2017-11-15T09:23:07-06:00 2016-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2016-01-01 390808498 THE RICHLAND HOSPITAL INC RICH 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 Karen Traynor Chief Financial Officer 6086476321 2017-11-15 1 PAUL M TRACZEK CPA P01368830 7158323407 2017-11-15 216.54.158.12 2017-11-15 08:50:47 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 88C093A45B44E7609F7EF3B03A58D76319306555 2016 2017-02-10 21:41:12Z Bruce Roesler 333 EAST SECOND STREET RICHLAND CENTER WI 53581 57564764 0 X www.richlandhospital.com X 1937 WI THE RICHLAND HOSPITAL, Inc. IS DEDICATED TO CARING, EDUCATING, AND HEALING. 10 9 341 162 4155 -12839 583119 312106 40034322 39140949 539711 609085 -134370 -151311 41022782 39910829 35021 24194 0 0 20469981 21088890 0 0 127840 15569759 16273677 36074761 37386761 4948021 2524068 74495393 76669364 17461995 17073218 57033398 59596146 X Our Mission is, "The Richland Hospital is dedicated to caring, educating, and healing - to be the community's first choice for better heath." 0 0 30598813 24194 35962088 The Richland Hospital, Inc. (the Hospital) operates a 25-bed critical access hospital in Richland Center, WI. Patients served by The Richland Hospital in 2016 included 3,015 adults and pediatrics inpatient days, 629 swing bed patient days, 283 newborn patient days, 39,931 total outpatient visits, and 5,810 emergency room visits. As a part of the Hospital's mission as a not-for-profit healthcare organization in the communities served, the Hospital provides care to patients who meet certain criteria under its community care policy without charge or at amounts less than its established rates. The hospital maintains records to identify and monitor the level of charity care it provides. In the current year, the total healthcare services provided to patients under the community care policy has been measured in both total charges and the estimated cost of providing care to patients under the community care policy. Both figures are reported and available by referring to Schedule H. In addition, Hospital is a provider under the Wisconsin Medicaid Program. Under this program, the hospital is legally bound to accept the amount determined by the State of Wisconsin as payment in full for each patient's charges even though reimbursement is less than the cost to provide the care; therefore, service to patients under this program should also be considered part of the organization's benefit provided to the community. (For additional information on the hospital's charity care program and practices and cost of participation in the Wisconsin Medicaid Program, please refer to Schedule H of the Form 990.) The Hospital also engages in a variety of community building activities that would not otherwise, without the efforts and specialized knowledge of the local community hospital, be provided for the benefit of the residents of Richland Center, Wisconsin and the surrounding communities. In 2016, the Richland Hospital hosted health fairs, participated in local wellness events, conducted educational seminars and provided informational packets for members of our community. Our target audience was the entire family: men, women, children, and infants. The Hospital supported Southwest Partners, a group committed to creating opportunities to enjoy the beautiful outdoors, supporting great schools, supporting strong businesses, and bringing individuals together. Projects that they are working on that support improved mental health and wellbeing, a defined unmet need from the Community Health Needs Assessment, fall under two subgroups:1. Career Education Cooperative - To create a regional school-to-career pathway that prepares students for living wage career opportunities, educational growth and good citizenship. 2. Pine River Trails Projects - Canoe and Kayaking the Pine, Biking Richland County, Snowshoe and Cross Country Ski, Safe Ways to School. The Richland Hospital hosted one Ladies Health Fair event, a heart health event and a toddler wellness event in Richland Center. In addition,, the Hospital hosted one Ladies Night Out in Muscoda. New in 2016, the Hospital served as the location for SMART Recovery. This is a free support group helping people learn self-empowering tools and providing support for each other in recovery. The goal of SMART Recovery is for you to achieve a healthy, positive and balanced lifestyle so you can conquer new challenges when you feel confident your addictive behavior is behind you. Each of the events was free to attend, open to the public and drew an average of 50 people each. Items donated