2015-05-08T09:31:03-05:00 2014-08-31 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2013-09-01 390868982 RIVERVIEW HOSPITAL ASSOCIATION RIVE 7154229292 410 Dewey Street Wisconsin Rapids WI 54494 Nancy Roth-Mallek Interim CFO 7154229292 2015-04-28 1 Kathleen J LaBrake CPA P00164006 7158453111 2015-04-28 2013 2016-02-25 16:41:14Z Nancy Roth-Mallek 410 Dewey Street Wisconsin Rapids WI 54494 136677519 0 X www.rhahealthcare.org X 1912 WI To provide compassionate, affordable, state-of-the-art healthcare to our communities. 15 12 773 380 760485 -35911 378441 377256 93609871 93262513 6131576 4902954 283752 380539 100403640 98923262 0 0 0 0 45171193 45740439 0 0 0 42744819 40894884 87916012 86635323 12487628 12287939 214699382 236278696 55245493 53506248 159453889 182772448 X To provide compassionate, affordable, state-of-the-art healthcare to our communities. 0 0 64205709 92147734 Riverview Hospital Association owns and operates the following entities: (1) Riverview Hospital, established in 1912; (2) the outpatient Riverview Rehabilitation Center; (3) Riverview Family Clinic - this service includes clinics in Wisconsin Rapids, Nekoosa, and the Rome-Lakes area; (4) the UW Cancer Center Riverview. UWCC-R opened in 2003 in cooperation with UW Comprehensive Cancer Center, Madison; and (5) Riverview Community Dental Clinic. RHA established this clinic in 2009 to serve residents of South Wood County.Riverview Hospital Association provides community benefit programs and services that address identified community health needs regardless of source or availability of payment, and it provides measurable improvement in health access, health status, and the use of health care resources. In addition, the programs and services considered community benefits should meet one or more of the following criteria: *Supports the organization's community-based mission *Targets the problems of the poor or medically underserved *Impacts the health status of the identified community *Reduces community health costs *Is accessible to the entire target community regardless of their ability to pay *Stimulates external community partnerships *Improves the access to needed health care servicesFONEMED is a free, confidential telephone service the community can call after the clinics are closed to get routine health advice or general health information from a Registered Nurse. Approximately 1,900 persons benefited from this program.Coalition Building: The Heatlhy People Wood County Obesity Prevention Team is focusing efforts on building environments and policies which can support healthy behavior change in terms of diet and exercise. Riverview's Health Promotion Coordinator also represents Riverview on the Safe Kids Coalition, working to prevent injury and death in children aged 0-14. The Community Relations Assistant represents Riverview on the 3-0 Day Committee (Our Bodies, Our Responsibilities). The Committee organizes a teen conference annually focusing on reducing at-risk behavior in junior and senior high students. Approximately 300 persons benefited from these coalitions.Riverview Dental Clinic in Wisconsin Rapids is open to patients who have Medicaid or Badger Care insurance coverage. This insurance is not typically accepted by independent dental clinics. Approximately 4,188 persons benefited from this program in 2014. Riverview Family Clinic physicians are helping educate area junior high students about sexual responsibility. Two physicians took part in several Wisconsin Rapids East Junior High School health classes, sharing information on the topics of sexually transmitted diseases, pregnancy, and pregnancy prevention. Prior to their visits each semester, the physicians share their presentation with the students' parents during a parent meeting and respond to any questions or concerns that may arise. The physicians' visits have been very well received and greatly appreciated by the students, parents, health class instructor and school administration. Approximately 100 students attended this program.The Lifeline program is a 24 hour a day personal response system. A Lifeline unit is installed in the "subscriber's" home and operates through their phone line. He/She wears a "personal help