2014-03-17T11:00:33-05:00 2013-08-31 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2012-09-01 390868982 RIVERVIEW HOSPITAL ASSOCIATION RIVE 7154217463 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 MICHAEL BOVEE 7154217463 2014-03-10 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2014-03-10 2012 2015-11-30 17:44:51Z MICHAEL BOVEE 410 DEWEY STREET WISCONSIN RAPIDS WI 54494 126651452 0 X WWW.RHAHEALTHCARE.ORG X 1912 WI TO PROVIDE COMPASSIONATE, AFFORDABLE, STATE-OF-THE-ART HEALTHCARE TO OUR COMMUNITIES. 15 12 772 466 1191080 -934786 322648 378441 90608869 93609871 2533784 6131576 122685 283752 93587986 100403640 0 0 0 0 41923325 45171193 0 0 0 43900421 42744819 85823746 87916012 7764240 12487628 197234446 213194012 56172562 53740123 141061884 159453889 X TO PROVIDE COMPASSIONATE, AFFORDABLE, STATE-OF-THE-ART HEALTHCARE TO OUR COMMUNITIES. 0 0 65242640 92104502 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 2,332 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. A REPRESENTATIVE FROM RIVERVIEW'S EMERGENCY DEPARTMENT 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 TEENS 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 4,156 PERSONS BENEFITED FROM THIS PROGRAM IN 2013. 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 300 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 ALZHEIMERS 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 2013, 11,668 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 2013, RIVERVIEW HAD 38 JOB SHADOW PARTICIPANTS.RIVERVIEW OFFERED 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 2013, RIVERVIEW PRESENTED THIS SEMINAR TO 60 INDIVIDUALS.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 ALL KINDERGARTEN AGED CHILDREN ENROLLED IN THE AREA SCHOOLS. 65242640 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 85 1 1 772 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 MICHAEL BOVEE 7154217462 410 DEWEY ST WI RAPIDS WI 54494 COLLEEN DICKMAN 1.00 X 0 0 0 DOUGLAS WENZLAFF 1.00 X X 0 0 0 MARJORIE MILLER MD 1.00 X 0 0 0 GREGORY NETTESHEIM 2.00 X X 0 0 0 KALIN LAMP 2.00 X X 0 0 0 PETER KOLAR 1.00 X 0 0 0 SUSAN KUNFERMAN 1.00 X 0 0 0 ROBERT BENKOWSKI 1.00 X 0 0 0 ROY BRANDELL MD 1.00 X 0 0 0 JAY GRODE 1.00 X 0 0 0 TIMOTHY MANCL 2.00 X X 0 0 0 TODD COUR 1.00 X 0 0 0 JOHN CLARK PHD 2.00 X X 0 0 0 JASON DEITZ 1.00 X 0 0 0 THOMAS FERK DO 40.00 X 326058 0 53250 CELSE BERARD 40.00 X 355696 0 53316 MICHAEL BOVEE 40.00 X 240561 0 42828 PEGGY OSE 40.00 X 183960 0 40152 RICHARD BAILEY MD FACP 40.00 X 340295 0 55142 CRAIG FLINDERS DO 40.00 X 320374 0 52459 JENNIFER MCELROY DO 40.00 X 335227 0 51660 RONNIE KIRSCHLING MD 40.00 X 1096952 0 54274 MORGAN BARNUM MD 40.00 X 335452 0 47208 MERCEDES DE LAS ALAS MD 40.00 X 264527 0 49760 3799102 0 500049 32 0 1 0 ELLIS STONE CONSTRUCTION CO PO BOX 366 STEVENS POINT WI 54481 BUILDING CONSTRUCTION SERVICE 1550547 HMP OF WISCONSIN RAPIDS LTD PO BOX 645037 CINCINNATI OH 452645037 HOSPITALISTS - MTHLY SUBSIDY & MGMT FEE 850088 INFINITY HEALTHCARE PHYSICIANS SC 111 E WISCONSIN AVE SUITE 2100 MILWAUKEE WI 53202 EMERGENCY ROOM PHYSICIANS & MEDICAL 652468 PARK & ASSOCIATES 3610 DEER ROAD WISCONSIN RAPIDS WI 54494 LABORATORY SERVICES 589148 NATIONAL WOUND CARE & HYBERBARIC 3087 MOMENTUM PLACE CHICAGO IL 606895330 WOUND CARE & HYPERBARIC FEE 484980 19 59246 75797 243398 378441 PATIENT SERVICES 900099 89633962 89633962 HEALTH RELATED PROGRAMS WHICH BEN 900099 2253361 2253361 LAB