OF REGISTRATION AND DISCHARGE FROM AN INPATIENT ADMISSION. THE COMMUNITY CARE PROGRAM POLICY, COMMUNITY CARE PROGRAM APPLICATION AND THE PLACEMENT FOR COLLECTION POLICY ARE AVAILABLE UPON REQUEST. SPANISH VERSIONS WILL ALSO BE AVAILABLE UPON REQUEST.3. PLAIN LANGUAGE SUMMARY, COMMUNITY CARE PROGRAM POLICY, COMMUNITY CARE PROGRAM APPLICATION AND PLACEMENT FOR COLLECTIONS POLICY INCLUDING SPANISH VERSIONS CAN BE OBTAINED BY:A. REQUESTING IN PERSON AT THE RICHLAND HOSPITAL, INC., RICHLAND HOSPITAL CLINIC, SPRING GREEN MEDICAL CENTER AND MUSCODA HEALTH CENTERB. CONTACTING THE RICHLAND HOSPITAL, INC. PATIENT ACCOUNTING DEPARTMENT AT 608-647-6321.C. ACCESSING THE RICHLAND HOSPITAL, INC. WEBSITE D. SUBMITTING A WRITTEN REQUEST TO THE RICHLAND HOSPITAL, INC.4. PLAIN LANGUAGE SUMMARY PROVIDED WITH WRITTEN CORRESPONDENCE.5. CONSPICUOUS MESSAGE ON PATIENT STATEMENTS.6. PLAIN LANGUAGE SUMMARY AVAILABLE AT THE LOCAL AGING AND DISABILITY RESOURCE CENTER AND AT THE RICHLAND COMMUNITY FREE CLINIC.7. DESIGNATED STAFF KNOWLEDGEABLE ON THE PROGRAM WILL BE AVAILABLE TO ANSWER PATIENT QUESTIONS AND/OR REFER PATIENTS TO THE PROGRAM.REGISTRATION CLERKS AT THE HOSPITAL, THE HOSPITAL CLINIC AND AT THE TWO HOSPITAL OWNED CLINICS, ARE TRAINED TO INQUIRE WITH PATIENTS UPON REGISTRATION IF THEY WOULD LIKE INFORMATION ON THIS PROGRAM. DURING THE COLLECTION PROCESS, THE RICHLAND HOSPITAL PROVIDES INFORMATION AND INCLUDES COMMUNITY CARE PROGRAM MATERIALS WITH CORRESPONDENCE. SOCIAL SERVICES AND BUSINESS OFFICE STAFF AT THE HOSPITAL ARE ALSO AVAILABLE TO PROVIDE INFORMATION TO PATIENTS ON OTHER GOVERNMENT PROGRAMS SUCH AS THE MEDICAID PROGRAM OR TO REFER PATIENTS TO PERSONNEL AT RICHLAND COUNTY OR OTHER STATE OF WISCONSIN OR COUNTY AGENCIES THAT MAY PROVIDE ACCESS TO CARE. PART VI, LINE 4: THE RICHLAND HOSPITAL, INC. IS LOCATED IN RICHLAND CENTER, WISCONSIN, WHICH IS A COMMUNITY OF APPROXIMATELY 5,000 PEOPLE AND IS LOCATED 50 MINUTES FROM MADISON, WISCONSIN. THE FACILITY OPERATES A 25-BED, ACUTE CARE CRITICAL ACCESS HOSPITAL AND TWO RURAL HEALTH CLINICS LOCATED IN NEIGHBORING COMMUNITIES. THE RICHLAND HOSPITAL OFFERS A WIDE VARIETY OF SERVICES IN ORDER TO FULFILL MANY OF THE NEEDS OF THE INDIVIDUALS IN THE LOCAL COMMUNITY. AMONG SERVICES PROVIDED ARE: DIAGNOSTIC CARE, 24-HOUR EMERGENCY ROOM, OBSTETRICS, REHABILITATION, SURGICAL CARE, AND DIABETES SELF-CARE PROGRAMS, ALONG WITH OTHER SPECIALTY SERVICES, WHICH INCLUDE: AUDIOLOGY, CARDIOLOGY, ORTHOPEDICS, CHEMOTHERAPY, CLINICAL SERVICES, AMONG OTHERS. CARE IS OFFERED TO PATIENTS REGARDLESS OF PAY SOURCE AND REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COMMUNITIES SERVED BY THE RICHLAND HOSPITAL AS PRIMARY SERVICE AREA ARE DEFINED BY THE FOLLOWING ZIP CODES: 53556 - LONE ROCK53518 - BLUE RIVER53573 - MUSCODA53581 - RICHLAND CENTER53588 - SPRING GREENTHEY ARE GEOGRAPHICALLY CONTIGUOUS COMMUNITIES. ACCORDING TO 2021 DATA PUBLISHED BY KAAVIO, THE RICHLAND HOSPITAL, INC. HAD AN OVERALL INPATIENT MARKET SHARE OF 70.75 PERCENT AND OUTPATIENT MARKET SHARE OF 71.83 PERCENT IN THESE ZIP CODES. NO OTHER HEALTHCARE PROVIDER PROVIDING THE SAME SERVICES