button", which they use to alert Lifeline simply by pressing the button. There is also an Auto Alert personal help button, which alerts Lifeline automatically if the subscriber falls. A Lifeline "Monitor" answers the call through the Lifeline unit and they call the subscriber's. After they determine what kind of help is needed, they call the subscriber's "responders", which are friends, neighbors, or relatives that can check on the subscriber, or if the subscriber needs more professional help the Monitor will call for it immediately. The Lifeline program helps people that would otherwise by unable to remain in their homes. It provides them with freedom and security to do so, while also putting their family at ease. Our program helps many people in Wisconsin Rapids and the surrounding area. This past year approximately 270 people benefited from the Lifeline program that Riverview Medical Center offers.Vulnerable people of all ages including the elderly can remain in their home and be self-sufficient by receiving a home delivered meal that meets their specific nutrition requirements. Health conditions or physical disabilities restrict the ability of individuals to remain independent. The Home Delivered Meals Program provides nutrition that is medically therapeutic to address the special needs of clients diagnosed with diabetes, cardiac and pulmonary issues, retinal disease, gluten intolerance, weight loss due to cancer and chewing and swallowing problems. The program also meets the needs of caretakers of the mentally and physically handicapped or Alzheimer's or other dementia disorders by providing meals to allow them to care for their loved ones. Nutrition education is also offered. Community volunteers deliver hot lunches Monday - Friday as well as brown bag meals for weekends. Food is prepared with consideration for each client's personal preferences as well as dietary restrictions. In 2014, 19,278 meals were delivered. In an effort to meet the community needs of students in the Wisconsin Rapids area, Riverview Hospital Association offers the opportunity for interested students to experience a glimpse of the role of its professional staff. This service is made available to students who are interested in learning more about health careers. In 2014, Riverview had 47 job shadow participants.Riverview offers a free seminar entitled Understand Your Joint Pain. This seminar discussed what you can do about knee, hip, and other joint pain. Attendants also learned about arthritis, the causes and symptoms, and treatment options including medications, nutrition, exercise, alternative treatments, and new concepts in joint replacement. In 2014, Riverview presented this seminar to 63 individuals.Riverview offers monthly events to all women in the surrounding communities. The events are free of charge and educate women on various health topics that could affect them and/or members of their families. Various health topices covered were bone density, sleep disorders, pelvic health and podiatry. In 2014, nearly 600 individuals benefited from these events.Pooh Visits Riverview is a program sponsored by Riverview Hospital Auxiliary that gives hospital tours to kindergarten children of the Wisconsin Rapids area (including special needs children and home-schooled children). The tours are 1.5 hours long and include a video showing someone calling 9-1-1, an ambulance, the pediatric area of the Emergency Room, the operating room, a patient room in the hospital, the nursery, a hand-washing station, show x-rays of various body parts and provide a gift bag at the end of the tour. The program is offered in the spring and serves young children. Riverview coordinates and facilitates several support groups for individuals and their loved ones who are dealing with chronic disease, cancer or loss. The support groups include both men's and women's cancer, diabetes, cellac disease, arthritis and loss. In addition, lactation specialists from the Riverview Family Birthplace offer breastfeeding support to new mothers. Approximately, 715 individuals benefited from these programs.Medical school students from the University of Wisconsin come to Riverview for a six week surgical rotation where they have the opportunity to shadow a surgeon throughout the course of his/her day. Riverview provides free room and board to these students for the entire six weeks. In 2014, 4 medical students benefited from this program.Riverview offers preceptorship opportunities to students enrolled in area nursing programs. This structured program provides instruction, direction and guidance to students who are not employees of Riverview. The program meets the requirements for course credit in a healthcare setting. In 2014, nearly 65 students benefited from preceptorship opportunities. 