included: staff time, materials, space, giveaways and/or equipment.Additionally, The Richland Hospital, Inc. participated in other free events open to the public and conducted screenings and provided free health and wellness information. Those events include: Richland County Fair, Senior Fest, Greater Richland Cancer Elimination Walk, and Weston Health Fair. The Richland Hospital saw an average of 250 people at each of these events. In response to requests to local employers, Richland Hospital provided staff time, educational materials, and giveaways at no charge for employee health fairs for Wisconsin Maximum Security Prison in Boscobel, WI; Riverdale School District in Muscoda, WI; and UW Richland Student Welcome. An average of 80 people were helped by hospital representatives at each event. The Richland Hospital provided free breastfeeding support groups for new moms and hosted eleven diabetes support group meetings. Educational materials were provided free of charge. Healthcare professionals spoke to the public at community events that were free and open to the public and they provided individual counseling as well to help people understand the services available locally. Registered Dietitians presented information at Richland Middle School and Richland Center High School once in 2016. Additionally, they supported the Richland FIT Point of Purchase program. The Richland FIT Point of Purchase represents one of several FIT strategies ongoing in the county since 2012 when a UW Partnership Program grant was awarded. The idea was to partner with food sellers and servers to create an environment where making the healthy choice is easier. Working together as a coalition, we aim to get those healthy choices on the table in an attractive way. Dietitians also worked to train Peer Educators and introduce Diabetes Education and Support programs to surrounding communities through the DEEP program. DEEP is a Medicare-approved, evidence based diabetes self-management program developed by the University of Illinois, Chicago that has been shown to be successful in helping participants take control of their disease & reduce the risk of complication. DEEP workshops meet once a week. DEEP provides opportunities for participants to acquire the knowledge and skills necessary to maintain a healthy weight and to reduce complications resulting from diabetes, such as kidney failure, amputation, vision loss, heart failure and stroke.Educational materials were provided free of charge in a variety of venues. They covered a wide range of healthcare topics including: cancer, diabetes, heart disease, infant and child development, nutrition, exercise, smoking cessation, breast health, advanced directives, colonoscopies, joint and muscle degeneration, women's health and more.The Blood Center of Wisconsin held multiple drives in the hospital's lower level at no cost. In addition, employees could donate blood while on work time and did not have to punch out. Home Health United held multiple Grief Support Group meetings in the hospital's lower level at no cost. These meetings were open to everyone and free of charge. The Richland Hospital provided promotions, snacks and beverages as well. Programs included: Drop-In Grief Support Group, When Mourning Dawns, Spouse/Partner Loss, Helping Children Grieve, and Resolve Through Sharing (RTS). The Hospital also participates in health education awareness and career building activities such as clinical training experience, speakers at local schools, and participation in career fairs for area middle and high schools and for adults. In addition, Richland Hospital provides Club Scrub, an experience designed for 7th and 8th graders that are interested in learning about healthcare careers. The 4 week program takes the students into various departments where they learn about careers in the setting they are provided in. Surgeons, nurses, technicians, and other staff members participate to provide a wonderful experience for the kids. Participation is free and open to all students in our market, but there is a limit of 25 kids for the club. The Hospital recognizes that it is important to educate local community members on these careers as a career building initiative so that local primary care and access to care will be continued in the future with well-trained and educated community members in health care related fields. Finally, while there is growing agreement in the United States about what constitutes a non-profit hospital's "community benefit", this remains a work in progress. The Richland Hospital provides significant charity care and other community benefits as defined by the IRS. But in addition, the Hospital believes that it provides a critically important community benefit which is not easily able to be quantified. Through its hospital services, like most rural hospitals, the Richland Hospital Inc. has created and is maintained in order to provide care locally. Without this hospital, this care would not be available locally and the economic well-being of the surrounding communities would be negatively affected by the loss of professional, technical, and service jobs. We are dedicated to caring, educating and healing - we want to be the community's first choice for better health. 