HAD A MARKET SHARE AS HIGH AS OR HIGHER THAN THE RICHLAND HOSPITAL, INC. (KAAVIO COMBINES STATEWIDE HEALTHCARE DATA FROM WISCONSIN HOSPITAL ASSOCIATION IN A WEB-BASED SUPPORT ENGINE THAT ALLOWS US TO ANALYZE OUR MARKET.)SOCIO-DEMOGRAPHIC PROFILE OF THE MARKET AREA SERVED BY THE RICHLAND HOSPITAL, INC. SERVES PERSONS WHO ARE REPRESENTATIVE OF THE POPULATION OF THE MARKET AREA. A HIGHER PERCENTAGE OF THE POPULATION SERVED IS ELDERLY; THIS IS DUE TO THE FACT THAT PERSONS 65 YEARS OF AGE AND OLDER ARE HOSPITALIZED AT NEARLY THREE TIMES THE OVERALL RATE. SOME THINGS TO NOTE RELATED TO PLANNING FOR MEETING COMMUNITY HEALTH NEEDS INCLUDES THE FOLLOWING:- THE OVERALL POPULATION OF THE MARKET AREA IS PROJECTED TO REMAIN VERY STABLE, WITH NEGLIGIBLE GROWTH OR DECLINE PROJECTED OVER THE NEXT FIVE YEARS.- THE OVERALL POPULATION OF RICHLAND COUNTY IS 17,160 AND IS PROJECTED TO REMAIN VERY STABLE, WITH NEGLIGIBLE DECLINE OVER THE NEXT FIVE YEARS. CENSUSREPORTER.ORG ACS2020 DATA TELLS US THAT 45% OF OUR POPULATION IS 50+. DURING 2022, MEDICARE AND MEDICARE ADVANTAGE PLAN BENEFICIARIES ACCOUNTED FOR OVER 52 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE AT THE RICHLAND HOSPITAL, INC. AND MEDICAID BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 16 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE. MEDICARE AND MEDICAID BENEFICIARIES MADE UP THE LARGEST PORTION OF PATIENTS THAT ARE SERVED BY THE RICHLAND HOSPITAL, INC. OVER THE PREVIOUS FEW YEARS. PART VI, LINE 5: THE RICHLAND HOSPITAL, INC. IS ACCREDITED THROUGH THE JOINT COMMISSION ("TJC"). THE TJC IS AN ORGANIZATION THAT EVALUATES HOSPITAL PERFORMANCE STANDARDS, FOCUSING ON THE QUALITY OF HEALTHCARE. ACCREDITATION THROUGH THE JOINT COMMISSION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY, AS IT REQUIRES RIGOROUS PERFORMANCE STANDARDS. TO EARN AND MAINTAIN ACCREDITATION, THE HOSPITAL IS EVALUATED THROUGH AN UNANNOUNCED SURVEY PROCESS COVERING NEARLY 600 STANDARDS RELATED TO QUALITY PATIENT CARE, SAFETY, INFECTION CONTROL, AND ONGOING PERFORMANCE-IMPROVEMENT ACTIVITIES, AMONG OTHERS. ALL HOSPITALS SURVEYED BY THE JOINT COMMISSION ARE EVALUATED AGAINST THE SAME CRITERIA, REGARDLESS OF SIZE OR LOCATION.THE ACTIVITIES OF THE RICHLAND HOSPITAL, INC. ARE SUPPORTED LOCALLY BY A VOLUNTEER BOARD OF DIRECTORS WHICH OVERSEE THE OPERATIONS OF THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS THAT RESIDE IN RICHLAND CENTER, WI, AND THE SURROUNDING AREA WHICH IS THE HOSPITAL'S PRIMARY PATIENT SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO A MAJORITY OF ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS WHO WISH TO BETTER SERVE THEIR PATIENTS BY PROVIDING CARE AT THE RICHLAND HOSPITAL, INC.ANY SURPLUSES IN OPERATIONS THAT ARE ACHIEVED BY THE HOSPITAL OPERATING IN AN EFFECTIVE MANNER AND CONTROLLING THE COST OF HEALTHCARE ARE PRIMARILY RESERVED FOR FUTURE BUILDING AND CAPITAL PURCHASE NEEDS. THE RICHLAND HOSPITAL, INC. RECOGNIZES THAT IT IS IMPORTANT TO SAVE THESE RESERVES DURING YEARS OF SURPLUS SO THAT IN TIMES OF ECONOMIC DOWNTURN, IF A LARGE CAPITAL ADDITION IS NEEDED, THE HOSPITAL WILL NOT