64205709 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 101 1 1 773 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X NANCY ROTH-MALLEK 7154229292 410 DEWEY ST WI RAPIDS WI 54494 MARJORIE MILLER MD BOARD MEMBER 1.00 X 0 0 0 GREGORY NETTESHEIM BOARD CHAIR 2.00 X X 0 0 0 KALIN LAMP TREASURER 2.00 X X 0 0 0 PETER KOLAR BOARD MEMBER 1.00 X 0 0 0 SUSAN KUNFERMAN BOARD MEMBER 1.00 X 0 0 0 ROBERT BENKOWSKI BOARD MEMBER 1.00 X 0 0 0 ROY BRANDELL MD BOARD MEMBER 1.00 X 0 0 0 JAY GRODE BOARD MEMBER 2.00 X 0 0 0 ELDEAN WALLING BOARD MEMBER 1.00 X 0 0 0 DAVID STARK BOARD MEMBER 1.00 X 0 0 0 KELLY SCHAEFFER BOARD MEMBER 1.00 X 0 0 0 TIMOTHY MANCL BOARD VICE CHAIR 2.00 X X 0 0 0 TODD COUR BOARD MEMBER 1.00 X 0 0 0 JASON DEITZ SECRETARY 1.00 X X 0 0 0 THOMAS FERK DO PHYSICIAN/BOARD 40.00 X 315478 0 49132 CELSE BERARD PRESIDENT 40.00 X 319091 0 51922 MICHAEL BOVEE V.P. - FINANCE 40.00 X 220265 0 38391 PEGGY OSE V.P. - PATIENT SVCS 40.00 X 170611 0 35399 RICHARD BAILEY MD FACP PRESIDENT OF MEDICAL AFFAIRS 40.00 X 307563 0 54666 KEVIN FERREIRA MD PHYSICIAN 40.00 X 443505 0 51086 JAMES TORHOST DPM PHYSICIAN 40.00 X 438089 0 55656 RONNIE KIRSCHLING MD PHYSICIAN 40.00 X 1127124 0 49814 THEODORE REAHM DO PHYSICIAN 40.00 X 415483 0 52320 YOLANDA JONES MD PHYSICIAN 40.00 X 335420 0 41868 4092629 0 480254 38 0 1 0 ELLIS STONE CONSTRUCTION CO PO BOX 366 STEVENS POINT WI 54481 BUILDING CONSTRUCTION SERVICE 1608559 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY SUITE 8 FORT LAUDERDALE FL 33308 STAFFING 799807 INFINITY HEALTHCARE PHYSICIANS SC 111 E WISCONSIN AVE SUITE 2100 MILWAUKEE WI 53202 EMERGENCY ROOM PHYSICIANS & MEDICAL 637372 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 LABORATORY SERVICES 578795 HEALOGICS WOUND CARE & HYPERBARIC SERVIC 3087 MOMENTUM PLACE CHICAGO IL 606895330 WOUND CARE & HYPERBARIC FEE 455423 20 55902 302124 19230 377256 PATIENT SERVICES 900099 90271177 90271177 HEALTH RELATED PROGRAMS WHICH BEN 900099 1592984 1592984 LAB SERVICE FOR NON PATIENTS 621500 470907 470907 INCOME RECEIVED FROM OTHER MISC. 900099 389687 389687 FOOD 900099 237100 237100 300658 11080 289578 93262513 3954537 3954537 657285 551533 105752 105752 105752 38137779 37182718 6644 955061 -6644 948417 948417 11068 55902 11068 0 4588 2294 2294 2294 INCOME RECEIVED FROM REBATES AND 900099 272493 272493 272493 98923262 92147734 760485 5637787 1549335 1549335 33621354 29881335 3740019 10569750 8980155 1589595 98330 53674 44656 112148 112148 300313 300313 3813895 2143038 1670857 440034 18105 421929 1453751 1418847 34904 211344 153742 57602 2443629 2443629 6389549 204595 6184954 372967 135135 237832 SUPPLIES 8934591 8703074 231517 DRUGS 6284607 6244331 40276 PROFESSIONAL FEES 5499178 4462025 1037153 OTHER 3045238 366327 2678911 1495310 1441326 53984 86635323 64205709 22429614 0 76036 69886 30279553 26516350 12073988 13007880 1788697 2003945 1176973 1287280 133138855 73425547 60546053 59713308 107366497 132834768 1391585 845279 214699382 236278696 8302738 7778888 1505370 1802703 44707385 43715901 730000 208756 55245493 53506248 X 158431410 182142105 1022479 630343 159453889 182772448 214699382 236278696 12287939 11030620 0 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 11162 11162 0 Part II-B, Line 1: Percentage of AHA dues used for lobbying in 2014 - $5,945 Percentage of WHA dues used for lobbying in 2014 - $5,217 Riverview Hospital Association is a member of the Wisconsin Hospital Association (WHA) and American Hospital Assocation (AHA). A portion of the dues paid to these organizations were utilized for lobbying activities. That amount is reported in part II-B. 2414939 2414939 71568773 26116216 45452557 