SERVICE FOR NON PATIENTS 621500 902437 902437 FOOD 900099 212898 212898 INCOME RECEIVED FROM REBATES AND 900099 188767 188767 418446 28412 288643 101391 93609871 3549874 3549874 674340 392861 281479 281479 281479 27246045 1176326 25393128 447541 1852917 728785 2581702 2581702 12009 59246 12009 0 4546 2273 2273 2273 100403640 92104502 1191080 6729617 1678046 1678046 33215877 29738324 3477553 10277270 8769481 1507789 98475 74091 24384 93723 93723 291109 291109 5288046 4355763 932283 437793 17154 420639 1414557 1410494 4063 244153 163581 80572 2470515 2470515 6557028 347303 6209725 372699 144354 228345 SUPPLIES 9357230 9146057 211173 DRUGS 5279003 5266802 12201 OTHER 4415552 1219620 3195932 PROFESSIONAL FEES 4051609 2273020 1778589 2373327 2316596 56731 87916012 65242640 22673372 0 10273 76036 29347913 30279553 12224636 12073988 1761627 1788697 646744 1176973 131106646 70560593 60992607 60546053 90780478 105861127 1470168 1391585 197234446 213194012 9758693 8302738 45663869 44707385 750000 730000 56172562 53740123 X 140308395 158431410 753489 1022479 141061884 159453889 197234446 213194012 12487628 5904377 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 8111 8111 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PERCENTAGE OF AHA DUES USED FOR LOBBYING IN 2013 - $5,220 PERCENTAGE OF WHA DUES USED FOR LOBBYING IN 2013 - $2,891 PART IV, SUPPLEMENTAL INFORMATION: 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. 2362953 2362953 67763111 23195377 44567734 2320923 1655490 665433 57008897 45709726 11299171 1650762 1650762 60546053 MALPRACTICE INSURANCE LIABILITY 730000 730000 X 97935596 -1448150 -1448150 99383746 291109 728785 1019894 100403640 85447968 392861 392861 85055107 291109 2569796 2860905 87916012 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 AUTHORITIES, 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 LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF AUGUST 31, 2013 AND 2012. THE ASSOCIATIONS FEDERAL RETURNS FOR YEARS ENDED AUGUST 31, 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. THE ASSOCIATIONS STATE INCOME TAX RETURNS FOR YEARS AUGUST 31, 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE STATE OF WISCONSIN. PART XI, LINE 2D - OTHER ADJUSTMENTS: MEDICAL BUILDING RENT NET WITH REV 299,551. RENT EXPENSES NET WITH REV 93,310. BAD DEBT -1,841,011. PART XI, LINE 4B - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF ASSETS 728,785. PART XII, LINE 2D - OTHER ADJUSTMENTS: MEDICAL BUILDING RENT NET WITH REV 299,551. RENT EXPENSES NET WITH REV 93,310. PART XII, LINE 4B - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF ASSETS 728,785. BAD DEBT 1,841,011. LOVE LIGHTS 41313 40160 1153 1153 CHRISTMAS AT THE RIDGES 14998 10700 4298 4298 1 14944 8386 6558 6558 71255 59246 12009 12009 12009 0 4546 2273 1 1.00000 4546 2273 2273 2273 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 0 1 1 1140174 652587 487587 0.00570 14085320 10813890 3271430 0.03800 15225494 11466477 3759017 0.04370 5460 294835 128316 166519 0.00190 32 130846 130846 0.00150 14938 3559668 2549763 1009905 0.01170 70695 12350 58345 0.00070 309703 81841 227862 0.00260 20430 4365747 2772270 1593477 0.01840 20430 19591241 14238747 5352494 0.06210 740 740 0.00000 43 1634 1634 0.00000 2793 2793 0.00000 106 1454 1454 0.00000 12900 12900 0.00010 149 19521 19521 0.00010 1 1841011 17070913 19736169 -2665256 X 1 1 1 1 RIVERVIEW HOSPITAL ASSOCIATION

410 DEWEY STREET WISCONSIN RAPIDS WI 54495