HAVE TO PASS HIGHER COSTS ON TO MEMBERS OF THE COMMUNITY. THE HOSPITAL FURTHER ACHIEVES ITS GOAL OF PROVIDING TRUE COMMUNITY SUPPORT BY PROVIDING CHARITY CARE AS DESCRIBED THROUGHOUT SCHEDULE H AND PROVIDING SERVICES TO MEMBERS OF OTHER PROGRAMS WHICH OFTEN REIMBURSE THE HOSPITAL BELOW THE COST OF PROVIDING THIS CARE SUCH AS CHAMPUS, TRICARE, AND THE WISCONSIN HEALTH INSURANCE RISK SHARING PROGRAM OR "HIRSP" (THE HIRSP PROGRAM REIMBURSES THE HOSPITAL AT RATES SIMILAR TO THE MEDICAID PROGRAM AND IS FOR PATIENTS THAT HAVE PRE-EXISTING ILLNESSES WHICH MAKE IT DIFFICULT TO OBTAIN INSURANCE FROM COMMERCIAL INSURANCE CARRIERS IN THE MARKETPLACE).FINALLY, THE RICHLAND HOSPITAL, INC. COMMUNITY RELATIONS DEPARTMENT MANAGES ALL SPONSORSHIP DOLLARS ANNUALLY AND ALLOCATES TO AREA NON-PROFIT ORGANIZATIONS BASED ON THAT ORGANIZATION'S OR EVENT'S POSITIVE IMPACT ON OUR IDENTIFIED COMMUNITY HEALTH NEEDS. LIKEWISE, ADVERTISING DOLLARS AND EARNED MEDIA PROMOTIONS POSITIVELY AFFECTING IDENTIFIED COMMUNITY HEALTH NEEDS TAKE PRECEDENCE OVER GENERAL 'AWARENESS' CAMPAIGNS (MENTAL HEALTH MONTH, NUTRITION MONTH, OVERDOSE AWARENESS). PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X 0 0 0 0 0 0 0 0 0 THOMAS BECK ORTHOPEDIC SURGEON 443890 0 120900 0 3853 0 12200 0 21256 0 602099 0 0 0 BRYAN MCCARVEL CRNA 432846 0 12833 0 1634 0 12200 0 41957 0 501470 0 0 0 SHAWN O' BRIEN ER DOCTOR 386206 0 1660 0 2668 0 12200 0 44406 0 447140 0 0 0 CRYSTAL LUMI GENERAL SURGEON 254714 0 156997 0 2668 0 10425 0 22053 0 446857 0 0 0 ANDREW WRIGHT FAMILY PHYSICIAN 270262 0 106329 0 3320 0 12200 0 37662 0 429773 0 0 0 BRUCE ROESLER CEO 307643 0 29780 0 3717 0 12200 0 32815 0 386155 0 0 0 CHRISTINE RICHARDS MD CHIEF OF STAFF 202497 0 113582 0 2757 0 12200 0 34572 0 365608 0 0 0 ELIZABETH MOORE CFO 201817 0 846 0 0 0 3071 0 43173 0 248907 0 0 0 KAY BALINK MD SECRETARY (& EMPLOYEE) 178264 0 1674 0 2223 0 7570 0 34320 0 224051 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBER: TRACI PETERSON, POTENTIALLY, SHE IS AN AREA CHIROPRACTOR THAT MAY REFER PATIENTS FOR CARE AT THE HOSPITAL. VICE PRESIDENT CLINIC SERVICES: BRIAN PULS, WIFE NON-PHYSICIAN PROVIDER EMPLOYEE AT THE RICHLAND HOSPITAL, INC. BOARD MEMBER: DR. RICHARDS, HOSPITAL PROVIDER EMPLOYEE AT THE RICHLAND HOSPITAL, INC. BOARD MEMBER: DR BALINK, HOSPITAL PROVIDER EMPLOYEE AT THE RICHLAND HOSPITAL, INC. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S MANAGEMENT AND FINANCE TEAM WORKS WITH THEIR PAID PREPARER TO ACCUMULATE AND ASSEMBLE THE IRS FORM 990. A COPY OF THE COMPLETED FORM WAS EMAILED OR MAILED TO ALL MEMBERS OF THE HOSPITAL'S BOARD OF DIRECTORS BEFORE IT WAS FILED. ALL BOARD MEMBERS WERE GIVEN THE OPPORTUNITY TO RESPOND WITH COMMENTS PRIOR TO THE FINAL SUBMISSION OF THE FORM 990 TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE RICHLAND HOSPITAL, INC. REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO COMPLETE ITS ANNUAL DISCLOSURE STATEMENT. THESE QUESTIONNAIRES ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. ANY INDIVIDUALS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING OR ACTING ON THOSE MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS AN ESTABLISHED PROCESS TO ANNUALLY REVIEW THE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND TO DEFINE APPROPRIATE MARKET AND PERFORMANCE-BASED ADJUSTMENTS. COMPARATIVE DATA IS OBTAINED FROM EITHER THE WISCONSIN HOSPITAL ASSOCIATION EXECUTIVE COMPENSATION SURVEY OR OTHER REPUTABLE THIRD-PARTY HEALTHCARE DATA SOURCES TO USE IN THE ESTABLISHMENT OF A MARKET FOR THIS KEY POSITION. THE PERSONNEL COMMITTEE OF THE BOARD OF DIRECTORS FULFILLS THIS ROLE. THE BOARD OF DIRECTORS HAS DELEGATED THE AUTHORITY AND RESPONSIBILITY FOR THE ONGOING MAINTENANCE OF OTHER KEY EMPLOYEES AND THE OVERALL ORGANIZATIONAL COMPENSATION MODEL TO THE CHIEF EXECUTIVE OFFICER AND HUMAN RESOURCE DIRECTOR. COMPARATIVE MARKET DATA IS OBTAINED VIA THE RURAL WISCONSIN HEALTH COOPERATIVE AND THE WISCONSIN SOCIETY OF HOSPITAL HUMAN RESOURCE ADMINISTRATORS VIA INDEPENDENT SALARY SURVEYS THAT PROVIDE BENCHMARK INFORMATION FOR HEALTHCARE JOB CLASSES. THIS DATA IS USED TO ESTABLISH SALARY RANGES FOR ALL JOB CLASSES WITHIN THE ORGANIZATION. THE BOARD OF DIRECTORS ANNUALLY AUTHORIZES THE OVERALL INCREASE TO THE SALARY BUDGET FOR THE ORGANIZATION WITH THE CEO MAINTAINING DELEGATED AUTHORITY FOR IMPLEMENTATION WITHIN THE ORGANIZATIONAL COMPENSATION MODEL. DURING THE REVIEW PROCESS, DECISIONS AFFECTING COMPENSATION AND CONTRACTS ARE ONLY REVIEWED AND APPROVED BY INDIVIDUALS WHO DO NOT HAVE NOTED CONFLICTS. FORM 990, PART VI, SECTION C, LINE 19 THE RICHLAND HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS HOSPITAL BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,549,683. MANAGEMENT AND GENERAL EXPENSES 1,656,342. FUNDRAISING EXPENSES 30. TOTAL EXPENSES 3,206,055. MEDICAL IMAGING PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,255,549. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,255,549. CLINICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 268,260. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 268,260. LABORATORY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 502,851. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 502,851. SURGICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,900,753. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,900,753. HOSPITALIST PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 871,063. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 871,063. BEHAVIORAL HEALTH PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 560,469. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 560,469. FORM 990, PART XI, LINE 9: NET CHANGE IN RESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS -22,017. NET CHANGE IN UNRESTRICTED NET ASSETS OF SUPPORTING ORGANIZATIONS -56,863. INCREASE IN EQUITY OF UNCONSOLIDATED AFFILIATE 49,970. RICHLAND HOSPITAL FOUNDATION INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391567249 FOUNDATION WI 501(C)(3) LINE 7 N/A 0 PARTNERS OF RICHLAND HOSPITAL INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391693458 AUXILIARY WI 501(C)(3) LINE 10 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 RICHLAND HOSPITAL FOUNDATION C 79483 CASH