1697326 2401701 THE RICHLAND HOSPITAL, INC. ALSO OPERATES TWO RURAL HEALTH CLINICS LOCATED IN SPRING GREEN AND MUSCODA, WI. DURING 2016 THESE TWO CLINICS PROVIDED A TOTAL OF 8,291 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. 32296139 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 53 0 341 1 1 1 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 WI X Karen Traynor 6086476321 333 EAST SECOND STREET RICHLAND CENTER WI 53581 David May MD CHIEF OF STAFF 5.20 X 20000 0 0 KEVIN WHITNEY MD DIRECTOR 1.50 X 0 0 0 Robby Anderson DIRECTOR 1.50 X 0 0 0 Jerry Gander DireCTOR 1.50 X 0 0 0 Jerry McCauley DIRECTOR 1.50 X 0 0 0 Traci Peterson DIRECTOR 1.50 X 0 0 0 Robert Nugent Chair 1.75 X X 0 0 0 John Poole Vice-Chair 1.75 X X 0 0 0 John Annear Treasurer 1.75 X X 0 0 0 Marilyn Rinehart Secretary 1.75 X X 0 0 0 KAREN TRAYNOR CFO 40.00 X 175911 0 11642 Bruce Roesler CEO 40.00 X 244972 0 39885 Allan Mottram MD ER PhySICIAN 38.00 X 377109 0 44031 Edith SHANNON-GOODRICH CRNA ANESTHETIST 38.00 X 290778 0 43025 MUHAMMAD S KHAN MD ER PHYSICIAN 41.00 X 311955 0 42830 BRYAN MCCARVEL ANESTHESIA DIRECTOR 40.00 X 325380 0 45726 Alex Pasquariello MD ER PHYSICIAN 39.00 X 296076 0 28049 Dorothy Behling Retired Board Member 0.00 X 0 0 304 Dennis Hamilton Retired Board Member 0.00 X 0 0 304 2042181 0 255796 21 0 1 0 THE RICHLAND MEDICAL CENTER LTD 301 EAST SECOND STREET RICHLAND CENTER WI 53581 physicians/clinic mgmt services 1022798 Quarles & Brady LLP 33 East Main Street Suite 900 Madison WI 53703 Legal 413210 ALBERT J ALTER JR W9107 SR 39 BLANCHARDVILLE WI 53516 RADIOLOGY SERVICES 190000 Meriter Laboratories 36 South Brooks St Milwaukee WI 53288 Lab Services 172088 WHITNEY SLEEP DIAGNOSTICS & CONSULTANTS 119 GRAYSTONE PLAZA STE 102 DETROIT LAKES MN 56501 SLEEP STUDY SERVICES 151200 6 299597 11509 1000 312106 PATIENT SERVICE REVENUE 621990 38367814 38363789 4025 CONTRACTED THERAPY 621990 302123 302123 MEALS 722320 200098 200098 MEDICAL RECORDS 621990 196483 196483 74431 74431 39140949 580848 580848 840718 992029 -151311 -151311 130 -151441 16688432 1711 16659484 2422 28948 -711 28237 28237 39910829 38363789 4155 1230779 X 24194 24194 543937 543937 15572198 13714557 1768156 89485 550138 484512 62465 3161 3356805 2956364 381151 19290 1065812 909897 149978 5937 424105 424105 82864 82864 4439294 3785912 645382 8000 144566 50 144516 258667 136084 121116 1467 319895 319895 1464629 1413190 51439 53791 41491 12300 60838 51154 9184 500 2598245 2598245 99389 99389 SUPPLIES 5140719 5010805 129914 Bad debt expense 886063 886063 EQUIPMENT RENTAL & MAIN 860734 843743 16991 Dietary Expense 251484 251484 -811606 -811606 37386761 32296139 4962782 127840 1107 1086 15860282 14824844 8625265 8067543 112993 0 1551757 1545813 270283 166172 58914560 34298824 25581927 24615736 16293206 22051463 3493963 3529563 2704610 1867144 74495393 76669364 3358631 3838373 13960000 13215000 143364 19845 17461995 17073218 X 56636588 59225366 336810 310780 60000 60000 57033398 59596146 74495393 76669364 X 2524068 242136 -203456 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4726 4726 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 $2,124 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 $2,602 OF THE FEES PAID BY THE HOSPITAL IN 2016 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. 71880 907 -1000 73787 71176 704 71880 70473 703 71176 70005 468 70473 69671 334 70005 0.00000 0.83600 0.16400 0 0 941726 941726 41601319 21667402 19933917 609073 563781 45292 14703326 11676761 3026565 1059116 390880 668236 24615736 DEFERRED COMPENSATION PLAN LIABILITY 189270 Bond amortization Premium - net against long-term debt -169425 19845 39990977 1001914 1001914 38989063 921766 921766 39910829 37457024 992029 992029 36464995 921766 921766 37386761 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 992,029. Net assets released from restrictions 9,885. Part XI, Line 4b - Other Adjustments: SCHOLARSHIP & GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENT 35,703. Provision for bad debts net against revenue on financial statements 886,063. Part XII, Line 2d - Other Adjustments: RENTAL EXPENSES INCLUDED WITH EXPENSES ON FINANCIAL STATEMENTS 992,029. Part XII, Line 4b - Other Adjustments: SCHOLARSHIP & GRANT EXPENSE NET AGAINST GRANT REVENUE ON FINANCIAL STATEMENT 35,703. Provision for bad debts net against revenue on financial statements 886,063. 