2253097 1518557 734540 56895229 45790774 11104455 6817 6817 59713308 MALPRACTICE INSURANCE LIABILITY 208756 208756 X 98221496 -408097 -408097 98629593 300313 -6644 293669 98923262 85933557 551533 551533 85382024 300313 952986 1253299 86635323 Part X, Line 2: In order to account for any uncertain income tax positions, the Association determines whether it is more likely than not that a tax position will be sustained upon examination by the taxing authoritites, based on the technical merits of the position, assuming the taxing authority has full knowledge of all information. If the tax position does not meet the more likely than not recognition threshold, the benefit of the tax position is not recognized in the financial statements. The Association has not recorded any assets or liabilitites related to uncertain tax positions or unrecognized tax benefits as of August 31, 2014 and 2013. Federal returns for the years ended August 31, 2011, and beyond, remain subject to examination by the Internal Revenue Service. Part XI, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV 452,647. RENT EXPENSES NET WITH REV 98,886. BAD DEBT -959,630. Part XI, Line 4b - Other Adjustments: GAIN/(LOSS) ON DISPOSAL OF ASSETS -6,644. Part XII, Line 2d - Other Adjustments: MEDICAL BUILDING RENT NET WITH REV 452,647. RENT EXPENSES NET WITH REV 98,886. Part XII, Line 4b - Other Adjustments: GAIN/(LOSS) ON DISPOSAL OF ASSETS -6,644. BAD DEBT 959,630. Love Lights 51093 44671 6422 6422 Christmas at the Ridges 15877 11231 4646 4646 66970 55902 11068 11068 11068 0 4588 2294 1 1.00000 4588 2294 2294 2294 WI 1 0 1 0 1.00000 Dianne Pokrandt 5849 Sarah Circle Wisconsin Rapids WI 54494 0 Elaine Semrow Treasurer of Auxiliary Fundraising Events X 0 1 1 1 X 1 X 1 1 1 0 1 1 1202214 214653 987561 0.01150 13507564 9181501 4326063 0.05050 14709778 9396154 5313624 0.06200 7867 230732 132299 98433 0.00110 71 451464 451464 0.00530 15670 3726036 2744299 981737 0.01150 63033 8725 54308 0.00060 309892 88936 220956 0.00260 23608 4781157 2974259 1806898 0.02110 23608 19490935 12370413 7120522 0.08310 2106 2106 0.00000 10 13824 13824 0.00020 2372 2372 0.00000 300 1614 1614 0.00000 0 310 19916 19916 0.00020 1 959630 16597177 19947506 -3350329 X 1 1 1 1 Riverview Hospital Association 410 Dewey Street Wisconsin Rapids WI 54495 http://www.riverviewhospital.net WI #11 X X X RIVERVIEW HOSPITAL ASSOCIATION 1 1 X X X X X X X X X 12 1 0 1 X See Part V, Section C, for line 5d X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X X X 1 1 X X X 1 0 1 X 0 0 RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 3: Focus group discussions were conducted with each of the two major stakeholder groups within Wood and Adams County. These stakeholder groups included health, social service, and local business agencies and Riverview Hospital Association Department Directors and Administrative Council. The purpose of the focus group discussions was to gather information and opinions from persons who represent the broad interests of the community served, including persons with special knowledge or expertise in public health and persons who represent the medically underserved and vulnerable populations. Stakeholders were contacted and asked to participate in the focus groups. A list of the stakeholder focus group participants can be found in Appendix 1 of the CHNA. Collectively, the stakeholders advocate on behalf of the medically underserved, low income, medically vulnerable and minority populations within the community through their organizations.Qualitative data including statistics and demographic information were obtained from a variety of local, county, and state sources as well as patient statistics and trends from Riverview Hospital Association's own internal records. Other published sources of information were also referenced for statistical and information purposes when needed throughout the process. RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 5d: http://www.riverviewhospital.net/pdf/CHNA.pdf RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 7: The Riverview Hospital Association Community Health Needs Assessment identified five priorities: 1. Dental Services for Low Income Populations2. Mental Health