HTTP://WWW.RIVERVIEWHOSPITAL.NET X X X RIVERVIEW HOSPITAL ASSOCIATION 1 1 X X X X X X X X X 12 1 0 1 X 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 1 1 X X 1 0 1 X 0 0 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 $348,440 WITH OFFSETTING REVENUE OF $181,177. THE BREASTFEEDING SUPPORT & RESPITE CARE REPORTED COSTS OF $66,312 WITH OFFSETTING REVENUE OF $1,548. THE LAKES FAMILY CLINIC REPORTED COSTS OF $1,369,858 WITH OFFSETTING REVENUE OF $1,026,488. THE NEKOOSA FAMILY CLINIC REPORTED COSTS OF $1,775,058 WITH OFFSETTING REVENUE OF $1,340,550. 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 $ 1841011. PART II: 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. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED CHARITY CARE.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. 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 5C: THE CHNA CAN BE FOUND AT HTTP://WWW.RIVERVIEWHOSPITAL.NET 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 20D: PER POLICY #0260110 THE DISCOUNT WILL BE DETERMINED ANNUALLY AT THE START OF THE FISCAL YEAR AND WILL BE THE AVERAGE DISCOUNT OFFERED ON OUR COMMERCIAL INSURANCE CONTRACTS. 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 WILL USE 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 4,156 PERSONS BENEFITED FROM THIS PROGRAM IN 2013 (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 12.3% OF ALL ADMISSIONS BETWEEN JULY 2012 AND JUNE 2013 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 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. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 THOMAS FERK DO 242037 0 83601 0 420 0 29375 0 23875 0 379308 0 0 0 CELSE BERARD 302452 0 51438 0 1806 0 31974 0 21342 0 409012 0 0 0 MICHAEL BOVEE 212187 0 27744 0 630 0 20632 0 22196 0 283389 0 0 0 PEGGY OSE 161686 0 19502 0 2772 0 14969 0 25183 0 224112 0 0 0 RICHARD BAILEY MD FACP 288227 0 51438 0 630 0 32500 0 22642 0 395437 0 0 0 CRAIG FLINDERS DO 236193 0 83761 0 420 0 31637 0 20822 0 372833 0 0 0 JENNIFER MCELROY DO 329749 0 5100 0 378 0 31284 0 20376 0 386887 0 0 0 RONNIE KIRSCHLING MD 1088408 0 6738 0 1806 0 30090 0 24184 0 1151226 0 0 0 MORGAN BARNUM MD 330016 0 5100 0 336 0 26508 0 20700 0 382660 0 0 0 MERCEDES DE LAS ALAS MD 258797 0 5100 0 630 0 26884 0 22876 0 314287 0 0 0 PART I, LINE 1A TAX GROSS-UP PAYMENTS OF $212 WERE PAID ON BEHALF OF THOMAS FERK. THE TAX GROSS-UP PAYMENT WAS INCLUDED IN TAXABLE INCOME. HEALTH AND SOCIAL CLUB DUES WERE PAID ON BEHALF OF CELSE BERARD AND MICHAEL BOVEE. THE AMOUNTS PAID WERE AS FOLLOWS: CELSE BERARD - $3,682 MICHAEL BOVEE - $3,682 PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS DURING THE YEAR FOR A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: DE LAS ALAS - $11,236 BERARD - $15,635 FLINDERS - $9,006 FERK - $11,770 KIRSCHLING - $8,758 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 1455000 27266182 2648998 539000 24078184 2009 0 0 1 1 B 1345000 20296089 1663538 347551 18285000 2010 0 0 1 1 A 0 0 0 0 0.00000 0.00000 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 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 338675 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 329875 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. 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, VICE PRESIDENT OF QUALITY IMPROVEMENT, SERVES AS RHA'S COMPLIANCE OFFICER. 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