1 1 1 X 1 X 1 1 1 0 1 1 581332 581332 0.01590 5970227 3351958 2618269 0.07170 6551559 3351958 3199601 0.08760 108943 1005 107938 0.00300 603 603 0.00000 5293542 3873342 1420200 0.03890 28216 28216 0.00080 12090 12090 0.00030 5443394 3874347 1569047 0.04300 11994953 7226305 4768648 0.13060 1000 1000 0.00000 8460 8460 0.00020 1331 1331 0.00000 10791 10791 0.00020 0 408852 204426 14072624 14203428 -130804 X 0 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 16 1 0 1 1 X http://www.richlandhospital.com/about/community-health-needs-assessment/ X See Part V, Section C, Line 7d X 1 16 1 http://www.richlandhospital.com/wp-content/uploads/2016/12/RH-CHIP-2017-19- 0 1 X 150.000000000000 300.000000000000 X 1 1 X X X 1 X http://www.richlandhospital.com/wp-content/uploads/2013/12/community_care_a X http://www.richlandhospital.com/wp-content/uploads/2017/01/Community-Care-B X X X X X X 1 X 0 X 1 X 0 0 The Richland Hospital, Inc. Part V, Section B, Line 5: In 2016, Richland County Public Health's Local Health Officer and The Richland Hospital's Director of Marketing partnered to conduct a combined community health needs assessment and improvement plan. As a result, a Health Assessment and Wellness Commission (HAWC) made up of key stakeholders in the community was established to create and oversee the process of assessing our community's health and wellness needs.Members of this commission included: 1. Chris Drea, Richland Hospital, Director of Marketing2. Marianne Stanek, Richland County Health and Human Services - Public Health, County Health Officer3. Chelsea Wunnicke, UW Extension, Richland County Family Living Agent4. Dr. David May, Richland Hospital, Medical Staff, Chief of Staff5. Cindy Chicker, Richland Hospital, Assistant Administrator6. Shawn Tjossem, Richland School District, School Psychologist7. Jarred Burke, Richland School District, District Administrator8. Betsy Roesler, Richland County Public Health, Richland F.I.T. (Fitness In Total) Health and Wellness CoordinatorData 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. Mailed to 2,000 randomly generated residence addresses in Richland County.3. Stakeholder Focus Groups - Purpose: multi-sector stakeholders review the results of the community survey and prioritize needs. Focus groups were by invitation only. 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: http://www.co.richland.wi.us/departments/hhs/publichealth/pdfs/Richland%20County%20Health%20Needs%20Assessment%20CHNA%202016.pdf; http://richland.uwex.edu/2016/11/28/2016-richland-area-community-health-needs-assessment-is-now-available/ The Richland Hospital, Inc. Part V, Section B, Line 11: The Health Assessment and Wellness Commission (HAWC) believes that the 2016 CHNA satisfactorily collected the health needs of the Richland County community. The process of analyzing secondary data, gathering input from key informants at focus groups, and conducting a random sample of Richland County residents via the mailed survey was designed to triangulate the actual health needs of the community. The HAWC members brought a diverse set of skills and perspectives to the analysis of these three data sets. Evaluating the results for both the strength of the need and the practicality of a community response, the HAWC's determined that the top health needs to be addressed in the community health improvement plan are: 1. Substance abuse prevention & treatment, 2. Overweight/obesity, prevention & treatment, 3. Mental health care. IN 2016, THE RICHLAND HOSPITAL, INC. EXPOUNDED ON THEIR EXISTING IMPLEMENTATION PLANS DESIGNED TO MEET THE THREE PRIORITIES IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AS COMPONENTS OF THE ORGANIZATIONAL STRATEGIC PLAN.1. ENSURING ACCESS TO CARE: - In an effort to address the shortage of mental health providers in our area, the Richland Hospital developed and began offering Senior Life Solutions in 2016. The Richland Hospital's Senior Life Solutions program is an intensive outpatient group counseling program that is designed to meet the unique needs of individuals over the age of 65 struggling with depression and anxiety often related to aging. After growing the program to the maximum number