Services, including Substance Abuse and Addiction Services3. Health Literacy and Nutrition Education4. Outreach to Minority Populations/Cultural Barriers5. Serving the Needs of the Uninsured and Low Income PopulationsRiverview Hospital Association chose to address priorities #1, #2 and #3. This decision was made because of the alignment of these priorities with the priorities identified in the Wood County Health Needs Assessment. In addition, Riverview Hospital Association felt that the other priorities identified were being addressed by current offerings and programming. RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 12i: Emergency care for patients residing outside the servicearea will qualify for consideration. RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 14g: THE FAP PLAIN LANGUAGE DOCUMENT IS INCLUDED ON EVERY COLLECTION LETTER. RIVERVIEW HOSPITAL ASSOCIATION Part V, Section B, Line 19d: PER POLICY #0250144 RIVERVIEW WILL LIMIT AMOUNTS CHARGED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO COMMUNITY CARE ELIGIBLE INDIVIDUALS TO NOT MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. THIS DISCOUNT WILL BE DETERMINED ANNUALLY AT THE START OF THE FISCAL YEAR IN ACCORDANCE WITH THE LOOK-BACK METHOD OUTLINED IN THE FEDERAL REGISTER. 5 UW Cancer Center Riverview 410 Dewey Street Wisconsin Rapids WI 54495 Cancer Center Riverview Family Clinic Wisconsin Rapids 420 Dewey Street PO Box 8080 Wisconsin Rapids WI 54495 Clinic Riverview Family Clinic Nekoosa 1015 Angelus Drive Nekossa WI 54457 Clinic Riverview Family Clinic Lakes Area 1160 Rome Center Drive Town of Rome Nekossa WI 54457 Clinic Riverview Community Dental Clinic 820 Two Mile Avenue Wisconsin Rapids WI 54494 Dental Clinic 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 organizations total operating expenses, excluding the provision for bad debts divided by gross patient service revenues. 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: The above costs of Subsidized Health Services are related to the Outpatient Mental Health Services, Breastfeeding Support & Respite Care, Lakes Family Clinic, and Nekoosa Family Clinic. Riverview Hospital utilized an internal departmental financial statement to report the cost and direct offsetting revenue that calculates the community benefit expense. The Outpatient Mental Health Services reported costs of $470,191 with offsetting revenue of $349,784. The Breastfeeding Support & Respite Care reported costs of $187,772. The Lakes Family Clinic reported costs of $1,392,292 with offsetting revenue of $1,059,517. The Nekoosa Family Clinic reported costs of $1,675,781 with offsetting revenue of $1,334,998. None of the costs indicated above are attributable to a physician clinic. 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 $ 959,630. Part II, Community Building Activities: While there is a growing argument in the United States about what constitutes a non-profit hospitals "community benefit," these efforts continue to be a work in progress. Riverview Hospital Association provides significant charity care and other community benefits as defined by the IRS and in addition, the organization believes that it provides a critically important community benefit which is not quantified. Riverview Hospital Association, like most community hospitals, was created and is maintained in order to provide care locally which without the hospital, would not be available locally. Beyond inpatient hospitalizations, the organization provides local access to many health services including: Cancer center, clinic services, dental services, diagnostic imaging, birthing center, laboratory services, respiratory care, sleep lab, womens services, surgical services, and rehabilitation services. Part III, Line 4: Management provides for probable uncollectible amounts, primarily uninsured patient 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 organization has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to accounts receivable. Sometimes patients are unable to complete the required financial assistance application and are screened thru the presumtive eligibility process but may be transferred to the collection agency regardless of all these efforts.The