of patients for the existing mental health team, the Richland Hospital's goal is to support the need for additional staff. This will bring increase the number of mental health providers in our area and it will improve access to this mental health service. -ATHLETIC TRAINERS PROVIDED WEEKLY COVERAGE AT THE LOCAL HIGH SCHOOL AND AT HOME SPORTING EVENTS TO ENSURE THAT LOCAL AND VISITING ATHLETES HAVE IMMEDIATE ACCESS TO HEALTHCARE IN THE EVENT THAT THEY ARE INJURED DURING PRACTICE OR COMPETITION. - In response to the upcoming retirement of the only general surgeon practicing in the Hospital's primary service area, THE RICHLAND HOSPITAL, INC. confirmed that the loss of this practitioner would result in a shortage within the communities we serve. The Hospital worked collaboratively with RICHLAND MEDICAL CENTER, LTD to support their successful recruitment of a new general surgeon. This will ensure that GENERAL SURGERY SERVICES remain AVAILABLE AFTER THE RETIREMENT OF THE CURRENT GENERAL SURGEON. Dr. Nicholas Czosnyka will LAUNCH HIS RICHLAND CENTER PRACTICE IN August 2017. - A SERIES OF COMMUNITY GRIEF SUPPORT SESSIONS WERE HOSTED FOR THOSE GRIEVING THE LOSS OF SOMEONE IN THEIR LIFE. IN ADDITION, A SPECIALIZED GRIEF SUPPORT GROUP WAS HOSTED FOR THOSE SUFFERING THE LOSS OF A PARTNER.- In 2016, Richland Hospital began providing support for SMART Recovery. This is a free support group helping people learn self-empowering tools and providing support for each other in recovery. The goal of SMART Recovery is for you to achieve a healthy, positive and balanced lifestyle so you can conquer new challenges when you feel confident your addictive behavior is behind you. - Dr. Andy Wright's began providing treatment to people in the Muscoda area experiencing substance use disorders at Muscoda Health Center, a division of the Richland Hospital. This treatment approach is offered in addition to continuing to provide Family Medicine and Obstetric care in that setting. 2. PREVENTING AND REDUCING OBESITY:- Richland Hospital dietitians worked to make Free Diabetes Education and Support available to neighboring communities by working with DEEP. DEEP is a Medicare-approved, evidence based diabetes self-management program developed by the University of Illinois, Chicago that has been shown to be successful in helping participants take control of their disease & reduce the risk of complication. DEEP workshops meet once a week. DEEP provides opportunities for participants to acquire the knowledge and skills necessary to maintain a healthy weight and to reduce complications resulting from diabetes, such as kidney failure, amputation, vision loss, heart failure and stroke. Richland Hospital supports the program by providing training and supporting Peer Educator and providing administrative support to the groups. - Richland Hospital maintains Baby Friendly Certification. Breastfeeding reduces the risk of childhood obesity. The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding.- THE RICHLAND HOSPITAL, INC. MAINTAINED ACTIVE PARTICIPATION WITH THE RICHLAND COUNTY'S RICHLAND FIT COALITION THROUGH A STANDING RICHLAND HOSPITAL EMPLOYEE SERVING ON THE STEERING COMMITTEE. - RICHLAND HOSPITAL STAFF ASSISTED WITH TWO ACTIVITY-BASED EVENTS OFFERED IN COLLABORATION WITH RICHLAND FIT AND RICHLAND CENTER PARKS AND RECREATION - QUARTERLY GROCERY TOURS WERE LED BY MEMBERS OF THE CLINICAL NUTRITION DEPARTMENT- IN PARTNERSHIP WITH RICHLAND FIT AND RICHLAND CENTER MASTER GARDENERS, STAFF FROM THE RICHLAND HOSPITAL HELPED PLAN AND PREPARE A NEW COMMUNITY GARDEN ON THE SITE OF A PREVIOUS COMMUNITY CENTER NEAR TWO LOW INCOME APARTMENT COMPLEXES. RAISED BEDS AND PLATFORM BEDS WERE BUILT, FILLED AND MADE READY FOR MEMBERS OF THE COMMUNITY TO PLANT AND HARVEST.- In partnership with Richland FIT, Richland Hospital dietitians were the Point of Purchase Program and help increase access to healthy options/ choices by creating self-sustaining programs at food stands, grocery stores, convenience stores and restaurants. The Richland FIT Point of Purchase represents one of several FIT strategies ongoing. We partner with food sellers and servers to create an environment where making the healthy choice is easier. Working together as a coalition, Richland FIT aims to get those healthy choices on the table in an attractive way3. COMMUNITY HEALTH AND WELLNESS:- A Women's Health Fair was held that offered health and wellness information to women in our region. A keynote speaker provided tips and suggestions for managing stress. - THE RICHLAND HOSPITAL, INC. PROVIDED FREE SMOKING CESSATION CLASSES. - IN PARTNERSHIP WITH RICHLAND FIT AND RICHLAND CENTER MASTER GARDENERS, STAFF FROM THE RICHLAND HOSPITAL HELPED PLAN AND PREPARE A NEW COMMUNITY GARDEN ON THE SITE OF A PREVIOUS COMMUNITY CENTER NEAR TWO LOW INCOME APARTMENT COMPLEXES. RAISED BEDS AND PLATFORM BEDS WERE BUILT, FILLED AND MADE READY FOR MEMBERS OF THE COMMUNITY TO PLANT AND HARVEST. - Richland Hospital supported the efforts of Southwest Partners to inspire people to get outside and experience Southwest Wisconsin through physical activity. Southwest Partners is committed to creating opportunities to enjoy the beautiful outdoors. Pine River Trails is a subcommittee of Southwest Partners and they have the following projects that they are working on that we have supported: Canoe and Kayaking the Pine, Biking Richland County, Snowshoe and Cross Country Ski, and Safe ways to School.THE RICHLAND HOSPITAL, INC. IS COMMITTED TO WORKING COLLABORATIVELY WITH OTHER HEALTHCARE PROVIDERS AND COMMUNITY ORGANIZATIONS TO ADDRESS THE UNMET COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED THROUGH THE CHNA. AS WITH ALL HEALTHCARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES SERVED. THERE ARE COMMUNITY HEALTH NEEDS THAT THE HOSPITAL WAS UNABLE TO ADDRESS EITHER INDIVIDUALLY OR THROUGH PARTNERSHIPS WITH OTHER ORGANIZATIONS THAT ALSO SERVE THESE COMMUNITIES. 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 The Richland Hospital, Inc. Part V, Section B, Line 16j: THE HOSPITAL ALSO PROVIDED FINANCIAL ASSISTANCE INFORMATION IN BROCHURES LOCATED IN THE CASHIERS OFFICE. BROCHURES CAN ALSO BE FOUND AT BOTH OF THE RURAL HEALTH CLINICS. In addition to the hospital's website, FURTHER INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE THROUGH PHONE CONVERSATIONS WITH FINANCIAL COUNSELORS AT THE HOSPITAL. BROCHURES ARE ALSO AVAILABLE AT THE REHAB DEPARTMENT, FREE CLINIC, AND RICHLAND COUNTY RESOURCE AND DISABILITY OFFICE. THE FAP AND PLAIN LANGUAGE SUMMARY OF THE FAP WERE ALSO AVAILABLE IN SPANISH. The Richland Hospital, Inc. Part V, Section B, Line 20e: THE HOSPITAL'S BUSINESS OFFICE STAFF ALSO MAKES AN ATTEMPT TO CONTACT EACH PATIENT WITH A BALANCE GREATER THAN $300 AND THE COMMUNITY CARE PROGRAM IS MENTIONED ON THE PHONE CALL. 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- Patient is eligible for other state or local assistance programs that are unfunded- Patient is eligible for food stamps or subsidized school lunch program - Patient is eligible for assistance under the Crime Victims Act or Sexual Assault Act- Patient 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. - 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. 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, the intensive care inpatient unit, AND THE OPERATION OF TWO RURAL HEALTH CLINICS. 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. 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 HEALTHCARE 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. 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 $ 886,063. Part II, Community Building Activities: The Richland Hospital, Inc. engages in a variety of community building activities that would otherwise not be met or provided without the efforts and specialized knowledge of the local community hospital to the residents of Richland Center, Wisconsin, and the surrounding areas. Some of the community building activities that the hospital participates in are the local health and wellness fairs, support groups, providing educational materials to community members, safe sitter classes, and local blood pressure screenings. In addition, the Hospital is a community partner and active member of the Richland FIT program. Richland FIT conducted a STUDY WHICH CREATED a strategic and implementation plan focusing on the high obesity rates in Richland County. The effort to develop the plan and do necessary related research was funded by the University of Wisconsin Partnership program in 2011, and implementation and measurement of outcomes is in process. The Hospital also takes an active role in wellness through its support of local athletes and maintains contracts with area school systems to provide athletic trainers for coverage at scheduled sporting events. This sports medicine program provides outreach services to Richland Center, Riverdale (Muscoda), and Ithaca school districts as well as to the local UW-Richland Center campus. Services provided include in-school injury prevention and assessments clinics, daily practice coverage (frequency varies with each school), "home" event coverage as requested by schools, and emergency action plan development