costing methodology used on form 990 is based on a cost to charge ratio which is developed based on the Organizations total operating expense, exclude the provision for bad debts divided by gross patient service revenues. This cost to charge ratio is applied against the total charges that are written off during the fiscal year to estimate the cost of the care of patients that have accounts that are deemed to be bad debts to the organization. The organization also provides discounts to eligible uninsured or underinsured patients under its charitable care policy. These amounts are included in the contractual adjustments on the financial statements are not included in the ratio as described above and approved by the IRS for use on form 990. If considered, these additional write-off amounts to uninsured or underinsured accounts would also increase the estimated bad debt expense amount associated with these uncollectible accounts to the organization. Part III, Line 8: Amount of Medicare allowable costs was taken directly from the Medicare cost report.Whether there is a shortfall or surplus on services to Medicare beneficiaries, these patients, 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. The total Medicare revenue shown on Schedule H is based on the IRS 990 Instructions and includes only the charges from Medicare program beneficiaries that are reported on the hospital's Medicare Cost Report. The amount listed for Medicare revenue does not include physician services for the coverage of the emergency department at Riverview Hospital, physician services provided at the outlying clinic locations, and a significant portion of lab services which are reimbursed by the Medicare program under another methodology. Physician coverage and outpatient lab services are reimbursed primarily on a fee schedule reimbursement at rates that are often below the costs of caring for patients. Emergency physician 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 Riverview Hospital provides to the community and the surrounding areas. The costing method used above for IRS 990 compliance reporting is also based on the overall average cost to charge ratio and does not consider Medicare non-allowable expenses as it is based on total operating expenses less the provision for bad debt expense divided by the hospital patient service revenue (ignoring contractual adjustments on fee schedule reimbursed items and non-allowable Medicare expenses as noted above). This ratio is then multiplied by the total Medicare services, which are reimbursed based on Medicare regulations. Including the fee schedule items, such as physician services, would produce a larger loss or shortfall on these services to be reported on the Form 990 in any given year. Part III, Line 9b: For patients qualifying for financial assistance, patients will only be billed if they have not provided current proof of eligibility, a spenddown has not been met, or there is a private third party payor also on the patient's record.For patients qualifying for charity care, arrangements for reduced or free care are made with a financial counselor. Should the patient default on this arrangement, standard collection practices would apply. Part VI, Line 2: RHA actively participates in Healthy People Wood County (HPWC). The purpose of HPWC is to establish priorities and recommend strategies to enhance the quality of life, health status, and the environment in Wood County. In order to accomplish this, multiple partners work together to analyze health data, quality of life indicators and the community's perception of health. Riverview Hospital Association, at the end of fiscal year 2013, completed a community health needs assessment report and has used the data and findings of this report to guide the organization in the future to be able to respond to those needs identified. Part VI, Line 3: Community Care information is provided on both the website (riverviewhospital.net) and the back of the patient statement. Financial Counselors offer Community Care applications to patients when they discover during conversations regarding establishing payment plan arrangements, that they would potentially meet the program qualifications. Part