for each school. The program provides skinfold testing for the wrestling programs in accordance with WIAA mandates. Finally, the program provides education for local EMS squads on the appropriate transport of injured athletes. The Richland Hospital, INC.'S sports medicine program is operated at a loss each year, an investment in the community that was in excess of $100,000 in 2015. The program has direct ties to one of the priorities identified both by the Richland FIT needs assessment but also by the Hospital's 2013 CHNA, the high obesity rate for youth and young adults in Richland County. The hospital also participates in health education awareness and career building activities such as clinical training experience, speakers at local schools, and career fairs. The hospital recognizes that it is important to educate local community members on these careers as a career building initiative so that local primary care and access to care will be continued in the future with well-trained and educated community members in healthcare related fields. A new document was developed in 2014 and introduced to support the business plan for Community Health and Wellness for the Hospital. The web of relationships assists in defining existing relationships and provides a mechanism for prioritizing health and wellness activities. 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 VI, Line 2: In addition to the comprehensive Community Health Needs Assessment, 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, potential need for expanded services, and the potential need for new service lines not offered locally. The hospital monitors the loss of speciality providers in the area and, working collaboratively with Richland Medical Center, carefully participates in a determination of whether and how this new need can best be met. A recent example was the impending loss of a general surgeon due to retirement. The hospital also reviews hospital statistics of patient visits to determine what types of services offered by the hospital are being utilized. In planning to meet community needs, the aging of the population is significant because persons in the age categories that are growing face more challenges related to healthcare than younger populations. In the older population groups, persons visit primary care physicians more frequently and have higher incident rates of heart disease, cancer, and related illnesses. The onset of chronic diseases are higher in this age category, e.g., onset of diabetes, COPD, or heart problems, and must be managed with assistance from the healthcare providers for the remainder of the person's life. Important to note is that as a person ages, travel becomes more challenging, so the ability to get as much of their healthcare needs met locally grows in importance. Having visiting specialists, for example, eliminates the need for a trip to a major medical center for many. In addition, it ensures that persons get the care that they need. An example of a recent service addition is the addition of Senior Life Solutions which has been well received by patients and physicians alike. The Hospital continues to more fully develop the electronic health record system (EHR) with one of the main goals being improved access to strong clinical documentation including patient medical histories as a means to support a more efficient and effective patient experience. Training our community members to use and access their personal health information through the EHR portal is another example of the Hospital's work to improve our patient's health status through access and information. In turn, the electronic health record system provides for a more complete medical history should that patient require treatment at other healthcare facilities. In response to increased patient demands for access to primary ambulatory clinic care, the hospital completed construction of a replacement clinic facility in Muscoda, Wisconsin in 2012 as a means to better serve the needs of the patients in Muscoda and the surrounding rural communities. 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 Spansih versions can be obtained by:A. Requesting in person at The Richland Hospital, Inc., 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, 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 are defined by the following zip codes: 53506 - Avoca53556 - Lone Rock53518 - Blue River53573 - Muscoda53581 - Richland Center53588 - Spring GreenThey are geographically contiguous communities. According TO data published by Intellimed, the Richland Hospital, INC. had an overall inpatient market share of 51.7 percent and outpatient market share of 40.8 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. (Intellimed 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 residents of the market area are aging significantly. There is a projected 6.3% growth in the population aged 45 to 64 and a projected 5.1% growth in the population aged 65 years of age and older. There is a corresponding 11.5% projected decline in the 25 to 44 year old population. Persons in the 0 to 14 age group are also projected to decrease by 0.7%.During 2016, Medicare and Medicare Advantage plan beneficiaries accounted for over 47 percent of all gross patient service revenue at The Richland Hospital, INC. and Medicaid beneficiaries accounted for approximately 17 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). Part VI, Line 7, Reports Filed With States WI 1 SCHOLARSHIPS FOR HEALTHCARE EDUCATION 26 21938 Part I, Line 2: THE RICHLAND HOSPITAL, INC. FOLLOWS A STANDARD PROCEDURE ON ISSUANCE OF SCHOLARSHIP FUNDS WHICH IS DETERMINATED BY THE BOARD OF DIRECTORS AND MANAGEMENT OF THE RICHLAND HOSPITAL, INC. and THE RICHLAND HOSPITAL FOUNDATION, INC. THESE SEPARATE ORGANIZATIONS HAVE ESTABLISHED CRITERIA FOR REVIEW OF APPLICATIONS FOR PROSPECTIVE SCHOLARSHIP RECIPIENTS TO ENSURE THAT SCHOLARSHIPS ARE BEING GRANTED FOR HEALTH EDUCATION RELATED PURPOSES AND TO A QUALIFIED STUDENT STUDYING AT AN ACCREDITED TECHNICAL COLLEGE, COLLEGE, OR UNIVERSITY. (A LARGE PORTION OF THE FUNDING FOR SCHOLARSHIPS IS ALSO GOVERNED BY DONOR AGREEMENTS AS NOTED IN SCHEDULE D TO THE FORM 990 RELATED TO ENDOWMENT FUNDS.) X 1 0 X X X X 0 0 0 0 0 0 0 0 0 KAREN TRAYNOR CFO 172633 0 1784 0 1494 0 6996 0 4646 0 187553 0 0 0 Bruce Roesler CEO 223927 0 17600 0 3445 0 7645 0 32240 0 284857 0 0 0 Allan Mottram MD ER PhySICIAN 354895 0 21044 0 1170 0 10600 0 33431 0 421140 0 0 0 Edith SHANNON-GOODRICH CRNA ANESTHETIST 285167 0 1784 0 3827 0 10600 0 32425 0 333803 0 0 0 MUHAMMAD S KHAN MD ER PHYSICIAN 308310 0 1776 0 1869 0 10600 0 32230 0 354785 0 0 0 BRYAN MCCARVEL ANESTHESIA DIRECTOR 322829 0 1833 0 718 0 10600 0 35126 0 371106 0 0 0 Alex Pasquariello MD ER PHYSICIAN 288045 0 1784 0 6247 0 10600 0 17449 0 324125 0 0 0 Part I, Line 1a Health club dueS gross ups, when applicable, were added to the individual's compensation at fair market value. Cory Nugent Son of Robert Nugent, Board Chair Employee Compensation 0 Jenna Sebranek MD Daughter of Jerry Gander, Director Recruitment Assistance Agreement, Forgiveable Sign-on Loan 0 Form 990, Part VI, Section B, line 11b A COPY OF FORM 990 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 1,299,151. Management and general expenses 645,382. Fundraising expenses 8,000. Total expenses 1,952,533. Medical Imaging Purchased Services: Program service expenses 1,164,741. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,164,741. Clinical Purchased Services: Program service expenses 750,256. Management and general expenses 0. Fundraising expenses 0. Total expenses 750,256. Laboratory Purchased Services: Program service expenses 225,706. Management and general expenses 0. Fundraising expenses 0. Total expenses 225,706. Surgical Purchased Services: Program service expenses 346,058. Management and general expenses 0. Fundraising expenses 0. Total expenses 346,058. Form 990, Part XI, line 9: NET CHANGE IN UNRESTRICTED NET ASSETS OF supporting organizations -186,397. NET CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION -17,059. FORM 990, PART XII, LINE 2C: SELECTION OF INDEPENDENT ACCOUNTANT THE FINANCE COMMITTEE of The Richland Hospital, Inc., WHICH IS A SUB-COMMITTEE TO THE HOSPITAL'S BOARD OF DIRECTORS, REVIEWS THE ANNUAL AUDIT PROCESS WITH THE INDEPENDENT ACCOUNTANTS. BOARD MEMBERS ARE ALSO GIVEN THE NAMES AND CONTACT INFORMATION OF THE INDEPENDENT ACCOUNTANTS AT THE ANNUAL FINANCE COMMITTEE'S REVIEW MEETING OF THE AUDITED FINANCIAL STATEMENTS SO THAT THEY MAY INQUIRE, IF NEEDED, WITH THE ACCOUNTANTS THROUGHOUT THE YEAR. A BOARD MEMBER IS ALSO SELECTED ANNUALLY FOR REVIEW AND INQUIRY BY THE INDEPENDENT ACCOUNTANTS FOR SEPARATE AND PRIVATE INTERVIEW AS A PART OF THE AUDIT PROCESS. THESE FUNCTIONS ALLOW A GREATER AMOUNT OF OVERSIGHT BY THE BOARD INTO THE ANNUAL AUDIT PROCESS. THERE HAS BEEN NO CHANGE TO THESE PROCEDURES DURING THE PAST YEAR. Form 990, Schedule H: Part V, Line 16A HTTP://WWW.RICHLANDHOSPITAL.COM/ABOUT/PATIENTS-VISITORS/COMMUNITY-CARE-F INA THE RICHLAND HOSPITAL FOUNDATION INC 333 EAST SECOND STREET RICHLAND CENTER WI 53581 391567249 FOUNDATION WI 501(c)(3) Line 10 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