VI, Line 4: Riverview Hospital Association owns and operates the following entities: (1) Riverview Hospital, established in 1912; (2) the outpatient Riverview Rehabilitation Center; (3) Riverview Family Clinic, This service includes clinics in Wisconsin Rapids, Nekoosa, and the Rome-Lakes area (4) the UW Cancer Center Riverview. UWCC-R opened in 2003 in cooperation with UW Comprehensive Cancer Center, Madison; and (5) Riverview Community Dental Clinic. RHA established this clinic in 2009 to serve residents of South Wood County. Riverview Dental Clinic in Wisconsin Rapids is open to patients who have Medicaid or Badger Care insurance coverage. This insurance is not typically accepted by independent dental clinics. Approximately 4,188 persons benefited from this program in 2014 (6) Riverview outpatient Psychiatric services were established in January of 2013 to meet the growing need for mental health services in the area.While many Riverview patients come from Wood County, an increasing number are coming to us from surrounding counties - specifically those along the Interstate 39 corridor: Marathon, Portage, Waupaca, Adams, Juneau, Waushara, Marquette, Columbia, Sauk, and Dane. For the Hospital, over 13.8% of all admissions between July 2013 and June 2014 came from these counties. For the UW Cancer Center-Riverview over the same period, over 18% of all patients came from these same counties-not including our "home" county of Wood.In the Riverview "service area" there are several federally designated "medically underserved areas." They are Wood County (the central part between Marshfield and Wisc. Rapids), Portage County (part), Adams County (all), Waushara County (all), Marquette County (all), Juneau County (the Northern half), Marathon County (part), and Clark County (all). There are scattered Indian tribal lands in Wood County, Juneau County, and Adams County (all Ho Chunk). These would be considered "medically underserved populations" per federal designation.Other hospitals in our service area include: St. Joseph's Hospital in Marshfield, St. Michael's Hospital in Stevens Point, Moundview Memorial Hospital in Friendship, and Hess Memorial Hospital in Mauston. Part VI, Line 5: As a community-based organization, Riverview Hospital Association provides services and educational opportunities either free of charge or at a nominal fee in an attempt to provide these opportunities to those members of the communities who otherwise may not be able to afford or have local access to these programs. These efforts are provided through a variety of educational speaker forums, support groups, health screenings, health education forums, and other educational opportunities for students. Part VI, Line 7, Reports Filed With States WI X X 1 1 X X X X 0 0 0 0 0 0 0 0 0 THOMAS FERK DO PHYSICIAN/BOARD 217398 0 97660 0 420 0 29962 0 19170 0 364610 0 0 0 CELSE BERARD PRESIDENT 317285 0 0 0 1806 0 32752 0 19170 0 371013 0 0 0 MICHAEL BOVEE V.P. - FINANCE 219415 0 0 0 850 0 19221 0 19170 0 258656 0 0 0 PEGGY OSE V.P. - PATIENT SVCS 167839 0 0 0 2772 0 13883 0 21516 0 206010 0 0 0 RICHARD BAILEY MD FACP PRESIDENT OF MEDICAL AFFAIRS 306933 0 0 0 630 0 33150 0 21516 0 362229 0 0 0 KEVIN FERREIRA MD PHYSICIAN 437877 0 5250 0 378 0 31916 0 19170 0 494591 0 0 0 JAMES TORHOST DPM PHYSICIAN 266045 0 171640 0 404 0 36486 0 19170 0 493745 0 0 0 RONNIE KIRSCHLING MD PHYSICIAN 1118406 0 6875 0 1843 0 30644 0 19170 0 1176938 0 0 0 THEODORE REAHM DO PHYSICIAN 408621 0 5250 0 1612 0 33150 0 19170 0 467803 0 0 0 YOLANDA JONES MD PHYSICIAN 330792 0 4250 0 378 0 22698 0 19170 0 377288 0 0 0 Part I, Line 1a HEALTH AND SOCIAL CLUB DUES WERE PAID ON BEHALF OF CELSE BERARD AND MICHAEL BOVEE. THE AMOUNTS PAID WERE AS FOLLOWS: CELSE BERARD - $4,009 MICHAEL BOVEE - $4,166 THESE ITEMS WERE TAXED AS INCOME ON THEIR RESPECTIVE W-2S. A Wisconsin Health and Educational Facilities Authority 391337855 97710V8S0 2008-04-16 27266182 Hospital addition 0 0 0 B Wisconsin Health and Educational Facilities Authority 391337855 97710BZW5 2010-12-16 20296089 Refinance 2001 Bond 0 0 0 A 1790000 24078184 2648998 539000 24078184 2009 0 0 1 1 B 2075000 18285000 1663538 347551 18285000 2010 0 0 1 1 A 0 0 0 0 0 0 0 B 0 1 0 0 0.01430 0.01430 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 1 0 1 0 0 0 0 0 A 1 B 1 Part I Line 1B 2010 CUSIP Identification The Series 2001 Bonds were refinanced in 2010 and each separate principal amount was assigned an individual CUSIP. The CUSIPs range from 97710BZW5 to 97710BA93. Part IV Line 2c No Rebate Due The 2008 bond's date of rebate computation was April 1, 2013. The 2010 bond's date of rebate computation was October 1, 2013. WOOD TRUST BANK JASON DIETZ IS A BOARD MEMBER AND SENIOR VICE PRESIDENT AT WOOD TRUST BANK 304872 RIVERVIEW HOSPITAL PAID INVESTMENT MANAGEMENT FEES TO WOOD TRUST BANK. 0 SURGICAL ASSOCIATES OF WISCONSIN RAPIDS SC DR.MARJORIE MILLER IS A BOARD MEMBER AND IS AN OWNER OF SURGICAL ASSOCIATES 278473 RIVERVIEW HOSPITAL PAID SURGICAL ASSOCIATES CALL PAY FOR PHYSICIAN SERVICES. 0 Form 990, Part VI, Section A, line 6 Members are those community members who have purchased a membership to Riverview Hospital Association. These are life time memberships once purchased, and each year there is very minimal activity related to the purchase of a membership. Form 990, Part VI, Section A, line 7a Members of Riverview Hospital Association are able to nominate and vote candidates to the Board of Directors. Form 990, Part VI, Section A, line 7b At the annual meeting with the community members, the members vote whether or not they approve the actions of the board. Form 990, Part VI, Section B, line 11 A copy of the 990 is presented to the board at a monthly board meeting and is reviewed in detail with them. Any questions are then answered at that time. Once reviewed, it is then mailed/submitted. Effective March 1, 2015 Riverview Hospital Association was acquired by Aspirus, Inc. The Form 990 and 990-T were provided to the newly formed Board of Directors for review and approval prior to its filing. Form 990, Part VI, Section B, line 12c The Board of Directors, the Medical Staff, and the Department Directors of the hospital annually sign their pledge to adhere to the conflict of interest policy here at Riverview Hospital Association (RHA). The signed attestations are filed and maintained by the Compliance Officer. Lisa Rowe-Peplinski, the Vice President-Quality Improvement serves as RHA's Compliance Officer. The Board reviews the potential conflicts of interest and if a conflict exists the individual is prohibited to vote on transactions where the potential conflict exists. Form 990, Part VI, Section B, line 15 The following process describes Riverview Hospital Associations (RHA's) compensation practices: Each non-union and non-physician position is evaluated and assigned to a salary grade based on that evaluation. Evaluation criteria include a position's decision-making impact, thinking challenges, thinking problem solving challenges, work environment and entry qualifications. Each salary grade is assigned a pay range based on the market data for the positions in that salary grade. The entire salary range structure will be reviewed at least annually, and based on market data and the Association's budgetary goal's may be adjusted. Such adjustments will occur on or about the start of the Association's fiscal year. This policy covers all non-physicians and non-union positions within Riverview Hospital Association. In addition, salaries of the CEO, Key Employees, and Physicians are determined in conjunction with an independent compensation consultant and industry studies to determine the proper levels of compensation. These results are approved by the Compensation Committee before finalized. Physician compensation is usually based on market data and productivity via an RVU-based approach. Pay for employees in Riverview's three unions is determined via collective bargaining. All approvals are completed by individuals that do not have a conflict of interest with the transaction. Form 990, Part VI, Section C, line 19 Available upon request. Form 990, Part XI, Line 2c The process is consistent with prior years. RIVERVIEW HEALTH CARE FOUNDATION INC PO BOX 8080 WISCONSIN RAPIDS WI 544958080 391509239 THE FOUNDATION IS OPERATED PRIMARILY FOR THE BENEFIT OF RIVERVIEW HOSPITAL WI 501 (C) 3 Line 11c, III-FI N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1